慢性阻塞性肺疾病与原发性支气管肺癌相关性的临床研究

Correlation of Chronic Obstructive Pulmonary Disease and Bronchogenic Carcinoma

目的回顾分析慢性阻塞性肺疾病(COPD)合并原发性支气管肺癌住院患者的临床资料,总结值得关注的临床特征,以指导临床能够早期诊断和治疗COPD合并原发性支气管肺癌。方法回顾分析2009年1月—2012年1月就诊的140例COPD合并原发性支气管肺癌患者的临床资料,包括年龄、性别、吸烟史、吸烟年支、临床症状及体征、发病部位及病理类型等。应用随机数字表法选出170例单纯COPD患者作为对照。采用SPSS 17.0统计软件对两组病例的临床资料进行统计学分析。结果 (1)COPD和非COPD患者肺癌的患病率分别为14.24%(325/2 238)、0.51%(1 941/382 974),COPD合并肺癌组和单纯COPD组的吸烟指数分别为(803±491)、(464±560)年支,二者间差异均有统计学意义(P<0.001)。(2)COPD合并肺癌组中最常见的临床症状:发热、咳嗽、咳痰、呼吸困难、乏力发生率与单纯COPD组相比差异无统计学意义(P>0.05),而胸痛、咯血、消瘦、声音嘶哑、胸腔积液、肺不张发生率与单纯COPD组相比差异有统计学意义(P<0.05)。(3)140例COPD合并肺癌中鳞癌97例(69.3%),腺癌20例(14.3%),小细胞肺癌23例(16.4%)。鳞癌中男84例,女13例;腺癌中男14例,女6例;小细胞癌中男18例,女5例,不同病理类型的肺癌患者性别分布上差异无统计学意义(P>0.05)。结论 COPD合并原发性支气管肺癌中以鳞癌比例最高。COPD合并原发性支气管肺癌好发于吸烟的老年男性患者,临床表现缺乏特异性,早期确诊率低,但COPD患者有长期吸烟史,伴胸痛、咯血、消瘦、声音嘶哑、胸腔积液、肺不张应警惕合并肺癌的可能。

Objective To investigate the clinical characteristics of patients with chronic obstructive pulmonary disease （COPD） combined with bronchogenic carcinoma, in order to provide guidance on early diagnosis and treatment of this comorbidi- ty. Methods Clinical data of 140 patients （study group） of COPD combined with bronchogenie carcinoma treated in our hospi- tal between January 2009 and January 2012, including age, sex, smoking history, number of cigarettes smoked per year, symp- toms and signs, site and pathological type of the carcinoma were retrospectively reviewed. The control group included 170 patients with only COPD selected using random number table. The clinical data were analyzed using the SPSS 17. 0. Results The preva- lence of COPD - combined and non - COPD - combined bronchogenic carcinoma were 14. 24% and 0. 51%, respectively （P 〈 0. 001 ）. The most common clinical symptoms in the study group included fever, cough, expectoration, dyspnea, and debilitati- on, which showed no significant difference from the control group （P 〉 0.05）. There were statistically significant differences in chest pain, hemoptysis, weight loss, hoarseness, pleural effusion, and atelectasis between the study and control group （ P 〈 0. 05）. Among the 140 cases of COPD, there were 97 cases （69. 3% ） of squamous cell carcinoma, 20 （14. 3% ） adenocarci- noma, and 23 （16.4%） small cell lung cancer. There was no statistically significant sex difference in each pathological type （P 〉 0. 05） . Conclusion Squamous cell carcinoma is the most common physiological type of bronchogenic carcinoma. COPD - combined bronchogenic carcinoma is liable to occur in older men with smoking habits. This comorbidity lacks specific manifes- tations and has low early diagnosis rate. COPD patients with long smoking history, chest pain, hemoptysis, weight loss, hoarse- ness, pleural effusion and atelectasis may be predisposed to have bronchogenic carcinoma.