间质性肺病合并肺癌的临床特点分析  

Clinical characteristics of interstitial lung disease with lung cancer

作　　者：李婉芳 程哲[1] 施洋峰 代灵灵[1] 王茜[1] 贾留群[1] 景晓刚[1] 蒋天赐 王欢[1] 安琳[1] 刘梦[1] 杨远舰 杨梦 Li Wanfang;Cheng Zhe;Shi Yangfeng;Dai Lingling;Wang Xi;Jia Liuqun;Jing Xiaogang;Jiang Tianci;Wang Huan;An Lin;Liu Meng;Yang Yuanjian;Yang Meng(Department of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Open Laboratory of Key Disciplines of Clinical Medicine of Universities in Henan,Zhengzhou 450052,China;Shao Yifu Hospital Affiliated to Medical College of Zhejiang University,Hangzhou 310020,China)

机构地区：[1]郑州大学第一附属医院呼吸与危重症医学五科河南省高等学校临床医学重点学科开放实验室,450052 [2]浙江大学医学院附属邵逸夫医院,杭州310020

出　　处：《中国实用医刊》2019年第8期1-5,共5页Chinese Journal of Practical Medicine

基　　金：国家重点研发计划(2016YFC1304000);河南省科技研发专项(162102410010);河南省高等学校重点科研项目(18A320056).

摘　　要：目的研究间质性肺病合并肺癌(ILD-LC)的临床特点。方法纳入郑州大学第一附属医院2015年1月至2018年1月在间质性肺病(ILD)基础上首次确诊合并肺癌(LC)的患者68例(ILD-LC组)和同期首次确诊的单纯ILD患者192例(ILD组),回顾性分析比较两组间一般资料、肿瘤标志物、肺功能的差异,并分析ILD-LC组高分辨计算机断层扫描(HRCT)表现、病理类型、病理分期及EGFR基因突变特点。结果ILD-LC组年龄、男性比例、吸烟者比例、吸烟指数均高于ILD组[(65.8±10.5)岁比(59.5±11.9)岁,86.8%比55.2%,70.6%比31.8%,36.71±18.10比13.47±8.45,P均<0.05]。ILD-LC组血清糖类抗原199(CA199)、糖类抗原125(CA125)、癌胚抗原(CEA)、神经特异性烯醇化酶(NSE)、细胞角蛋白19片断(Cyafra21-1)水平均高于正常值上限,ILD-LC组血清CA199、CA125、CEA、NSE和Cyafra21-1水平均高于ILD组[(40.15±10.18)U/ml比(20.69±4.53)U/ml,(58.03±11.87)U/ml比(35.55±9.55)U/ml,(30.22±2.86)ng/ml比(8.25±0.62)ng/ml,(22.14±7.19)ng/ml比(14.34±6.20)ng/ml,(10.45±3.45)ng/ml比(3.67±1.22)ng/ml,P均<0.05]。ILD-LC组弥散功能较ILD组更差(P<0.05)。ILD-LC组患者HRCT表现以普通型间质性肺炎(UIP型)为主;ILD-LC合并的肺癌以外周型为主,多位于肺下叶、ILD病变范围之内,病理类型均以腺癌(39.7%)和鳞癌(32.4%)为主。在临床分期上,ILD-LC组非小细胞肺癌(NSCLC)以Ⅲ期(44.9%)和Ⅳ期(38.8%)为主,小细胞肺癌(SCLC)有19例,均为广泛期。结论高龄、吸烟、男性ILD患者更易合并LC,ILD-LC患者较ILD患者肿瘤标志物更高、肺功能更差,监测ILD患者肿瘤标志物、肺功能及定期行HRCT检查有助于ILD-LC的早期诊断。Objective To investigate the clinical characteristics of interstitial lung disease associated with lung cancer(ILD-LC).Methods Sixty-eight patients with lung cancer firstly detected on the basis of diagnosis with interstitial lung disease(ILD)from January 2015 to January 2018 in the First Affiliated Hospital of Zhengzhou University were allocated to ILD-LC group;and 192 patients with ILD firstly detected in the same period were set as ILD group.The differences in general data,tumor markers and lung function between the two groups were retrospectively analyzed and compared,and the characteristics of the ILD-LC group in the high-resolution computed tomography(HRCT)manifestations,pathological types,pathological stages and EGFR gene mutations were analyzed.Results The differences were significant in sex,age,smoking history and smoking index of patients between the ILD-LC group and ILD group(P all<0.05).It was significantly higher in age,male proportion,proportion of smokers and smoking index of patients in the ILD-LC group than those in the ILD group[(65.8±10.5)years vs.(59.5±11.9)years,86.8%vs.55.2%,70.6%vs.31.8%,36.71±18.10 vs.13.47±8.45,P all<0.05].In the ILD-LC group,the serum levels of CA199,CA125,CEA,NSE and Cyafra21-1 were higher than the normal levels,and the serum levels of CA199,CA125,CEA,NSE and Cyafra21-1 of patients were significantly higher than those in the ILD-LC group[(40.15±10.18)U/ml vs.(20.69±4.53)U/ml,(58.03±11.87)U/ml vs.(35.55±9.55)U/ml,(30.22±2.86)ng/ml vs.(8.25±0.62)ng/ml,(22.14±7.19)ng/ml vs.(14.34±6.20)ng/ml,(10.45±3.45)ng/ml vs.(3.67±1.22)ng/ml,P all<0.05].The pulmonic dispersion function of the ILD-LC group was worse than the ILD group(P<0.05).The HRCT scan pattern of the ILD-LC patients showed that the UIP-type was the main type in interstitial changes,and the majority of tumors of the ILD-LC group were peripheral lung cancers,located in the lower lobes and the leison of ILD.The pathological types of lung cancer mainly were adenocarcinoma(39.7%)and squamous cell lung cancer

关 键 词：间质性肺病 肺癌 临床特点 

分 类 号：R734.2[医药卫生—肿瘤]