32例慢性阻塞性肺疾病合并肺癌患者的临床特征分析

发布时间：2018-04-24 12:37

本文选题：慢性阻塞性肺疾病 + 肺癌　；参考：《吉林大学》2017年硕士论文

【摘要】：背景:在我国城市人口十大死因中,呼吸系统疾病(主要是慢阻肺)占13.89%,居第四位,在农村占22.04%,居第一位,全国因慢阻肺死亡的人数约100万。同时,在我国,肺癌的发病率、死亡率已跃居所有恶性肿瘤之首,人类的健康已经严重受到肺癌的威胁。2005年,我国大约有536 407例新发肺癌病例,全年约有475 768人死于肺癌[1]。Young[2]等研究认为遗传、环境、异常免疫反应等是慢阻肺和肺癌发生、发展的共同危险因素。另外Steven Bozinovski等人指出慢阻肺引起的氧化及炎症反应可能通过破坏基因组的稳定性、抑制肿瘤免疫监视作用以及促进肿瘤生长和迁移引起肺癌的发生[3]。目前慢阻肺向肺癌转化的机制尚不明确,但大量流行病学数据表明慢阻肺是肺癌的独立危险因素,肺癌在慢阻肺人群中的患病率是正常人群肺癌患病率的2-5倍。随着目前空气污染逐渐加重,长期暴露于空气中的PM2.5使得罹患呼吸系统疾病的概率也随之增加,值得提出的是,烟草烟雾中富含高浓度的PM2.5,是室内PM2.5的主要来源,也是慢阻肺及肺癌的共同危险因素。我们国家自然科学基金项目课题组已经证实了暴露于高浓度的香烟烟雾PM2.5下,可直接诱发支气管上皮细胞发生恶性转变。目前课题组正通过微流控技术证明表皮生长因子受体(Epidermal growth factor receptor,EGFR)、信号转导和转录激活因子3(Signal transducer and activator of transcription 3,STAT3)在慢阻肺诱发肺癌过程中起到的重要作用[4],为今后深入研究慢阻肺向肺癌的转化提供了良好的理论基础和技术支持。目的:通过研究慢性阻塞性肺疾病(慢阻肺)合并肺癌患者的临床特征,探讨肺癌在慢阻肺患者中的发病率,为早期发现、诊断肺癌提供帮助。方法:应用随机数字表法选取我院2014年01月01日至2016年09月01日收治的符合纳入标准的慢阻肺急性加重期患者208例,慢阻肺合并肺癌患者32例进行回顾性分析,记录两组患者的一般资料、吸烟史、吸烟指数、临床症状及体征、肺功能检查结果、肺癌病理类型、肺癌分期、肿瘤标志物等,采用SPSS16.0统计软件对上述结果进行统计分析。结果:1、年龄及性别:慢阻肺合并肺癌组患者共32例。其中男性16例,女性16例,年龄(49~80岁),平均年龄(64.44±7.582)岁,慢阻肺急性加重期患者共208例,其中男性110例,女性98例,年龄(42~85岁),平均年龄(62.83±7.628)岁,两组患者的年龄、性别比较差异无统计学意义(P0.05),两组患病人群均为高龄人群。2、吸烟史及吸烟指数:慢阻肺合并肺癌组吸烟指数(平均748.209支年)明显高于慢阻肺组(平均376.015支年)(P0.05),差异具有统计学意义。3、肺功能:慢阻肺合并肺癌患者与慢阻肺急性加重期患者肺功能比较,前者FEV1/FVC(%)(平均59.01±9.85)高于后者(平均55.78±11.85),差异具有统计学意义(P0.05);前者FVC(L)(平均1.93±0.45)低于后者(平均2.47±0.83),差异具有统计学意义(P0.05)。4、临床症状及体征:慢阻肺合并肺癌组痰中带血、胸痛、肺不张及胸腔积液患者人数均高于慢阻肺组,差异有统计学意义(P0.05)。5、实验室检查(肿瘤标志物):比较慢阻肺合并肺癌组中不同类型肺癌之间的肿瘤标志物,得出CEA、NSE、总前列腺特异抗原、角蛋白19片段在不同类型肺癌之间的差异具有统计学意义(P0.05),其他肿瘤标志物在各类型肺癌之间无明显统计学差异。6、病理类型、分期:慢阻肺合并肺癌患者中I期患者占6.3%、Ⅱ期患者占21.9%、Ⅲ期患者占40.6%、Ⅳ期患者占31.3%。中央型肺癌占53.1%,周围型肺癌患者占46.9%。鳞癌患者占25.0%,腺癌患者占46.9%,小细胞肺癌患者占28.1%。鳞癌患者中男性7例,女性1例;腺癌患者中男性4例,女性11例;小细胞癌患者中男性5例,女性4例。鳞癌患者中,男性患者占43.8%,明显高于女性;在腺癌患者中女性占73.3%,明显高于男性,其差异具有统计学意义(P0.05),小细胞肺癌中男女性别比较,其差异无统计学意义(P0.05)。7、肺癌在慢阻肺人群中的患病率:本实验中符合纳入标准的慢阻肺合并肺癌患者与同期入院的慢阻肺急性加重期患者人数比较,得出慢阻肺患者肺癌的患病率为11.4‰,根据本组实验数据得出肺癌在慢阻肺人群中的患病率为正常人群的2.85倍。由此可以看出合并有慢阻肺的人群更容易罹患肺癌。结论：1、肺癌在慢阻肺人群中的患病率为11.4‰,为正常人群肺癌患病率的2.85倍。2、当慢阻肺患者出现胸痛、痰中带血、肺不张及胸腔积液等临床表现时应高度警惕肺癌的存在。3、肿瘤标志物CEA、NSE、角蛋白19片段分别对腺癌、小细胞癌及鳞癌的诊断有提示价值。4、统计显示慢阻肺合并肺癌患者多为中央型肺癌,确诊时多为Ⅲ期至Ⅳ期,其病理类型以腺癌为主,其次为小细胞癌及鳞癌。同时男性中鳞癌较多见,而在女性中腺癌更多见。
[Abstract]:Background: among the ten major causes of death of urban population in China, respiratory diseases (mainly slow resistance lung) account for 13.89%, occupy fourth, occupy 22.04% in rural areas, occupy the first place, and the number of people who have died of chronic obstructive pulmonary disease is about 1 million. At the same time, in China, the incidence of lung cancer and mortality have been the first of malignant tumors, and human health has been seriously affected by lung cancer. In.2005, there were about 536407 cases of new lung cancer in China, and about 475768 people died of lung cancer [1].Young[2] throughout the year. The genetic, environmental, and abnormal immune responses were the common risk factors for the development of slow resistance lung and lung cancer. In addition, Steven Bozinovski et al. Pointed out that the oxidative and inflammatory reactions caused by slow lung obstruction may pass