肺癌转移相关性急性胰腺炎的临床特征和预后分析  

Clinical characteristics of metastasis-induced acute pancreatitis in patients with lung cancer

作　　者：熊洋洋[1] 徐燕[2] 赵一[1] 孙翰[1] 柏小寅 吴东 钱家鸣[1] Xiong Yangyang;Xu Yan;Zhao Yi;Sun Han;Bai Xiaoyin;Wu Dong;Qian Jiaming(Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Respiratory Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Clinical Epidemiology Unit,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院呼吸内科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院临床流行病学教研室,北京100730

出　　处：《中华医学杂志》2020年第6期442-446,共5页National Medical Journal of China

基　　金：北京市自然科学基金(7192162)。

摘　　要：目的分析肺癌转移相关性急性胰腺炎(MIAP)患者的临床特征及预后,为临床早期诊断提供线索。方法回顾性分析2002年1月至2019年9月北京协和医院收治的8例肺癌MIAP患者病例特点及转归,并与非肿瘤所致急性胰腺炎(AP)进行比较。结果7例(7/8)为轻症AP,1例(1/8)为重症AP。4例(4/8)以AP为首发表现,自AP起病至肺癌确诊平均时间为(112±36)d。临床表现以腹痛(8/8)为主,其次为消瘦(4/8)、恶心呕吐(2/8)、梗阻性黄疸(1/8)等。肺癌分期均为Ⅳ期,7例(7/8)为小细胞肺癌,1例(1/8)为低分化腺癌。中位生存期11个月。与非肿瘤所致AP对比,肺癌MIAP患者年龄更大[(62±9)岁比(48±15)岁,P=0.018],主胰管扩张(37.5%比3.1%,P=0.004)和腹腔淋巴结肿大(37.5%比6.3%,P=0.017)发生率更高;血红蛋白[(105.3±15.6)g/L比(147.9±24.8)g/L,P<0.001]和红细胞压积(31.4±5.3比42.5±6.1,P<0.001)更低。结论肺癌MIAP预后较差,症状不特异。老年、贫血、主胰管扩张和腹腔淋巴结肿大是其诊断线索,诊疗中应予以重视。Objective To analyze the clinical features and prognosis of lung cancer patients with metastasis-induced acute pancreatitis(MIAP),and to provide clues for early diagnosis.Methods The characteristics and prognosis of 8 patients with MIAP in lung cancer admitted to Peking Union Medical College Hospital from January 2002 to September 2019 were retrospectively analyzed and were compared with non-tumor-induced AP.Results Sevencases(7/8)were Mild AP,one(1/8)was Severe AP.Four patients(4/8)presented with AP as the reporting sign and lung cancer was not diagnosed until(112±36)days after the onset of AP.Clinical manifestations included abdominal pain(8/8),weight loss(4/8),nausea and vomiting(2/8),and jaundice(1/8).Stages of lung cancer were allⅣ.Histopathology proved that seven cases(7/8)were small cell lung cancer,and one case(1/8)was poorly differentiated adenocarcinoma.The median survival time was 11 months.Compared with non-tumor-induced AP,lung cancer patients with MIAP were older[(62±9)vs(48±15),P=0.018],the incidence of primary pancreatic duct dilatation(37.5%vs 3.1%,P=0.004)and abdominal lymphadenopathy(37.5%vs 6.3%,P=0.017)were higher;the level of hemoglobin[(105.3±15.6)g/L vs(147.9±24.8)g/L,P<0.001]and hematocrit[(31.4±5.3)vs(42.5±6.1),P<0.001]were lower.Conclusions Patientswith MIAP in lung cancer had poor outcome and unspecific symptoms.Old age,anemia,main pancreatic duct dilatation and abdominal lymphadenopathy are diagnostic clues that merit clinical attention.

关 键 词：肺癌 急性胰腺炎 贫血 胰管扩张 腹腔淋巴结肿大 

分 类 号：R57[医药卫生—消化系统] R73[医药卫生—内科学]