【摘要】：目的探討特發(fā)性肺間質(zhì)纖維化(IPF)合并肺癌(IPF-LC)的臨床和影像學(xué)特點(diǎn)。方法回顧性分析2009年4月—2014年4月在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院住院期間被診斷為IPF-LC的21例患者(IPF-LC組)的臨床和影像學(xué)特點(diǎn),并與同期23例單純IPF患者(單純IPF組)進(jìn)行比較。結(jié)果 IPF-LC組患者的平均年齡為(65.2±10.1)歲,平均吸煙指數(shù)為(43.1±27.6)包·年,臨床表現(xiàn)為咳嗽、咳痰15例(71%),氣促18例(86%),咯血4例(19%);腫瘤病理類型以鱗癌(11例,52%)和腺癌(7例,33%)為主,好發(fā)于兩肺下葉(67%)和外周帶(81%),多與網(wǎng)格狀、蜂窩樣結(jié)構(gòu)不相鄰(76%),且均為實(shí)性占位(100%)。IPF-LC組的男性患者比例和吸煙指數(shù)均顯著高于單純IPF組(P值分別0.05、0.01),動脈血氧分壓(p_aO_2)顯著低于單純IPF組(P0.05),生存時間顯著短于單純IPF組(P0.05)。綜合21例IPF-LC患者的年齡、是否吸煙、腫瘤分期、血腫瘤標(biāo)志物(血癌胚抗原、血糖類抗原199水平升高)、是否合并低氧血癥等進(jìn)行18個月生存率的Cox比例風(fēng)險回歸模型分析,結(jié)果提示除吸煙、合并低氧血癥外(P值均0.05),其余各因素與其生存率均不相關(guān)(P值均0.05)。綜合21例IPF-LC和23例單純IPF患者的年齡、是否吸煙、血腫瘤標(biāo)志物(血癌胚抗原、血糖類抗原199水平升高)、是否合并低氧血癥、是否合并肺癌等進(jìn)行18個月生存率的Cox比例風(fēng)險回歸模型分析,結(jié)果提示IPF-LC患者的預(yù)后差(P0.05),其余各因素與IPF患者的生存率均不相關(guān)(P值均0.05)。結(jié)論 IPF患者CT檢查新出現(xiàn)的占位需警惕腫瘤可能。是否合并肺癌影響IPF患者的預(yù)后,吸煙、低氧血癥與IPF-LC患者生存率存在相關(guān)性。
[Abstract]:Objective to investigate the clinical and imaging features of idiopathic pulmonary interstitial fibrosis (IPF) with lung cancer (IPF-LC). Methods the clinical and imaging features of 21 patients (IPF-LC group) who were diagnosed with IPF-LC during hospitalization in the first affiliated Hospital of Zhejiang University Medical College from April 2009 to April 2014 were retrospectively analyzed. The results were compared with 23 patients with IPF alone (IPF group) at the same time. Results in IPF-LC group, the average age was (65.2 鹵10.1) years and the average smoking index was (43.1 鹵27.6) years. The clinical manifestations were cough, expectoration in 15 cases (71%), shortness of breath in 18 cases (86%), hemoptysis in 4 cases (19%). Squamous cell carcinoma (11 cases, 52%) and adenocarcinoma (7 cases, 33%) mainly occurred in the lower lobe of lung (67%) and peripheral zone (81%). The percentage of male patients and smoking index in IPF-LC group were significantly higher than those in IPF group (P < 0.05), and the arterial partial pressure of oxygen (p_aO_2) was significantly lower in IPF-LC group than in IPF group (P0.05). The survival time was significantly shorter than that in simple IPF group (P0.05). Age, smoking, tumor stage, serum tumor markers (serum carcinoembryonic antigen, serum carbohydrate antigen 199) were measured in 21 patients with IPF-LC. The Cox proportional risk regression analysis of 18 months survival rate was carried out. The results showed that except smoking and hypoxemia (P < 0. 05), none of the other factors were related to the survival rate (P = 0. 05). Age of 21 patients with IPF-LC and 23 patients with simple IPF, smoking, tumor markers (elevated levels of serum carcinoembryonic antigen, serum carbohydrate antigen 199), and hypoxiaemia were analyzed. The results showed that the prognosis of patients with IPF-LC was poor (P0.05), and the other factors were not correlated with the survival rate of IPF patients (P < 0. 05). Conclusion IPF patients should be alert to the possibility of neoplasms on CT examination. The prognosis of patients with IPF was affected by lung cancer. Smoking, hypoxemia and survival rate of IPF-LC patients were correlated.
【作者單位】： 浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院呼吸科;寧波市第二醫(yī)院呼吸科;
【基金】：浙江省科技專項(xiàng)重大社會發(fā)展項(xiàng)目(2012C13022-2) 浙江省中醫(yī)藥科學(xué)研究基金計劃(2010ZB059)資助項(xiàng)目
【分類號】：R734.2;R563

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