本文選題：特發(fā)性肺纖維化 + 特發(fā)性肺纖維化合并肺癌　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:肺癌是特發(fā)性肺纖維化(Idiopathic pulmonary fibrosis,IPF)患者中常見的并發(fā)癥之一,且 IPF 合并肺癌(Lung cancer associated with idiopathic pulmonary fibrosis,IPF-LC)患者的預(yù)后差、病死率高。本文旨在分析特發(fā)性肺纖維化組(IPF組)、特發(fā)性肺纖維化合并肺癌組(IPF-LC組)患者的臨床特點(diǎn)包括性別、年齡、吸煙指數(shù)、臨床癥狀、體征、肺功能、腫瘤標(biāo)記物、影像學(xué)表現(xiàn)、腫瘤分型、分期及分化等方面,為臨床醫(yī)師提供早期診斷及評(píng)估預(yù)測(cè)特發(fā)性肺纖維化合并肺癌可能的參考依據(jù)。方法:本研究收集了 2011年1月-2017年1月間于大連醫(yī)科大學(xué)附屬第一醫(yī)院、大連醫(yī)科大學(xué)附屬二院住院并且符合入選標(biāo)準(zhǔn)的確診為IPF的患者150例、IPF-LC的患者23例。對(duì)以上兩組患者的臨床特點(diǎn)包括性別、年齡、吸煙指數(shù)、臨床癥狀、體征、肺功能、腫瘤標(biāo)記物、影像學(xué)表現(xiàn)、腫瘤分型、分期及分化等方面進(jìn)行總結(jié)并進(jìn)行統(tǒng)計(jì)學(xué)分析,在本研究中將腫瘤的分期合并為I-II期、III-IV期。收集的各組樣本數(shù)據(jù)中符合正態(tài)分布的計(jì)量資料以X±s表示,組間比較應(yīng)用t檢驗(yàn),計(jì)數(shù)資料以百分率表示,非正態(tài)分布的計(jì)量資料和率采用秩和檢驗(yàn)和卡方檢驗(yàn)。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.在IPF中合并肺癌患者的所占比為13.3%,顯著高于普通人群。2.IPF組患者中年齡為(67.25±8.622)歲,男性123例(82%);IPF-LC組患者年齡為(69.52±6.728)歲,男性21例(91.3%);在男女性別、年齡分布上無(wú)統(tǒng)計(jì)學(xué)差異,但各組內(nèi)均以男性患者更常見。3.IPF組患者中40-64歲、65歲或以上兩個(gè)年齡段的比例分別為44%、56%,IPF-LC組患者以上兩個(gè)年齡段的比例分別為21.7%、78.3%,兩個(gè)年齡段間的IPF組及IPF-LC組患者之間比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.IPF組、IPF-LC組患者吸煙指數(shù)分別為800(0,2000)(支*年)、1200(0,3000)(支*年),二者之間比較,IPF-LC組患者吸煙指數(shù)明顯高于IPF組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5.IPF組患者中咯血者13例(8.7%、胸痛者11例(7.3%)、體重下降者25例(16.7%),IPF-LC組患者中咯血者7例(30.4%)、胸痛者6(26.1%)、體重下降者8例(34.8%),兩組相比有統(tǒng)計(jì)學(xué)差異(P0.05)。在其他臨床表現(xiàn)上二者之間比較均無(wú)統(tǒng)計(jì)學(xué)差異。6.IPF-LC組患者胸腔積液者11例(47.8%)明顯多于IPF組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在腫瘤的分布上,IPF-LC組患者主要分布在下葉(48%)和外周(76.2%)。7.IPF-LC組患者血清CEA、CYFRA21-1、NSE水平分別為24.68(0.89,1000)ng/ml、10.71(2.33,124.8)ng/ml、10.64(2.2,119.8)U/ml,明顯高于IPF組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。8.IPF-LC患者中鱗癌為26.1%、腺癌為56.5%,其中低分化癌占87%。結(jié)論:1.在IPF患者中肺癌的發(fā)生較普通人群顯著升高。2.IPF-LC患者中以老年男性吸煙指數(shù)高者更為常見。3.IPF-LC患者中咯血、胸痛及體重下降者較未合并肺癌的IPF患者常見。4.IPF-LC患者中腫瘤的發(fā)生部位以下葉及外周常見,且容易出現(xiàn)胸腔積液。5.IPF-LC患者中血清腫瘤標(biāo)記物CEA、CYFRA21-1、NSE水平較IPF組升高明顯,可作為協(xié)助診斷IPF-LC的初步依據(jù)。6.IPF-LC患者中以腺癌和鱗癌常見,且多數(shù)為低分化癌。
[Abstract]:Objective: lung cancer is one of the common complications in patients with Idiopathic pulmonary fibrosis (IPF), and IPF combined with lung cancer (Lung cancer associated with idiopathic pulmonary fibrosis) has a poor prognosis and high mortality. This article is aimed at analyzing idiopathic pulmonary fibrosis group, idiopathic pulmonary fibrosis The clinical characteristics of the patients with lung cancer group (group IPF-LC) include sex, age, smoking index, clinical symptoms, signs, lung function, tumor markers, imaging manifestations, tumor typing, staging and differentiation, providing early diagnosis and evaluation for clinicians to predict and predict idiopathic pulmonary fibrosis and lung cancer. In January 2011, the First Affiliated Hospital of Dalian Medical University, the Second Affiliated Hospital of Dalian Medical University, the Second Affiliated Hospital of the Dalian Medical University and the admission criteria were 150 patients with IPF and 23 patients with IPF-LC. The clinical characteristics of the above two groups included sex, age, smoking index, clinical symptoms, signs, lung