Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (2): 170-178.doi: 10.24920/003540

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  1. 1. 四川大学华西医院 麻醉科 成都 610041,中国
    2. 四川大学华西医院 呼吸与危重症医学科 成都 610041,中国
  • 收稿日期:2019-07-08 接受日期:2020-03-29 出版日期:2020-06-30 发布日期:2020-07-20
  • 通讯作者: 左云霞

Impacts of Preoperative Smoking and Smoking Cessation Time on Preoperative Peripheral Blood Inflammatory Indexes and Postoperative Hospitalization Outcome in Male Patients with Lung Cancer and Surgery Treatment

Xu Longming1,Dai Shuiping2,Zuo Yunxia1,*()   

  1. 1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
    2. Department of Respiratory Medicine, West China Hospital,Sichuan University, Chengdu 610041, China
  • Received:2019-07-08 Accepted:2020-03-29 Published:2020-06-30 Online:2020-07-20
  • Contact: Zuo Yunxia

摘要: 目的 探讨术前吸烟和戒烟时间对男性肺癌患者术前外周血炎性相关指标及住院治疗结局的影响。方法 回顾性收集2014年1月至2016年12月行肺癌切除术的637例肺癌男性患者。根据吸烟史将患者分为持续吸烟组、从不吸烟组和戒烟组,戒烟组患者按戒烟时间(cessation time,CeT)分为5个亚组:CeT≤6周、6周<CeT≤1年、1年<CeT≤5年、5年<CeT≤10年、CeT>10年。比较不同吸烟/戒烟状态各组间及不同戒烟时间各亚组间术前外周血炎症指标白细胞计数(WBC),血白蛋白水平、PLR、NLR,以及住院治疗和围手术期结局相关指标(术中失血量、胸腔闭式引流管拔除时间、ICU驻留时间、住院时间、住院费、术后30天死亡率)情况。结果 持续吸烟组、不同戒烟时间各亚组及从未吸烟组间外周血WBC均数及白蛋白水平有显著性差异(F=5.275,P<0.001;F=2.470,P<0.05)。持续吸烟组血WBC计数(7.7×10 9/L)显著高于已戒烟组(7.0×10 9/L)及从不吸烟组(5.9×10 9/L)(t=-2.145,P<0.05;t=-6.073,P<0.01)。术前持续吸烟组外周血白蛋白水平(41.1 g/L)显著低于术前已戒烟组(42.1 g/L)及从不吸烟组(43.2 g/L)(t=2.323,P<0.05;t=3.995,P<0.01)。术前持续吸烟组外周血NLR水平高于戒烟组及从不吸烟组(3.7 vs. 3.1,t=-1.836,P<0.05;3.7 vs. 2.8,t=-2.889,P<0.01)。戒烟组内不同戒烟时间五个亚组的WBC、白蛋白和NLR值差异无统计学意义。各亚组在术中失血量、术后30天死亡率、住院费用、住院时间、ICU驻留时间、胸腔闭式引流管拔除时间差异无统计学意义。 结果 吸烟升高肺癌患者手术前外周血炎性相关指标,戒烟有助于降低其水平,但戒烟时间长短在其中可能并不产生影响。因此,应随时鼓励肺癌患者戒烟。

关键词: 吸烟, 戒烟, 肺癌, 外科治疗, 炎症因子, 术后转归

Abstract: Objective s To investigate the effects of preoperative smoking and smoking cessation time on preoperative peripheral blood inflammatory indexes and postoperative hospitalization outcomes in male patients with lung cancer and surgery therapy.Methods We retrospectively enrolled 637 male patients who underwent curative-intent lung cancer resection between January 2014 and December 2016. Patients were classified as the current smokers, the never smokers, and the ex-smokers based on their smoking history, and the ex-smokers were allocated into five subgroups according to their smoking cessation times (CeT): CeT≤6 weeks, 6weeks<CeT≤1year, 1year<CeT≤5years, 5years<CeT≤10years, CeT>10years. The preoperative peripheral blood white blood cells (WBCs), albumin, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), intraoperative blood loss, 30-day mortality, in-hospital days, hospitalization costs, intensive care unit (ICU), admission days and placement time of closed thoracic drainage tube were compared among different groups.Results There were significant differences in WBC (F=5.275, P<0.001) and albumin (F=2.470, P<0.05) among patients of current smokers, ex-smokers with different smoking cessation time, and never-smokers. The blood WBC count in current smokers (7.7×10 9/L) was significantly higher than that in ex-smokers (7.0×10 9/L)and never-smokers (5.9×10 9/L) (t=-2.145, P<0.05; t=-6.073, P<0.01, respectively). The level of peripheral blood albumin in current smokers (41.1 g/L) was lower than that in ex-smokers (42.1 g/L) and never-smokers (43.2 g/L) (t=2.323, P<0.05; t=3.995, P<0.01, respectively). The level of peripheral blood NLR in current smokers (3.7) was higher than that in ex-smokers (3.1) and never smokers (2.8) (t=-1.836, P<0.05; t=-2.889, P<0.01, respectively). There was no significant difference in WBC, albumin and NLR among five subgroups of different smoking cessation time. No significant difference was observed in intraoperative blood loss, 30-day mortality, hospitalization costs, hospital stay, ICU stay and placement time of closed thoracic drainage tube among groups either. Conclusion Smoking increases the preoperative inflammatory indexes in peripheral blood of lung cancer patients. Smoking cessation has beneficial effect on reducing levels of these inflammatory indexes, which may be not impacted by the time length of smoking cessation. Therefore, lung cancer patients should be encouraged to quit smoking at any time.

Key words: smoking, smoking cessation, lung cancer, surgical treatment, inflammatory factors, postoperative outcomes

基金资助: 国家重点研发计划项目(2018YFC2001800)

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