Epidemiologic characteristics and influencing factors of lung infection after radiotherapy for nasopharyngeal carcinoma
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摘要:
目的 鼻咽癌患者放化疗后肺部感染的发病率较高，严重影响患者生活质量和预后，但相关文献报道较少，因此本研究旨在分析鼻咽癌放化疗后肺部感染的现状和危险因素，为该类患者放化疗后肺部感染的早期评估、预防和护理措施干预提供参考。 方法 回顾性分析2019年1月—2023年12月广西壮族自治区人民医院收治的1 033例符合放化疗指征的鼻咽癌患者临床资料。根据是否发生肺部感染将患者分为发生肺部感染的A组（299例）和未发生肺部感染的B组（734例），进行单因素分析和多因素logistic回归分析研究鼻咽癌放化疗后肺部感染的影响因素。 结果 1 033例患者中肺部感染发生率为28.94%。Logistic回归分析显示，年龄（OR= 1.028）、吸烟史（OR=2.526）、BMI（OR=0.906）、是否复发（OR=0.085）、靶向治疗（OR=0.540）和血浆EB病毒-DNA定量（OR=19.616）均是肺部感染发生的影响因素。 结论 鼻咽癌放化疗后肺部感染发生率较高，高龄、吸烟史、BMI低、肿瘤未复发、未进行靶向治疗以及血浆EB病毒-DNA定量阳性的患者发生肺部感染风险越高。建议临床实践中可针对这些危险因素对鼻咽癌放化疗患者进行早期评估，对高风险患者加强监测和干预，降低肺部感染的发生风险。 Abstract:Objective Patients with nasopharyngeal carcinoma (NPC) have a high incidence of pulmonary infection after chemoradiotherapy, which seriously affects their quality of life and prognosis. However, relevant literature reports on this issue are scarce. Therefore, this study aims to analyze the epidemiological characteristics and risk factors of pulmonary infection in NPC patients following chemoradiotherapy, so as to provide a reference for early assessment, prevention, and targeted nursing interventions. Methods A retrospective analysis was performed on the clinical data of 1 033 nasopharyngeal carcinoma patients who met the indications for chemoradiotherapy and were admitted to the People's Hospital of Guangxi Zhuang Autonomous Region from January 2019 to December 2023. The patients were divided into group A (299 cases) with pulmonary infection and group B (734 cases) without pulmonary infection. Univariate analysis and multivariate logistic regression analysis were conducted to explore the influencing factors of pulmonary infection in nasopharyngeal carcinoma patients after chemoradiotherapy. Results The incidence of pulmonary infection was 28.94% among 1 033 enrolled patients. Logistic regression analysis revealed that age (OR=1.028), smoking history (OR=2.526), body mass index (BMI, OR=0.906), tumor recurrence status (OR=0.085), targeted therapy (OR=0.540) and plasma Epstein-Barr virus DNA load (OR=19.616) were influencing factors for pulmonary infection. Conclusions The incidence of pulmonary infection is relatively high in nasopharyngeal carcinoma patients after radiotherapy and chemotherapy. Advanced age, smoking history, low BMI, non-recurrent tumor, absence of targeted therapy and elevated plasma Epstein-Barr virus DNA level are associated with increased risk of pulmonary infection. It is recommended that early assessment targeting these risk factors be conducted for these patients. For high-risk ones, increased monitoring frequency and enhanced respiratory care should be implemented to reduce the risk of concurrent pulmonary infection. -
Key words:
- Nasopharyngeal carcinoma /
- Chemoradiotherapy /
- Pulmonary infection /
- Risk factors
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表 1 鼻咽癌放化疗后患者发生肺部感染影响因素的单因素分析
Table 1. Univariate analysis of influencing factors for pulmonary infection in patients with nasopharyngeal carcinoma after radiotherapy and chemotherapy
项目 A组(n=299) B组(n=734) 统计量 P值 年龄(x±s，岁) 51.48±11.62 47.42±11.66 5.081a ＜0.001 吸烟[例(%)] 56.809b ＜0.001 否 147(49.16) 540(73.57) 是 152(50.84) 194(26.43) 是否复发[例(%)] 4.227b 0.040 否 282(94.31) 712(97.00) 是 17(5.69) 22(3.00) 放疗后年限[例(%)] -2.807c 0.005 1年 68(22.74) 127(17.30) 2年 63(21.07) 138(18.80) 3年 69(23.08) 188(25.61) 4年 71(23.75) 153(20.84) 5年 28(9.36) 128(17.44) 是否靶向治疗[例(%)] 11.202b 0.001 否 34(11.37) 40(5.45) 是 265(88.63) 694(94.55) 是否免疫治疗[例(%)] 7.973b 0.005 否 141(47.16) 417(56.81) 是 158(52.84) 317(43.19) 是否肺部CT检查[例(%)] 22.758b ＜0.001 否 0 53(7.22) 是 299(100.00) 681(92.78) 血红蛋白(x±s，g/L) 111.69±18.00 112.67±18.97 4.116a ＜0.001 血浆EB病毒-DNA定量是否阳性[例(%)] 92.463b ＜0.001 否 231(77.26) 707(96.32) 是 68(22.74) 27(3.68) BMI(x±s) 19.65±2.71 20.44±2.82 4.116a ＜0.001 注：a为t值，b为χ2值，c为Z值。表中仅列出差异有统计学意义的项目。 
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表 2 自变量赋值情况
Table 2. The assignment situation of independent variables
自变量 赋值方法 年龄 以实际值赋值 吸烟 不吸烟=0，吸烟=1 BMI 以实际值赋值 是否复发 否=0，是=1 放疗后年限 以实际值赋值 靶向治疗 否=0，是=1 免疫治疗 否=0，是=1 是否肺部CT检查 否=0，是=1 血浆EBV-DNA定量 阴性=0，阳性=1 血红蛋白 以实际值赋值
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表 3 鼻咽癌放化疗后患者发生肺部感染的logistic回归分析
Table 3. Logistic regression analysis of pulmonary infection in patients with NPC after chemoradiotherapy
变量 B SE Waldχ2 P值 OR(95% CI) 年龄 0.028 0.007 16.607 ＜0.001 1.028(1.014~1.042) 吸烟 0.927 0.159 34.033 ＜0.001 2.526(1.850~3.499) BMI -0.099 0.031 9.969 0.002 0.906(0.852~0.963) 是否复发 -2.463 0.592 17.322 ＜0.001 0.085(0.027~0.272) 靶向治疗 -0.616 0.285 4.680 0.031 0.540(0.309~0.944) 血浆EBV-DNA定量 2.976 0.484 37.815 ＜0.001 19.616(7.597~50.653) 注：本表仅列出差异有统计学意义的变量。
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