function, tumor markers. The imaging findings, tumor typing, staging and differentiation were summarized and analyzed statistically. In this study, the stages of the tumor were merged into I-II phase, III-IV phase. The measured data in the samples collected in this study were expressed as X + s, and the comparison between the groups should be compared with the t test. The count data were expressed as percentage and non normal. The measurement data and rate of the cloth were statistically significant by rank sum test and chi square test.P0.05. Results: 1. in IPF, the proportion of patients with lung cancer was 13.3%, which was significantly higher than that in group.2.IPF (67.25 + 8.622) and 123 (82%) in the normal group; the age of group IPF-LC was (69.52 + 6.728) years, and the male was 21 (91.3%); There was no statistical difference in sex and age distribution in men and women, but the proportion of male patients in group.3.IPF was 40-64 years old, and the proportion of 65 years old or above two age groups were 44% and 56% respectively. The proportion of two age groups above in group IPF-LC were 21.7%, 78.3%, and the difference between group IPF and group IPF-LC of two age groups was different. The smoking index of group IPF-LC patients was 800 (02000) (02000) and 1200 (03000). The smoking index of group IPF-LC was significantly higher than that of group IPF, and the difference was statistically significant (P0.05) in group.5.IPF, 13 cases of hemoptysis (8.7%, 11 cases of chest pain (7.3%), and 25 weight declines (16.7%). In group IPF-LC, there were 7 cases of hemoptysis (30.4%), chest pain 6 (26.1%), 8 cases of weight loss (34.8%) and two groups (P0.05). In other clinical manifestations, there was no statistical difference between the two patients in group.6.IPF-LC and group IPF (47.8%), and the difference was statistically significant (P0.05). In group IPF-LC, the serum CEA, CYFRA21-1, and NSE levels were 24.68 (0.891000) ng/ml, 10.71 (2.33124.8) ng/ml, 10.64 (2.2119.8) U/ml respectively in the lower leaves (48%) and the peripheral (76.2%).7.IPF-LC groups, which were significantly higher than those in the IPF group. The difference was statistically significant (P0.05) the squamous cell carcinoma was 26.1%, and the adenocarcinoma was 56.5%, of which the differentiation was low. Cancer accounts for 87%. conclusion: 1. in patients with IPF, the incidence of lung cancer is significantly higher than that of the common population. In the patients with high smoking index in the elderly, the patients with high smoking index are more common in the patients with.3.IPF-LC, and the patients with chest pain and weight loss are more common than those of the common.4.IPF-LC patients who are not combined with lung cancer in the IPF patients, and it is easy to find the.2.IPF-LC. The level of serum tumor markers CEA, CYFRA21-1, and NSE in.5.IPF-LC patients with pleural effusion is higher than that in the IPF group. It can be used as a preliminary basis for the diagnosis of IPF-LC, which is common in adenocarcinoma and squamous cell carcinoma in.6.IPF-LC patients, and most of them are low differentiated carcinoma.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563;R734.2
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本文編號(hào)：1877314