摘要:
目的 分析特发性肺纤维化(idiopathic pulmonary fibrosis，IPF)合并单纯肺癌(carcinoma，Ca)的临床表现、诊断、治疗及预后，以了解IPF与肺癌之间的发病关系。 方法 回顾性分析2003年1月- 2013年12月本院住院诊断明确的21例特发性肺纤维化合并肺癌(IPF-Ca)、21例IPF及21例单纯肺癌患者的临床资料，对上述3组的患者的临床表现、肺功能及生存时间进行了比较，并对IPF发生肺癌的高危因素进行分析。 结果 与IPF组及单纯肺癌组相比，IPF-Ca组患者的生存期最短，中位生存时间IPF组为33个月，单纯肺癌组为17个月，IPF-Ca组为12个月(P< 0.05)。发病初期IPF-Ca组(52.4%)发生呼吸衰竭比例明显高于IPF组(14.3%)(P< 0.05)。IPF-Ca组一氧化碳弥散量(carbon monoxide diffusion capacity，DLCO)占预计值百分比(54.9%±22.0%)明显低于IPF组(39%±19.1%) (P< 0.05)。IPF患者发生肺癌的危险因素是高龄(OR=4.06，95% CI：1.15 ～ 14.41，P=0.030 0)和吸烟(OR=3.86，95% CI：1.00 ～ 14.89，P=0.049 5)；IPF-Ca组患者的胸部CT示52.4%肺癌灶位于肺纤维灶内，47.6%位于肺纤维灶外，IPF合并肺癌的病理类型以鳞癌(47.6%)多见，其次为腺癌(38.1%)、小细胞癌(9.5%)、大细胞癌(4.8%)。 结论 IPF-Ca患者确诊后中位生存时间明显短于IPF及单纯肺癌患者。IPF患者发生肺癌的危险因素是高龄、吸烟，病理类型以鳞癌和腺癌多见。
关键词:
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特发性肺纤维化
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肺癌
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诊断
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治疗
Abstract:
Objective To analyze the clinical manifestation, diagnosis, treatment and prognosis of patients with combined idiopathic pulmonary fi brosis and lung cancer. Methods Clinical data about 21 patients with defined idiopathic pulmonary fi brosis and lung cancer (IPF-Ca), 21 patients with defined idiopathic pulmonary fi brosis and 21 patients with defined lung cancer admitted to Chinese PLA General Hospital from January 2003 to December 2013, were retrospectively analyzed. Results The mean survival time of patients with IPF-Ca was shorter than patients with IPF or lung cancer (12 months, 33 months, 17 months, P< 0.05). At the onset of the disease, patients with IPF-Ca (52.4%) had higher incidence of respiratory failure than patients with IPF (14.3%) (P< 0.05). Patients with IPF-Ca had higher carbon monoxide diffusion capacity (DLco) (54.9%±22.0%) than patients with IPF-Ca (39.0%±19.1%) (P< 0.05). Oldness (OR=4.06, 95% CI: 1.15 - 14.41, P=0.030 0) and smoking (OR=3.86, 95% CI: 1.00 - 14.89, P=0.049 5) were the primary risk factors of patients with IPF-Ca. On chest CT, 52.4% of lung cancers were inside the fi brotic area while 47.6% were outside the fibrotic area. The major pathological types were squamous carcinoma (47.6%), adenocarcinoma (38.1%), small cell lung cancer (9.5%) and large cell lung cancer (4.8%). Conclusion The mean survival time of patients with IPFCa is shorter than patients with IPF or lung cancer. The risk factors are oldness and smoking, and the major pathological types are squamous carcinoma and adenocarcinoma.
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