Risk factors of perioperative cardiac events in lungcancer patients with high-risk coronary heart disease undergoing pulmonary lobectomy
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摘要:目的 探索高风险冠心病患者肺癌肺叶切除术的围术期心脏事件的发生率及危险因素。方法 收集本院收治的1 647例肺癌患者的病例资料进行Framingham评分，将高风险冠心病患者(评分>20%)纳入研究，以围术期主要心脏事件为终点，探索患者围术期心脏事件的相关影响因素。结果 高风险冠心病肺癌患者围术期主要心血管不良事件(MACE)发生率为26.4%。多因素回归分析显示，各因素对患者发生围术期心脏事件影响由大到小依次为: 高血压>高密度脂蛋白胆固醇(HDL-C)>糖尿病>年龄>冠脉造影>脑卒中>吸烟指数。结论 高风险冠心病肺癌患者围术期心脏事件发生率较高，充分的术前心脏风险评分、冠脉造影及干预有助于降低高风险冠心病患者肺癌围术期心脏事件的发生率。Abstract:Objective To explore the incidence and risk factors of perioperative major adverse cardiac events (MACE) in lung cancer patients with high-risk coronary heart disease undergoing pulmonary lobectomy.Methods The clinical dataof 1 647 high-risk coronary heart disease patients diagnosed with lung cancer undergoing lobectomy in our hospital was analyzed, and performed Framingham scoring. High-risk patients (score >20%) were included in the study, and the periopertive major adverse cardiac events was defined as primary endpoint. The risk factors of MACE were analyzed.Results Perioperative MACE occurred in 26.4% of lung cancer patients with high-risk coronary heart disease undergoing lobectomy. Multivariate analysis demonstrated that hypertension, high density lipoprotein (HDL-C), diabetes, age, coronary angiography, stroke, smoking index in descending sequence were independent risk factors of perioperative cardiac events in lung cancer patients. While shorter operative time, coronary angiography and clinical intervention was protective factor.Conclusion Lung cancer patients with high-risk coronary heart disease undergoing lobectomy has higher risk of perioperative MACE. Preoperative sufficient cardiac risk scores, coronary angiography andclinical interventioncan reduce the incidence of perioperative MACE in lung cancer patients with high-risk coronary heart disease.
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表 1 216例患者一般情况比较[n(%)](x±s)
变量 数值 性别 男 180(83.33) 女 36(16.67) 年龄/岁 66.47±6.03 BMI/(kg/m2) 23.79±2.94 吸烟指数/(支×年) 600.00[0.00, 1 000.00] 高血压 64(29.63) 收缩压/mmHg 138.68±14.81 射血分数(EF)值/% 63.05±5.11 疾病 糖尿病 43(19.91) 慢性阻塞性肺病(COPD) 7(3.24) 脑卒中 30(13.89) 血脂指标 总胆固醇/(mmol/L) 4.94±1.18 高密度脂蛋白/(mmol/L) 1.34±0.37 冠脉造影 97(44.91) 冠心病/冠脉粥样硬化 55(25.46) 临床干预 179(82.91) 手术时间/min 147.96±26.50 失血量/mL 113.52±63.73 围术期心血管事件 57(26.39) 吸烟指数以M[P25, P75]表示。 
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表 2 不同心血管事件结局者的临床资料比较(x±s)[n(%)]
变量 心血管事件组(n=57) 无心血管事件组(n=159) t/χ2 P值 性别 男 47(82.46) 133(83.64) 0.043 0.836 女 10(17.54) 26(16.36) 年龄/岁 68.12±5.75 65.87±6.03 2.444 0.015 BIM/(kg/m2) 23.51±2.81 23.89±2.99 -0.833 0.406 吸烟指数/(支×年) 800[0, 1200] 600[0, 800] -2.146 0.032 高血压 有 32(56.14) 32(20.12) 26.101 <0.001 无 25(43.86) 127(79.87) 收缩压/mmHg 140.91±14.75 137.88±14.80 1.328 0.186 EF值/% 62.56±4.77 63.22±5.23 -0.835 0.405 糖尿病史 有 23(40.35) 20(12.58) 20.297 <0.001 无 34(59.65) 139(87.42) COPD 有 3(5.26) 4(2.52) 0.324 0.569 无 54(94.73) 155(97.48) 脑卒中 有 17(29.82) 13(8.18) 16.442 <0.001 无 40(79.17) 146(91.82) 总胆固醇/(mmol/L) 5.00±1.51 4.95±1.04 0.229 0.819 高密度脂蛋白/(mmol/L) 1.25±0.43 1.37±0.35 -2.101 0.037 冠脉造影 有 19(8.80) 78(36.10) 4.193 0.041 无 38(17.60) 81(37.50) 冠心病/冠脉粥样硬化 有 14(24.56) 41(25.79) 0.033 0.856 无 43(75.44) 118(75.21) 临床干预 有 42(73.68) 137(86.16) 4.603 0.032 无 15(26.32) 22(13.83) 手术时间/min 142.02±28.75 150.09±25.41 -1.988 0.048 失血量/mL 112.98±55.55 113.71±66.59 -0.074 0.941
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表 3 围术期心脏事件发生影响因素患者的单因素Logistics回归分析
变量 OR值 95%CI P值 年龄 2.124 1.075~4.196 0.030 吸烟指数 1.547 0.841~2.844 0.161 高血压史 5.080 2.649~9.742 < 0.001 糖尿病史 4.701 2.319~9.533 < 0.001 脑卒中史 4.773 2.140~10.648 < 0.001 HDL-C 5.321 2.229~12.706 < 0.001 冠脉造影 0.519 0.276~0.977 0.042 临床干预 0.450 0.214~0.944 0.035 手术时间 0.441 0.231~0.843 0.013
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表 4 围术期心脏事件发生影响因素患者的多因素Logistics回归模型
因素 B S. E Wals df P值 OR 95% CI 年龄 0.877 0.431 4.133 1 0.042 2.403 1.032~5.594 吸烟指数 0.897 0.395 5.164 1 0.023 2.453 1.131~5.320 高血压史 1.506 0.415 13.147 1 < 0.001 4.510 1.998~10.182 糖尿病史 1.214 0.477 6.494 1 0.011 3.368 1.324~8.570 脑卒中史 1.079 0.506 4.548 1 0.033 2.941 1.091~7.926 HDL-C降低 1.381 0.588 5.504 1 0.019 3.977 1.255~12.602 冠脉造影 -1.207 0.410 8.647 1 0.003 0.299 0.134~0.669 常量 -2.771 0.494 31.491 1 < 0.001 0.063 -
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