慢性阻塞性肺疾病合并肺腺癌患者EGFR突变及ALK重排的相关研究

发布时间：2019-02-25 12:38

【摘要】：目的:了解慢性阻塞性肺疾病合并肺腺癌患者驱动突变的表达水平,并进一步探讨驱动突变的相关影响因素。方法:本研究回顾性分析了2015年1月至2017年1月就诊于兰州大学第二医院的肺腺癌患者的临床资料,按照肺功能检查结果分为COPD合并肺腺癌组及非COPD合并肺腺癌组,收集患者的年龄、性别、身高、体重、吸烟史、最初的肿瘤分期等资料。采用PCR-直接测序法检测患者EGFR突变状态,采用RT-PCR联合Sanger测序法检测患者ALK重排状态。采用t检验及卡方检验比较COPD合并肺腺癌组与非COPD合并肺腺癌组之间EGFR突变、ALK重排及其他临床特征之间的差异是否具有统计学意义;采用Spearman秩检验分析气流受限程度与EGFR突变、ALK重排的相关性;采用logistic回归分析对驱动突变的相关影响因素进行分析。结果:(1)101例患者中44例(43.6%)被诊断为COPD,24例(23.8%)存在EGFR突变,18例(17.8%)存在ALK重排,并且COPD合并肺腺癌组EGFR突变、ALK重排的发生率均低于非COPD合并肺腺癌组(EGFR:6.8%比36.8%,P0.01;ALK:4.5%比28.1%,P0.01)。(2)logistic回归分析结果显示:EGFR突变多见于女性、无吸烟史和非COPD患者(P0.05),ALK重排多见于较年轻、男性、无吸烟史和非COPD患者(P0.05)。(3)Spearman秩检验结果显示:EGFR突变和ALK重排的发生率随着气流受限程度的增加而降低(EGFR:r=-0.372,P0.01;ALK:r=-0.314,P0.01)。(4)在无吸烟史患者中,COPD合并肺腺癌组EGFR突变的发生率较非COPD合并肺腺癌组低(23.1%比63.3%,P0.05),而两组之间ALK重排的发生率差异无统计学意义(15.4%比33.3%,P0.05)。结论:性别、吸烟史、COPD是EGFR突变的相关影响因素,性别、年龄、吸烟史、COPD是ALK重排的相关影响因素。EGFR突变、ALK重排的发生率与气流受限程度呈负相关。
[Abstract]:Aim: to investigate the expression level of drive mutation in patients with chronic obstructive pulmonary disease (COPD) complicated with lung adenocarcinoma and to explore the related factors of drive mutation. Methods: the clinical data of lung adenocarcinoma patients treated in the second Hospital of Lanzhou University from January 2015 to January 2017 were retrospectively analyzed. According to the results of pulmonary function examination, the patients were divided into two groups: COPD with lung adenocarcinoma group and non-COPD with lung adenocarcinoma group. Collect patient's age, sex, height, weight, smoking history, initial tumor stage and so on. The mutation status of EGFR was detected by PCR- direct sequencing, and the ALK rearrangement was detected by RT-PCR combined with Sanger sequencing. T-test and chi-square test were used to compare the difference of EGFR mutation, ALK rearrangement and other clinical features between COPD with lung adenocarcinoma group and non-COPD complicated lung adenocarcinoma group. Spearman rank test was used to analyze the correlation between airflow restriction degree and EGFR mutation and ALK rearrangement, and logistic regression analysis was used to analyze the related factors of driving mutation. Results: (1) among the 101 patients, 44 (43.6%) were diagnosed as COPD,24 with EGFR mutation (23.8%), 18 (17.8%) with ALK rearrangement, and COPD with EGFR mutation in lung adenocarcinoma group. The incidence of ALK rearrangement was lower in non-COPD patients with lung adenocarcinoma than in non-COPD patients (36.8% vs 36.8%, P 0.01). ALK:4.5% ratio was 28.1%, P0.01). (2) logistic regression analysis showed that EGFR mutation was more common in women, non-smoking history and non-COPD patients (P0.05), ALK rearrangement was more common in younger males, P 0.05). The results of Spearman rank test in non-smoking history and non-COPD patients (P0.05). (3) showed that the incidence of EGFR mutation and ALK rearrangement decreased with the increase of airflow restriction (EGFR:r=-0.372,P0.01;). ALK:r=-0.314,P0.01). (4) in non-smoking patients, the incidence of EGFR mutation in COPD with lung adenocarcinoma group was lower than that in non-COPD with lung adenocarcinoma group (23.1% vs 63.3%, P0.05). There was no significant difference in the incidence of ALK rearrangement between the two groups (15.4% vs 33.3%, P0.05). Conclusion: sex, smoking history, COPD are related factors of EGFR mutation, sex, age, smoking history and COPD are related factors of ALK rearrangement. The incidence of EGFR mutation and ALK rearrangement is negatively correlated with the degree of airflow restriction.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R563.9

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