有食管癌病史的肺炎療效差的危險因素分析

[摘要] 目的 評價在呼吸內科住院的有食管癌病史的肺炎患者療效差的危險因素。方法 對2008年3月—2014年2月共6年來在呼吸內科住院的94例食管癌合并肺炎患者的臨床資料進行了回顧性分析。療效差定義為死亡，或者癥狀、體溫、血常規、血氣分析、肺部影像學中任一項差的結局。采用單因素和多因素分析各種危險因素。結果 有食管癌病史的肺炎的主要癥狀為咳嗽、咳痰、呼吸困難。常見的體征為呼吸音降低和濕啰音。痰病原菌多樣。影像學特征包括肺炎的多肺葉浸潤、胸腔胃、胸腔積液、氣管支氣管受壓、肺氣腫、肺間質改變、支氣管擴張、心包積液、可疑肺轉移瘤等。差療效組54例（占57.4%），好療效組40例（占42.6%）。2組的基線人口學特征、食管癌治療史、肺炎類型差異無統計學意義。多因素分析發現，呼吸困難（P=0.022， OR=3.791， 95%CI：1.215～11.826）是療效差的獨立危險因素，咯血（P=0.007，OR=0.143， 95%CI：0.035～0.593）是療效好的獨立相關因素。結論 早期識別療效差的危險因素可能有助于改進治療策略，提高有食管癌病史的肺炎患者的存活率。

[關鍵詞] 食管癌；肺炎；療效差；危險因素

[中圖分類號] R4 [文獻標識碼] A [文章編號] 1674-0742（2016）12（b）-0017-06

Analysis of the Risk Factors of Pneumonia Patients with a History of Esophageal Cancer

WANG Zhang-hui

Department of Respiratory Medicine，the First Affiliated Hospital of Xiamen University，Xiamen，Fujian Province， 361003 China

[Abstract] Objective To evaluate risk factors for poor discharge outcome among pneumonia patients with histories of esophageal cancer admitted to respiratory department. Methods We retrospectively analyzed 94 pneumonia patients with histories of esophageal cancer admitted to respiratory department in from March 2008 to Febmary 2014. A poor outcome at discharge was defined as death， or any poor outcome of symptoms， temperature， complete blood count， arterial blood gas analysis， or pulmonary imaging. The risk factors were examined by univariate and multivariate logistic regression. Results Most pneumonia patients with histories of esophageal cancer complained of cough， expectoration and dyspnea. Common signs were decreased breath sounds and crackles. Varied kinds of bacteria was detected in sputum. The imaging characteristics included pneumonia of multilobar infiltrates， thoracostomach， pleural effusion， trachea or bronchus compression， emphysema， interstitial abnormalities， bronchiectasis， pericardial effusion， suspect pulmonary metastatic tumor， et al. There were 54 patients （57.4%） in poor outcome group and 40 patients （42.6%） in good outcome group， with on statistical difference in baseline demographic characteristics， histories of esophageal cancer treatment， and types of pneumonia. At multivariate analysis， dyspnea（P=0.022， OR=3.791， 95%CI：1.215～11.826）was the independent risk factor for an adverse outcome at discharge， whereas hemoptysis（P=0.007，OR=0.143， 95%CI：0.035～0.593）was the independent risk factor for a positive outcome. Conclusion The early identification of factors associated with a poor prognosis could improve management strategies and the likelihood of survival of pneumonia with histories of esophageal cancer.

[Key words] Esophageal carcinoma；Pneumonia；Poor outcome；Risk factors

食管癌是全世界高發惡性腫瘤之一。我國大陸食管癌的發病率和死亡率分別位于各類惡性腫瘤的第5位和第4位。我國食管癌的發病和死亡人數均占全世界一半以上[1]。食管癌容易合并肺炎。腫瘤患者的免疫系統會因其基礎疾病受到明顯抑制，表現為吞噬細胞功能減弱，淋巴細胞功能受損，患者機體的抗原抗體反應降低而易導致感染。……