through. The stability of the genome, the inhibition of the role of the tumor immune surveillance and the promotion of tumor growth and migration, the mechanism of the transformation of lung cancer by [3]. is not clear, but a large number of epidemiological data indicate that the chronic obstructive pulmonary disease is an independent risk factor for lung cancer, and the prevalence rate of lung cancer in the chronic obstructive lung population is normal. The incidence of lung cancer is 2-5 times. As the current air pollution progressively worsens, PM2.5, which is exposed to the air for a long time, increases the probability of respiratory disease. It is worth mentioning that the high concentration of PM2.5 in tobacco smoke is the main source of indoor PM2.5 and a common risk factor for chronic obstructive lung and lung cancer. However, the science foundation project team has confirmed that exposure to high concentration of cigarette smoke PM2.5 can directly induce malignant transformation of bronchial epithelial cells. The research group is currently using microfluidic technology to prove Epidermal growth factor receptor (EGFR), signal transduction and transcription activator 3 (Signal transd). Ucer and activator of transcription 3, STAT3) plays an important role in the process of lung cancer induced by slow resistance lung. It provides a good theoretical basis and technical support for further study of the transformation of chronic obstructive pulmonary disease to lung cancer in the future. Objective: To explore the clinical characteristics of chronic obstructive pulmonary disease (COPD) with lung cancer and to explore the lung cancer in the future. The incidence of chronic obstructive pulmonary disease was helpful for early detection and diagnosis of lung cancer. Methods: a random digital table was used to select 208 cases of acute exacerbation of chronic obstructive pulmonary disease, which were admitted in our hospital from 01 to 2016, 2014 to 2016 09, and 32 cases of chronic obstructive pulmonary disease combined with lung cancer were retrospectively analyzed, and a record of two groups of patients was recorded. Data, smoking history, smoking index, clinical symptoms and signs, lung function examination results, lung cancer pathological types, lung cancer stages, tumor markers, and so on. The results were statistically analyzed by SPSS16.0 software. Results: 1, age and sex: 32 cases of chronic obstructive pulmonary disease combined with lung cancer group, including 16 cases of male, 16 women, age (49~80 years), The average age (64.44 + 7.582) years and the acute exacerbation of the chronic obstructive pulmonary disease were 208 cases, including 110 men, 98 women, age (42~85 years), the average age (62.83 + 7.628) years, the age of the two groups, and the gender difference was not statistically significant (P0.05). The two group of patients were all.2, smoking history and smoking index: slow resistance lung combined lung cancer. The smoking index (average 748.209 years) was significantly higher than that in the slow resistance Lung Group (376.015 years average) (P0.05). The difference was