Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (2): 170-178.doi: 10.24920/003540
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
徐龙明1,代水平2,左云霞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
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收稿日期:2019-07-08接受日期:2020-03-29出版日期:2020-06-30 -
通讯作者:左云霞 E-mail:zuoyxhxa@163.com
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. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
2. Department of Respiratory Medicine, West China Hospital,Sichuan University, Chengdu 610041, China
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Received:2019-07-08Accepted:2020-03-29Published:2020-06-30 -
Contact:Zuo Yunxia E-mail:zuoyxhxa@163.com
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。
引用本文
Xu Longming,Dai Shuiping,Zuo Yunxia. 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[J].Chinese Medical Sciences Journal, 2020, 35(2): 170-178.
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| Characteristics | Current smoker (n=177) | Ex-smoker (n=372) | Never- smoker (n=88) | F/X2 | P | ||||
|---|---|---|---|---|---|---|---|---|---|
| CeT≤6w (n=90) | 6w<CeT≤1y (n=107) | 1y<CeT≤5y (n=86) | 5y<CeT≤10y (n=34) | CeT>10y (n=55) | |||||
| Age [years, mean(SD)] | 57.9 (8.0) | 59.9 (8.6) | 58.1 (8.5) | 60.7 (8.4) | 63.7 (7.2) | 64.8 (10.7) | 57.7 (13.3) | 4.525 | 0.000 |
| BMI [kg/m2, mean (SD)] | 22.7 (3.3) | 22.9 (2.9) | 22.9 (2.9) | 23.1 (2.9) | 24.1 (2.3) | 23.2 (2.7) | 23.5 (2.6) | 1.049 | 0.537 |
| 8th edition IASLC Classification [n (%)] | 26.079 | 0.098 | |||||||
| StageⅠ | 32 (18.1) | 18 (20.0) | 14 (13.1) | 18 (20.9) | 6 (17.6) | 6 (17.6) | 19 (21.6) | ||
| Stage Ⅱ | 46 (26.0) | 32 (35.6) | 41 (38.3) | 31 (36) | 12 (35.3) | 9 (16.4) | 25 (28.4) | ||
| Stage Ⅲ | 93 (52.5) | 36 (40.0) | 42 (39.3) | 33 (38.4) | 13 (38.2) | 32 (58.2) | 38 (43.2) | ||
| Stage Ⅳ | 6 (3.4) | 4 (4.4) | 10 (9.3) | 4 (4.7) | 3 (8.8) | 1 (1.8) | 6 (6.8) | ||
| Surgery procedures [n (%)] | 9.888 | 0.626 | |||||||
| Lobectomy | 165 (93.2) | 85 (94.4) | 102 (95.3) | 79 (91.9) | 31 (91.2) | 47 (85.5) | 82 (93.2) | ||
| Segmentec- tomy/wedge | 110 (5.6) | 4 (4.4) | 5 (4.7) | 7 (8.1) | 3 (8.8) | 7 (12.7) | 6 (6.8) | ||
| Sleeve | 1 (1.1) | 1 (1.1) | 0 (0) | 0 (0) | 0 (0) | 1 (1.8) | 0 (0) | ||
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| Variables | Never-smokers (n=88) | Ex-smokers (n=372) | Current smokers (n=177) | F/X2 | P |
|---|---|---|---|---|---|
| WBC [×109/L, mean (SD)] | 5.9 (1.4)**? | 7.0(2.6)* | 7.7(3.4) | 13.277 | 0.000 |
| Albumin [g/L, mean (SD)] | 43.2 (3.5)**? | 42.1(4.3)* | 41.1(4.6) | 7.040 | 0.001 |
| NLR [mean(SD)] | 2.8 (1.1)* | 3.1(1.9)* | 3.7(3.9) | 4.727 | 0.009 |
| PLR [mean(SD)] | 132.6 (55.7) | 134.9(68.8) | 146.7(89.9) | 1.625 | 0.198 |
| Blood loss [mL, mean(SD)] | 153.8 | 186.8 | 185.2 | 0.473 | 0.623 |
| Placement time of closed thoracic drainage tube (days, median) | 4 | 4 | 6 | 1.450 | 0.235 |
| ICU admission days (days, median) | 2 | 2 | 3 | 0.963 | 0.382 |
| In-hospital days (days, median) | 9 | 10 | 11 | 0.308 | 0.735 |
| Hospitalization costs [RMB Yuan, mean(SD)] | 60 546.8 (30 060.6) | 64 466.8 (33 187.1) | 71 072.9 (81 904.9) | 1.522 | 0.219 |
| 30-day mortality (%) # | 1.1 | 3.0 | 2.8 | 0.659 | 0.743 |
"
| Variables | Current smokers (n=88) | Ex-smokers (n=372) | Never- smokers (n=177) | X2/F* | P* | X2/F? | P? | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| CeT≤6w (n=90) | 6w<CeT≤1y (n=107) | 1y<CeT≤5y (n=86) | 5y<CeT≤10y (n=34) | CeT>10y (n=55) | |||||||
| WBC [×109/L, mean (SD)] | 7.7(3.4) | 7.5(2.5) | 7.1(3.1) | 6.6(2.0) | 6.8(2.8) | 6.8(2.6) | 5.9(1.4) | 5.275 | 0.000 | 1.362 | 0.247 |
| Albumin [g/L, mean(SD)] | 41.7(4.4) | 41.4(3.9) | 41.7(5.4) | 41.6(4.1) | 43.9(3.1) | 42.2 (4.0) | 43.3 (3.3) | 2.470 | 0.023 | 2.072 | 0.084 |
| PLR [mean(SD)] | 146.5 (89.9) | 117.4 (45.4) | 136.9 (75.2) | 138.8 (71.3) | 147.4 (78.6) | 144.7 (73.5) | 132.6 (55.7) | 1.709 | 0.116 | 2.008 | 0.093 |
| NLR[mean(SD)] | 3.7(3.9) | 2.9(1.5) | 3.2(2.5) | 3.1(1.6) | 3.2(1.7) | 3.3(1.8) | 2.8(1.1) | 1.697 | 0.119 | 0.344 | 0.848 |
| Blood loss [mL, mean(SD)] | 185.2 | 162.0 | 159.5 | 216.8 | 207.9 | 219.8 | 153.8 | 0.715 | 0.638 | 0.336 | 0.649 |
| Placement time of closed thoracic drainage tube (days, median) | 6 | 5 | 5 | 5 | 4 | 5 | 4 | 0.528 | 0.787 | 0.344 | 0.848 |
| ICU admission days (days, median) | 3 | 2 | 2 | 2 | 2 | 2 | 2 | 0.401 | 0.878 | 0.415 | 0.798 |
| In-hospital days (days, median) | 11 | 11 | 11 | 11 | 8 | 9 | 9 | 0.510 | 0.801 | 1.001 | 0.407 |
| Hospitalization costs [Yuan, mean (SD)] | 71 072.9 (81 904.9) | 61 959.2 (31 302.4) | 63 165.9 (27 290.2) | 67 739.4 (36 379.9) | 64 668.7 (32 870.4) | 63 123.6 (33 953.1) | 60 546.8 (30 060.6) | 0.599 | 0.732 | 0.336 | 0.854 |
| 30-day mortality (%)# | 2.8 | 1.1 | 2.8 | 2.3 | 5.9 | 5.5 | 1.1 | 4.768 | 0.529 | 3.710 | 0.406 |
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