肺结核合并非小细胞肺癌患者临床特征分析:一项单中心临床研究  

Clinical Characteristics of Pulmonary Tuberculosis Patients with Non-small Cell Lung Cancer:A Single Center Clinical Study

作　　者：郝鹏菲 刘晓飞[3] 张红[4] 刘冬旭 刘亚冬 保鹏涛 赵卫国[1,2] HAO Peng-fei;LIU Xiao-fei;ZHANG Hong;LIU Dong-xu;LIU Ya-dong;BAO Peng-tao;ZHAO Wei-guo(Department of Clinical Medicine,Hebei North University,Zhangjiakou 075000,China;Department of Pulmonary and Critical Care Medicine,The Eighth Medical Center of PLA General Hospital,Beijing 100091,China;Department of Nuclear Medicine,The Eighth Medical Center of PLA General Hospital,Beijing 100091,China;Department of Pathology,The Eighth Medical Center of PLA General Hospital,Beijing 100091,China)

机构地区：[1]河北北方学院临床医学院,张家口075000 [2]解放军总医院第八医学中心呼吸与危重症医学部,北京100091 [3]解放军总医院第八医学中心核医学科,北京100091 [4]解放军总医院第八医学中心病理科,北京100091

出　　处：《科学技术与工程》2022年第35期15554-15564,共11页Science Technology and Engineering

基　　金：北京市自然科学基金面上项目(7212104);军队医学科技青年培育计划孵化项目(21QNPY118)。

摘　　要：为早期诊断肺结核合并非小细胞肺癌(pulmonary tuberculosis and non-small cell lung cancer,PTB-NSCLC)患者,对其进行了临床、影像及病理资料的分析,以减少漏诊误诊的发生,做到精准诊断、精准治疗。选取解放军总医院第八医学中心2016年1月—2020年12月病理诊断为PTB-NSCLC的54例患者作为病例组,同期收治的一般资料相匹配的NSCLC、PTB患者各54例作为对照组。比较PTB-NSCLC组与对照组在吸烟史、临床症状、肺结核状态、病理学特征及影像学特征等方面的差异。在鉴别PTB-NSCLC患者、单纯性NSCLC、单纯PTB三者时,尽管根据临床表现、影像学特征以及葡萄糖代谢的最大标准摄取值(maximum standard uptake value,SUVmax)难以鉴别,但根据吸烟、结节影、空洞、体力状况(performance status,PS)评分、痰培养阳性率情况,且在纳入多因素分析后,提示具有多年吸烟史(>400支/年)、CT表现为结节影、空洞、PS评分≥2有助于早期诊断及鉴别PTB-NSCLC。局部晚期及进展期NSCLC更易合并活动性肺结核。同时,在肺结核患者中,具有吸烟史、伴有纤维钙化病变是肺癌发生的危险因素。In order to diagnose co-existent pulmonary tuberculosis and not small cell lung cancer(PTB-NSCLC)in an early stage,the clinical、imaging and pathological data were analyzed to reduce the occurrence of missed diagnosis and misdiagnosis,so as to achieve accurate diagnosis and precise treatment.A total of 54 patients with PTB-NSCLC were participated by The Eighth Medical Center of PLA General Hospital as the case group from January 2016 to December 2020.Age-and sex-matched PTB-only(N=54)and NSCLC-only(N=54)patients were selected as the control groups.The smoking,tuberculosis history,clinical symptoms,pathological and imaging characteristics of patients in the case group and control groups were compared.The risk factors of lung cancer were analyzed.When distinguishing PTB-NSCLC patients with simple NSCLC and simple PTB,although it is difficult to distinguish from the SUVmax(maximum standard uptake value)value of glucose metabolism、clinical manifestations,imaging features,in smoking,nodule shadow,cavity,PS(performance status)score,positive rate of sputum culture.The inclusion of multifactor was analyzed,it is found that smoking history of many years(>400 cigarettes/year),CT findings of nodule,cavity and PS score≥2 are helpful for early diagnosis and differentiation of PTB-NSCLC.Locally advanced and advanced NSCLC is more likely to be associated with active pulmonary tuberculosis.At the same time,smoking history and fibrous calcification were risk factors for lung cancer in patients with pulmonary tuberculosis.

关 键 词：肺结核 非小细胞肺癌 多因素分析 危险因素 

分 类 号：R521[医药卫生—内科学] R563[医药卫生—临床医学]