肺结核后肺癌的发生及早期诊断

Occurrence and early diagnosis of lung cancer patients with previous pulmonary tuberculosis

目的研究肺结核后肺癌(LCWPTB)的临床特点及早期的筛查方法,为LCWPTB的早期诊断提供相关理论依据。方法回顾性分析2005年12月~2016年12月在皖医二附院和皖医一附院住院的64例LCWPTB(研究组)患者和60例结核病患者(对照组)临床资料、胸部CT、肿瘤标记物(TM)水平等特点。结果 64例LCWPTB病理类型主要为鳞癌占27例(42.2%),Ⅲ期、Ⅳ期的肺癌占比较大。LCWPTB和肺结核的临床症状相似,对比分析仅痰中带血、消瘦、胸背部疼痛的差异具统计学意(P<0.05)。LCWPTB影像学表现呈现多样化,具有肺结核、肺癌双重影像特征。.血清CA199、CEA、SCC水平在两组间的差异明显(P<0.05),约登指数由高到低分别是CEA(0.550),SCC(0.484),CA199(0.217)和CA125(0.017),AUC由高到低分别为CEA(0.82),SCC(0.80),CAl99(0.66)和CAl25(0.56).结论 LCWPTB确诊多在中晚期阶段,主要病理类型为鳞癌。肺结核患者若出现反复痰血、不明原因消瘦、持续性胸背痛时需警惕癌变可能。对高危肺结核人群应定期胸部CT、血清SCC+CA199+CEA检测有助于LCWPTB的早发现,可能为患者赢得更多治疗时间。

Objective To investigate clinical characteristic of LCWPTB and early Diagnosis for LCWPTB and provide theoretical basis for diagnosing LCWPTB early.Methods The clinical data,chest CT features and levels of TM of64 LCWPTB of the patients hospitalized in two affiliated hospitals of Wannan Medical college during 2005.12-2016.12 were retrospectively analyzed.Results The squamous was the mainly pathology of LCWPTB.The majority of staging was Ⅲ or Ⅳ.LCWPTB and PTB had similar clinical manifestations.The comparative analyzed reveal that only the differences of bloody sputum,emaciation,chest/back pain had statistically significant（P〈0.05）.LCWPTB had the both tuberculosis and lung cancer dual imaging characteristics.Only the level of CA199,CEA,SCC between the two groups had significance（P〈0.05）.The content of Youden index in sequence wer from CEA（0.550）,SCC（0.484）,CA199（0.217）to CA125（0.017）.The AUC were in the sequence of CEA（0.82）,SCC（0.80）,CA199（0.66）and CA125（0.56）.Conclusion The majority of LCWPTB are diagnosed in mid and late stage,and main pathological type is squamous carcinoma.If PTB patients have repeated bloody sputum,emaciation,chest/back pain they should be complicated with lung cancer.Periodically,chest CT,SCC＋CA199＋CEA are helpful for lung cancer be early diagnosis,and patients can get more time to treatment.