特发性肺纤维化合并肺癌患者的临床特点分析

发布时间：2018-05-12 05:36

  本文选题：特发性肺纤维化 + 特发性肺纤维化合并肺癌　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:肺癌是特发性肺纤维化(Idiopathic pulmonary fibrosis,IPF)患者中常见的并发症之一,且 IPF 合并肺癌(Lung cancer associated with idiopathic pulmonary fibrosis,IPF-LC)患者的预后差、病死率高。本文旨在分析特发性肺纤维化组(IPF组)、特发性肺纤维化合并肺癌组(IPF-LC组)患者的临床特点包括性别、年龄、吸烟指数、临床症状、体征、肺功能、肿瘤标记物、影像学表现、肿瘤分型、分期及分化等方面,为临床医师提供早期诊断及评估预测特发性肺纤维化合并肺癌可能的参考依据。方法:本研究收集了 2011年1月-2017年1月间于大连医科大学附属第一医院、大连医科大学附属二院住院并且符合入选标准的确诊为IPF的患者150例、IPF-LC的患者23例。对以上两组患者的临床特点包括性别、年龄、吸烟指数、临床症状、体征、肺功能、肿瘤标记物、影像学表现、肿瘤分型、分期及分化等方面进行总结并进行统计学分析,在本研究中将肿瘤的分期合并为I-II期、III-IV期。收集的各组样本数据中符合正态分布的计量资料以X±s表示,组间比较应用t检验,计数资料以百分率表示,非正态分布的计量资料和率采用秩和检验和卡方检验。P0.05为差异有统计学意义。结果:1.在IPF中合并肺癌患者的所占比为13.3%,显著高于普通人群。2.IPF组患者中年龄为(67.25±8.622)岁,男性123例(82%);IPF-LC组患者年龄为(69.52±6.728)岁,男性21例(91.3%);在男女性别、年龄分布上无统计学差异,但各组内均以男性患者更常见。3.IPF组患者中40-64岁、65岁或以上两个年龄段的比例分别为44%、56%,IPF-LC组患者以上两个年龄段的比例分别为21.7%、78.3%,两个年龄段间的IPF组及IPF-LC组患者之间比较,差异具有统计学意义(P0.05)。4.IPF组、IPF-LC组患者吸烟指数分别为800(0,2000)(支*年)、1200(0,3000)(支*年),二者之间比较,IPF-LC组患者吸烟指数明显高于IPF组,差异有统计学意义(P0.05)。5.IPF组患者中咯血者13例(8.7%、胸痛者11例(7.3%)、体重下降者25例(16.7%),IPF-LC组患者中咯血者7例(30.4%)、胸痛者6(26.1%)、体重下降者8例(34.8%),两组相比有统计学差异(P0.05)。在其他临床表现上二者之间比较均无统计学差异。6.IPF-LC组患者胸腔积液者11例(47.8%)明显多于IPF组,差异有统计学意义(P0.05)。在肿瘤的分布上,IPF-LC组患者主要分布在下叶(48%)和外周(76.2%)。7.IPF-LC组患者血清CEA、CYFRA21-1、NSE水平分别为24.68(0.89,1000)ng/ml、10.71(2.33,124.8)ng/ml、10.64(2.2,119.8)U/ml,明显高于IPF组,差异有统计学意义(P0.05)。8.IPF-LC患者中鳞癌为26.1%、腺癌为56.5%,其中低分化癌占87%。结论:1.在IPF患者中肺癌的发生较普通人群显著升高。2.IPF-LC患者中以老年男性吸烟指数高者更为常见。3.IPF-LC患者中咯血、胸痛及体重下降者较未合并肺癌的IPF患者常见。4.IPF-LC患者中肿瘤的发生部位以下叶及外周常见,且容易出现胸腔积液。5.IPF-LC患者中血清肿瘤标记物CEA、CYFRA21-1、NSE水平较IPF组升高明显,可作为协助诊断IPF-LC的初步依据。6.IPF-LC患者中以腺癌和鳞癌常见,且多数为低分化癌。
[Abstract]:Objective: lung cancer is one of the common complications in patients with Idiopathic pulmonary fibrosis (IPF), and IPF combined with lung cancer (Lung cancer associated with idiopathic pulmonary fibrosis) has a poor prognosis and high mortality. This article is aimed at analyzing idiopathic pulmonary fibrosis group, idiopathic pulmonary fibrosis The clinical characteristics of the patients with lung cancer group (group IPF-LC) include sex, age, smoking index, clinical symptoms, signs, lung function, tumor markers, imaging manifestations, tumor typing, staging and differentiation, providing early diagnosis and evaluation for clinicians to predict and predict idiopathic pulmonary fibrosis and lung cancer. In January 2011, the First Affiliated Hospital of Dalian Medical University, the Second Affiliated Hospital of Dalian Medical University, the Second Affiliated Hospital of the Dalian Medical University and the admission criteria were 150 patients with IPF and 23 patients with IPF-LC. The clinical characteristics of the above two groups included sex, age, smoking index, clinical symptoms, signs, lung function, tumor markers. The imaging findings, tumor typing, staging and differentiation were summarized and analyzed statistically. In this study, the stages of the tumor were merged into I-II phase, III-IV phase. The measured data in the