肺结核合并肺癌的危险因素及预后分析

The risk and prognostic factors for pulmonary tuberculosis complicated with carcinoma

目的:探讨肺结核并发肺癌的危险因素及预后。方法:采用对照研究,对1967年1月至2007年9月上海市肺科医院肺结核并发肺癌患者行流行病学调查,对危险因素进行Logistic回归分析。并通过COX模型,计算累积生存率,对12个可能影响预后的因素进行多因素分析。结果:长期吸烟、刺激性咳嗽、明显消瘦、胸部CT显示分叶、毛刺以及肺不张是肺结核患者并发肺癌的危险因素。肿瘤与原发结核病灶的关系、手术方式及分期与患者的预后相关(P<0.01)。结论:肺结核并发肺癌易被漏诊,应该注意有恶变危险因素的患者,手术是主要治疗方法,疗效满意。

Objective To investigate the risk and prognostic factors for pulmonary tuberculosis complicated with carcinoma.Methods In this case-control study, we conducted an epidemiological survey of pulmonary tuberculosis complicated with carcinoma in patients treated between January 1967 and September 2007.Logistic regression was conducted to analyzed the risk factors, and multivariate analysis of twelve factors influencing prognosis was also conducted.Results Long-term smoking, irritating cough, obvious weigh loss, and atelectasis, lobulation or burr formation on chest CT scan were the risk factors for pulmonary tuberculosis complicated with carcinoma.The association of tumor with primary tuberculosis, surgical procedures, and lung cancer stage were related with prognosis（P 0.01）.Conclusions The diagnosis of ulmonary tuberculosis complicated with carcinoma is easier to miss.Clinicians should pay more attention to those patients with the risk factors of malignancy.Surgery is the main treatment for tuberculosis complicated with lung cancer and has a satisfactory efficacy.