摘要
目的探讨影响接受抗癌治疗的肺癌患者发生活动性肺结核的风险。方法回顾性分析2018年7月至2023年7月安徽省胸科医院收治的242例接受手术、化疗、放疗、分子靶向、免疫等肺癌患者的临床资料及抗癌治疗前的血液学指标,其中包含了一年内发生活动性肺结核的患者30例,一年内未发生活动性肺结核的有212例。采用单因素及多因素Logistic分析确定住院期间发生肺结核的相关危险因素;根据多元Logistic回归的结果,使用R软件绘制列线图;使用C指数评估模型的预测性能,采用受试者工作特征(ROC)曲线与决策曲线分析法(DCA)将ECOG评分与列线图进行比较。结果基于单因素及多因素Logistic分析结果发现结核病史(OR:4.690,95%CI:1.406~15.701)、一线治疗方式(OR:7.061,95%CI:6.719~22.407)、ECOG评分(OR:1.566,95%CI:1.211~4.976)、NLR比值(OR:1.124,95%CI:1.059~2.098)、CRP(OR:2.059,95%CI:1.648~6.655)及低蛋白血症(OR:2.212,95%CI:1.273~6.995)为肺癌患者发生肺结核的独立危险因素(均P<0.05);并以此为基础建立预测模型;C-指数和校准曲线均表明该列线图有较好的预测效果,同时相较于ECOG评分在预测肺癌患者结核发生方面,具有更好的预测效能与校准度。结论治疗前结核病史、治疗方式、ECOG评分、NLR比值、CRP及低蛋白血症为肺癌患者发生肺结核的独立危险因素,以此建立列线图模型能预测肺癌患者一年内发生活动性肺结核的风险。
Objective To explore the risk of developing active tuberculosis in lung cancer patients receiving anticancer therapy.Methods The clinical data of 242 lung cancer patients admitted to Anhui Chest Hospital from July 2018 to July 2023 who underwent surgery,chemotherapy,radiotherapy,molecular targeting,and immunity,as well as the hematological indicators before anticancer treatment,were retrospectively analyzed,including 30 cases of active pulmonary tuberculosis within one year and 212 cases without active pulmonary tuberculosis within one year.Univariate and multivariate logistic analyses were used to determine the risk factors related to pulmonary tuberculosis during hospitalization.According to the results of multivariate logistic regression,the nomogram was drawn by R software.The predictive performance of the model was evaluated using the C-index,and the ECOG score was compared with the nomogram using receiver operating characteristic(ROC)and decision curve analysis(DCA)curves.Results Based on the results of univariate and multivariate logistic analysis,it was found that tuberculosis history(OR:4.690,95%CI:1.406~15.701),treatment mode(OR:7.061,95%CI:6.719~22.407),ECOG score(OR:1.566,95%CI:1.211~4.976),NLR ratio(OR:1.124,95%CI:1.059~2.098),CRP(OR:2.059,95%CI:1.648~6.655)and hypoproteinemia(OR:2.212,95%CI:1.273~6.995)were independent risk factors for pulmonary tuberculosis in lung cancer patients(all P<0.05).And build a prediction model based on this;Both the C-index and calibration curve showed that this column chart had a better prediction effect,and compared with the ECOG score,it had better prediction efficiency and calibration degree in predicting tuberculosis occurrence in lung cancer patients.Conclusion The history of tuberculosis before treatment,treatment style,ECOG score,NLR ratio,CRP,and hypoproteinemia were independent risk factors for pulmonary tuberculosis in lung cancer patients,and a nomogram model was established to predict the risk of developing active pulmonary tuberculosis in lung cancer patients within one year.
作者
郑芳
尤青海
黄鑫
王卫阳
ZHENG Fang;YOU Qinghai;HUANG Xin;WANG Weiyang(Department of Internal Medicine,Anhui Chest Hospital,Hefei,Anhui 230022,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)
出处
《临床肺科杂志》
2024年第7期1066-1073,共8页
Journal of Clinical Pulmonary Medicine
基金
安徽省自然科学基金(No.2208085MH195)。
