特发性肺间质纤维化合并肺癌的临床和影像学特点

发布时间：2018-11-07 21:10

【摘要】：目的探讨特发性肺间质纤维化(IPF)合并肺癌(IPF-LC)的临床和影像学特点。方法回顾性分析2009年4月—2014年4月在浙江大学医学院附属第一医院住院期间被诊断为IPF-LC的21例患者(IPF-LC组)的临床和影像学特点,并与同期23例单纯IPF患者(单纯IPF组)进行比较。结果 IPF-LC组患者的平均年龄为(65.2±10.1)岁,平均吸烟指数为(43.1±27.6)包·年,临床表现为咳嗽、咳痰15例(71%),气促18例(86%),咯血4例(19%);肿瘤病理类型以鳞癌(11例,52%)和腺癌(7例,33%)为主,好发于两肺下叶(67%)和外周带(81%),多与网格状、蜂窝样结构不相邻(76%),且均为实性占位(100%)。IPF-LC组的男性患者比例和吸烟指数均显著高于单纯IPF组(P值分别0.05、0.01),动脉血氧分压(p_aO_2)显著低于单纯IPF组(P0.05),生存时间显著短于单纯IPF组(P0.05)。综合21例IPF-LC患者的年龄、是否吸烟、肿瘤分期、血肿瘤标志物(血癌胚抗原、血糖类抗原199水平升高)、是否合并低氧血症等进行18个月生存率的Cox比例风险回归模型分析,结果提示除吸烟、合并低氧血症外(P值均0.05),其余各因素与其生存率均不相关(P值均0.05)。综合21例IPF-LC和23例单纯IPF患者的年龄、是否吸烟、血肿瘤标志物(血癌胚抗原、血糖类抗原199水平升高)、是否合并低氧血症、是否合并肺癌等进行18个月生存率的Cox比例风险回归模型分析,结果提示IPF-LC患者的预后差(P0.05),其余各因素与IPF患者的生存率均不相关(P值均0.05)。结论 IPF患者CT检查新出现的占位需警惕肿瘤可能。是否合并肺癌影响IPF患者的预后,吸烟、低氧血症与IPF-LC患者生存率存在相关性。
[Abstract]:Objective to investigate the clinical and imaging features of idiopathic pulmonary interstitial fibrosis (IPF) with lung cancer (IPF-LC). Methods the clinical and imaging features of 21 patients (IPF-LC group) who were diagnosed with IPF-LC during hospitalization in the first affiliated Hospital of Zhejiang University Medical College from April 2009 to April 2014 were retrospectively analyzed. The results were compared with 23 patients with IPF alone (IPF group) at the same time. Results in IPF-LC group, the average age was (65.2 卤10.1) years and the average smoking index was (43.1 卤27.6) years. The clinical manifestations were cough, expectoration in 15 cases (71%), shortness of breath in 18 cases (86%), hemoptysis in 4 cases (19%). Squamous cell carcinoma (11 cases, 52%) and adenocarcinoma (7 cases, 33%) mainly occurred in the lower lobe of lung (67%) and peripheral zone (81%). The percentage of male patients and smoking index in IPF-LC group were significantly higher than those in IPF group (P < 0.05), and the arterial partial pressure of oxygen (p_aO_2) was significantly lower in IPF-LC group than in IPF group (P0.05). The survival time was significantly shorter than that in simple IPF group (P0.05). Age, smoking, tumor stage, serum tumor markers (serum carcinoembryonic antigen, serum carbohydrate antigen 199) were measured in 21 patients with IPF-LC. The Cox proportional risk regression analysis of 18 months survival rate was carried out. The results showed that except smoking and hypoxemia (P < 0. 05), none of the other factors were related to the survival rate (P = 0. 05). Age of 21 patients with IPF-LC and 23 patients with simple IPF, smoking, tumor markers (elevated levels of serum carcinoembryonic antigen, serum carbohydrate antigen 199), and hypoxiaemia were analyzed. The results showed that the prognosis of patients with IPF-LC was poor (P0.05), and the other factors were not correlated with the survival rate of IPF patients (P < 0. 05). Conclusion IPF patients should be alert to the possibility of neoplasms on CT examination. The prognosis of patients with IPF was affected by lung cancer. Smoking, hypoxemia and survival rate of IPF-LC patients were correlated.
【作者单位】：浙江大学医学院附属第一医院呼吸科;宁波市第二医院呼吸科;
【基金】：浙江省科技专项重大社会发展项目(2012C13022-2) 浙江省中医药科学研究基金计划(2010ZB059)资助项目
【分类号】：R734.2;R563

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