samples collected in this study were expressed as X + s, and the comparison between the groups should be compared with the t test. The count data were expressed as percentage and non normal. The measurement data and rate of the cloth were statistically significant by rank sum test and chi square test.P0.05. Results: 1. in IPF, the proportion of patients with lung cancer was 13.3%, which was significantly higher than that in group.2.IPF (67.25 + 8.622) and 123 (82%) in the normal group; the age of group IPF-LC was (69.52 + 6.728) years, and the male was 21 (91.3%); There was no statistical difference in sex and age distribution in men and women, but the proportion of male patients in group.3.IPF was 40-64 years old, and the proportion of 65 years old or above two age groups were 44% and 56% respectively. The proportion of two age groups above in group IPF-LC were 21.7%, 78.3%, and the difference between group IPF and group IPF-LC of two age groups was different. The smoking index of group IPF-LC patients was 800 (02000) (02000) and 1200 (03000). The smoking index of group IPF-LC was significantly higher than that of group IPF, and the difference was statistically significant (P0.05) in group.5.IPF, 13 cases of hemoptysis (8.7%, 11 cases of chest pain (7.3%), and 25 weight declines (16.7%). In group IPF-LC, there were 7 cases of hemoptysis (30.4%), chest pain 6 (26.1%), 8 cases of weight loss (34.8%) and two groups (P0.05). In other clinical manifestations, there was no statistical difference between the two patients in group.6.IPF-LC and group IPF (47.8%), and the difference was statistically significant (P0.05). In group IPF-LC, the serum CEA, CYFRA21-1, and NSE levels were 24.68 (0.891000) ng/ml, 10.71 (2.33124.8) ng/ml, 10.64 (2.2119.8) U/ml respectively in the lower leaves (48%) and the peripheral (76.2%).7.IPF-LC groups, which were significantly higher than those in the IPF group. The difference was statistically significant (P0.05) the squamous cell carcinoma was 26.1%, and the adenocarcinoma was 56.5%, of which the differentiation was low. Cancer accounts for 87%. conclusion: 1. in patients with IPF, the incidence of lung cancer is significantly higher than that of the common population. In the patients with high smoking index in the elderly, the patients with high smoking index are more common in the patients with.3.IPF-LC, and the patients with chest pain and weight loss are more common than those of the common.4.IPF-LC patients who are not combined with lung cancer in the IPF patients, and it is easy to find the.2.IPF-LC. The level of serum tumor markers CEA, CYFRA21-1, and NSE in.5.IPF-LC patients with pleural effusion is higher than that in the IPF group. It can be used as a preliminary basis for the diagnosis of IPF-LC, which is common in adenocarcinoma and squamous cell carcinoma in.6.IPF-LC patients, and most of them are low differentiated carcinoma.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563;R734.2
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本文编号：1877314