特发性肺间质纤维化合并肺癌的临床和影像学特点  

Clinical and imaging characteristics of idiopathic pulmonary fibrosis combined with lung cancer

作　　者：周勇[1,2] 周华[1] 沈茜[1] 潘志杰[1] 姚亚克 周建英[1] 

机构地区：[1]浙江大学医学院附属第一医院呼吸科,浙江杭州310003 [2]宁波市第二医院呼吸科

出　　处：《上海医学》2016年第11期643-647,I0002,共6页Shanghai Medical Journal

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

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(P<0.05),生存时间显著短于单纯IPF组(P<0.05)。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(P<0.05),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。Objective To study the clinical and radiological features of idiopathic pulmonary fibrosis combined with lung cancer （IPF-LC）. Methods Clinical and image characteristics of 21 patients who had been admitted to the First Affiliated Hospital, Zhejiang University School of Medicine from April 2009 to April 2014 and diagnosed as IPF-LC, were retrospectively analyzed and compared with those in 23 （idiopathic pulmonary fibrosis） IPF patients without lung cancer （LC）. Results In the IPF-LC group, the average age of patients was （65.2 ~ 10.1） years~ mean smoking index was （43.1 ~ 27.6） pack per year~ main clinical manifestations were cough and expetoration （ 15 cases, 71%）, shortness of breath （ 18 cases, 86 % ）, and hemoptysis （4 cases, 19% ） ~ the main pathological types of LC were squamous carcinoma （11 cases, 52 % ） and adenocarcinoma （7 cases, 33 % ）, and were basically solid space-occupying lesion （100%）, most of which were not adjacent to the honeycomb- shaped pulmonary structure （76%）. The LC was predominately found in the inferior lobes （67%） and peripheral region （81% ） of bilateral lungs, IPF-LC group had a significantly higher percentage of male （P〈0.05）, smoking index （P〈0.01） and lower partial pressure of oxygen （p,O2） level （P〈0.05）, shorter overall survival （P〈 0.05）when compared with IPF patients without LC. Cox proportional hazard models indicated that among the 21 IPF-LC patients, smoking history and lower p802 level were statistically correlated with a shorter overall survival （both P〈0：05）. In all the 44 patients, IPF patients complicated with LC had worse clinical outcome （P〈0.05）, while smoking, tumor markers （higher carcino-embryonic antigen Iovel, higher 0A-199 level）, or P,Oz level were not related to overall survival （all P 〉 0. 05）. Conclusion Newly found space-occupying lesions by chest computed tomography in IPF patients is a risk factor for LC and predicts a poor clinical prognosis, S

关 键 词：特发性肺间质纤维化 肺癌 吸烟 

分 类 号：R734.2[医药卫生—肿瘤] R563[医药卫生—临床医学]