恶性胸膜间皮瘤43例临床分析  

Clinical Analysis of 43 Patients with Malignant Pleurai Mesothelioma

作　　者：仝丽[1] 李宝兰[1] 贺伟[2] 王敬萍[1] 孙怡芬[1] 张红梅[1] 

机构地区：[1]北京胸科医院内科 [2]北京胸科医院放射科

出　　处：《结核病与胸部肿瘤》2008年第3期201-205,共5页Tuberculosis and Thoracic Tumor

摘　　要：目的回顾性分析43例恶性胸膜间皮瘤的临床特点，以提高恶性胸膜间皮瘤的诊治水平。方法分析43例胸膜间皮瘤的临床资料，包括年龄、石棉接触史、临床表现、影像学检查、实验室检查，用Kaplan—Meier模型的log—rank检验分析年龄、性别、侵犯范围、分期和汾疗方式等因素与预后的关系，用Cox模型分析影响预后的独立危险因素。结果43例患者均无明确石棉接触史；24例患者曾被误诊为结核性胸膜炎。43例均有不规则胸膜增厚。弥漫性增厚者共36例，局限性胸膜增厚有7例。40例可见纵隔胸膜受累，2例胸水中查到恶性间皮细胞。43例弥漫性恶性胸膜间皮瘤患者的中位生存时间为637月（范围0．23～90．30月），在单因素生存分析中，用单因素生存分析，侵犯范围、年龄和分期与预后相关，多因素Cox回归模型分析发现，局限型恶性胸膜间皮瘤预后较好。结论胸膜活检及免疫组化是确诊恶性胸膜间皮瘤的主要方法，侵犯范围是预后的独立影响因素。Objective Retrospectively analyze the clinical features of 43 patients with malignant pleural mesothelioma （MPM） to improve the diagnosis of the disease. Methods To analyze the clinical data of 43 patients with MPM, including age, history of exposure to asbestos, clinical manifestations, imaging and laboratory examination, and investigate the relationship between prognosis and gender, extent of invasion, mode of treatment and stage. Kaplan-Meier method and log-rank test were used to evaluate the survival rates. Cox regression model was used to explore prognostic factors of MPM. Results None of the 43 patients had history of exposure to asbestos. 24 cases were formerly misdiagnosed as tuberculous pleuritis. All patients had irregular pleural thickness, including 36 cases with diffuse thickness and 7 cases with local thickness. Mediastinal pleura thickness was found in 40 cases, and 2 cases malignant mesothelial cell were detected in the pleural effusion. The median survival period was 6.37 months（range 0.23 to 90.30 months）. There are significant difference of survival on age, stage and extent of invasion. Multivariate analysis showed that local MPM had a better prognosis. Conclusion Biopsy of pleura and immunohistochemistry are the main way to diagnose MPM, and extent of invasion was an independent prognostic factor of MPM.

关 键 词：胸膜间皮瘤 预后 诊断 

分 类 号：R734.305[医药卫生—肿瘤] R734.3[医药卫生—临床医学]