statistically significant.3. The pulmonary function: the pulmonary function of the patients with chronic obstructive pulmonary disease and the acute exacerbation of the chronic obstructive pulmonary disease was FEV1/FVC (59.01%) (average 59.01 + 9.85) higher than that of the latter (mean 55.78 + 11.85), and the difference was statistically significant Meaning (P0.05); the former FVC (L) (average 1.93 + 0.45) was lower than the latter (mean 2.47 + 0.83), the difference was statistically significant (P0.05).4, the clinical symptoms and signs: the number of patients in the sputum with blood, chest pain, atelectasis and pleural effusion in the slow resistance lung combined with lung cancer group were higher than that in the slow obstructive pulmonary group, the difference was statistically significant (P0.05).5, laboratory examination (tumor markers) Compared with the tumor markers of different types of lung cancer in the chronic lung cancer group, the difference of CEA, NSE, total prostatic specific antigen and keratin 19 fragment between different types of lung cancer was statistically significant (P0.05), and there was no significant difference between other tumor markers in different types of lung cancer.6, pathological type, staging: slow resistance lung Of the patients with lung cancer, 6.3% were I, 21.9% in stage II, 40.6% in stage III, 53.1% in central type lung cancer in stage IV, 25% in 46.9%. squamous cell carcinoma, 46.9% in adenocarcinoma, 46.9% in adenocarcinoma, 7 in 28.1%. squamous cell carcinoma and 1 in female, 4 in adenocarcinoma and 11 in women. In cases of small cell carcinoma, there were 5 males and 4 females. Among the squamous carcinoma patients, 43.8% of the male patients were significantly higher than those of women. In adenocarcinoma patients, women accounted for 73.3%, significantly higher than men, and the difference was statistically significant (P0.05). There was no statistical difference between men and women in small cell lung cancer (P0.05).7, and lung cancer in the slow resistance lung population. The prevalence of lung cancer in slow resistance lung patients was 11.4 per thousand, and the prevalence rate of lung cancer in the slow resistance lung was 2.85 times that of the normal population. Conclusion: 1, the prevalence rate of lung cancer in the slow resistance lung population is 11.4 per thousand, which is 2.85 times.2 of the normal population of lung cancer. When the patients with chronic obstructive pulmonary disease have chest pain, phlegm, atelectasis and pleural effusion, we should be highly vigilant for the existence of.3, tumor markers CEA, NSE, horns eggs The 19 fragments of white 19 were valuable for the diagnosis of adenocarcinoma, small cell carcinoma and squamous cell carcinoma. The statistics showed that most of the patients with chronic obstructive pulmonary disease were central type lung cancer, and most of them were stage III to IV. The pathological types were mainly adenocarcinoma, followed by small cell carcinoma and squamous cell carcinoma.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R563.9

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