广西医学

目的探讨原发性非小细胞肺癌(NSCLC)患者程序性细胞死亡蛋白1(PD-1)/程序性细胞死亡蛋白配体1(PD-L1)抑制剂治疗后发生肿瘤治疗相关心功能不全(CTRCD)的危险因素。方法回顾性分析192例接受PD-1/PD-L1抑制剂治疗的原发性NSCLC患者的临床资料，根据是否发生CTRCD,将患者分为CTRCD组（n=18）和非CTRCD组（n=174）。比较CTRCD组与非CTRCD患者的临床资料，采用多因素Logistic回归模型分析原发性NSCLC患者接受PD-1/PD-L1抑制剂治疗后发生CTRCD的危险因素，采用受试者工作特征(ROC)曲线评估危险因素单独及联合预测患者发生CTRCD的效能。结果CTRCD组患者合并高血压的比例、血红蛋白水平、红细胞体积分布宽度标准差（RDW-SD）、血浆D-二聚体水平、血清胱抑素C水平高于非CTRCD组(P＜0.05)。多因素Logistic回归分析结果显示，血清胱抑素C水平、血浆D-二聚体水平和RDW-SD是原发性NSCLC患者PD-1/PD-L1抑制剂治疗后发生CTRCD的独立危险因素(P＜0.05)。ROC曲线分析结果显示，血清胱抑素C水平、血浆D-二聚体水平、RDW-SD预测原发性NSCLC患者接受PD-1/PD-L1抑制剂治疗后发生CTRCD的曲线下面积分别为0.711、0.774、0.687，3者联合预测的曲线下面积为0.808。结论血清胱抑素C水平、血浆D-二聚体水平和RDW-SD是原发性NSCLC患者接受PD-1/PD-L1抑制剂治疗后发生CTRCD的独立危险因素，3者联合检测对该类患者发生CTRCD有较好的预测价值。

ObjectiveTo investigate the risk factors for patients with primary non-small cell lung cancer (NSCLC) suffering from cancer treatment-related cardiac dysfunction (CTRCD) after programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors therapy. MethodsThe clinical data of 192 patients with primary NSCLC receiving PD-1/PD-L1 inhibitors therapy were retrospectively analyzed, and they were assigned to CTRCD group (n=18) or non-CTRCD group (n=174) according to the presence of CTRCD occurred. The clinical data were compared between the CTRCD group and the non-CTRCD group. The risk factors for patients with primary NSCLC suffering from CTRCD after receiving PD-1/PD-L1 inhibitors therapy were analyzed by using the multivariate Logistic regression model. The efficiency of risk factors for alone and jointly predicting patients suffering from CTRCD was evaluated by employing the receiver operating characteristic (ROC) curve.ResultsPatients of the CTRCD group obtained a higher proportion of concomitant hypertension, and higher hemoglobin level, red blood cell distribution width-standard deviation (RDW-SD), plasma D-dimer level, serum cystatin C level as compared with the non-CTRCD group (P＜0.05). The results of multivariate Logistic regression analysis revealed that serum cystatin C level, plasma D-dimer level, and RDW-SD were the independent risk factors for patients with primary NSCLC suffering from CTRCD after PD-1/PD-L1 inhibitors therapy (P＜0.05). The results of ROC analysis indicated that areas under the curve of serum cystatin C level, plasma D-dimer level, and RDW-SD in predicting patients with primary NSCLC suffering from CTRCD after receiving PD-1/PD-L1 inhibitors therapy were 0.711, 0.774, 0.687, respectively, and area under the curve of the combined prediction of the three was 0.808. ConclusionSerum cystatin C level, plasma D-dimer level, and RDW-SD are the independent risk factors for patients with primary NSCLC suffering from CTRCD after receiving PD-1/PD-L1 inhibitors therapy, and the combined detection of the three exerts relatively favorable predictive values on these patients suffering from CTRCD.