中国人群肺癌合并肺结核与单纯肺结核临床及影像学特征Meta分析

Meta-analysis of clinical and imaging features of lung cancer with pulmonary tuberculosis and simple pulmonary tuberculosis in Chinese population

目的探讨中国人群肺结核合并肺癌病人与单纯肺结核病人之间的临床特征及CT影像学特征,并分析两者之间差异。方法计算机检索中国知网(CNKI)、维普网(VIP)及万方数据知识服务平台等数据库,收集1994-2018年中国科技论文统计源期刊发表的肺癌合并肺结核与单纯肺结核的病例对照研究文献并进行Meta分析。对照组为单纯肺结核病人,观察组为肺结核并肺癌组,观察指征为吸烟史、主要症状及影像学表现。按预定标准进行筛选,对纳入研究进行质量评价,并提取相应指标完成Meta分析。结果根据本研究的纳入与排除标准,最终纳入文献13篇,均为中文文献,共包括1 477例病人(肺癌合并肺结核病人765例,单纯肺结核病人712例)。Meta分析表明:肺结核合并肺癌病人相比较于单纯肺结核病人,有吸烟史的发生率增高,OR(95%CI)为6.54(3.40~12.57);临床症状刺激性咳嗽发生率提高,OR(95%CI)为4.99(2.67~9.36);胸痛发生率提高,OR(95%CI)为8.26(3.83~17.83);呼吸困难的发生率提高,OR(95%CI)为3.17(1.23~8.14);消瘦的发生率提高,OR(95%CI)为3.81(2.60~5.59);血性胸水的发生率提高,OR(95%CI)为7.85(3.01~20.47);声音嘶哑的发生率提高,OR(95%CI)值为4.94(2.71~9.00);乏力、盗汗和咯血症状的发生率在两组之间差异无统计学意义(P=0.06;P<0.65)。影像学表现为斑片影发生率降低,OR(95%CI)为0.11(0.03~0.43);空洞发生率降低,OR(95%CI)为0.29(0.21~0.40);团块影发生率提高,OR(95%CI)为7.20(5.12~10.12);肺不张发生率提高,OR(95%CI)为9.59(3.21~28.69);卫星灶的发生率在两组之间差异无统计学意义(P=0.2)。结论吸烟史是中国人群肺结核合并肺癌病人的危险因素,临床症状表现类似于单纯肺结核表现,但对迁延不愈的老年人肺结核病人、且有致癌因素存在时,应警惕合并肺癌的可能。影像学表现有其特征性,对诊断有一定的提示意义。

Objective To investigate the clinical features and CT imaging features of patients with pulmonary tuberculosis complicated with lung cancer and and patients with simple pulmonary tuberculosis,and to analyze the differences between them.MethodsThe database of CNKI,VIP and Wanfang Data Knowledge Service Platform were searched by computer.Case-control studies of lung cancer complicated with tuberculosis and simple tuberculosis published in the statistical source journal of Chinese scientific and technological papers from 1994 to 2018 were collected and meta analyzed.The control group was simple pulmonary tuberculosis(TB control group)and the observation group was pulmonary tuberculosis and lung cancer(TB+Ca group).Smoking history,main symptoms and imaging manifestations were observed.Screening was carried out according to the predetermined criteria,the quality of the included studies was evaluated,and the corresponding indicators were extracted to complete the meta-analysis.ResultsAccording to the inclusion and exclusion criteria of this study,13 articles were finally included in the Chinese literature,including1477 cases(765 cases of lung cancer with tuberculosis,712 cases of simple tuberculosis).Meta-analysis showed that compared with patients with simple pulmonary tuberculosis,patients with pulmonary tuberculosis complicated with lung cancer had higer incidence of smoking history:the OR(95%CI)was 6.54(3.40~12.57);the incidence of irritative cough was increased,the OR(95%CI)was 4.99(2.67~9.36);the incidence of chest pain was increased,the OR(95%CI)was 8.26(3.83~17.83);the incidence of dyspnea was increased,the OR(95%CI)was 3.17(1.23~8.14);the incidence of emaciation was increased,the OR(95%CI)was3.81(2.60~5.59);the incidence of bloody pleural effusion was increased,the OR(95%CI)was 7.85(3.01~20.47);the incidence of hoarseness increased,the OR(95%CI)was 4.94(2.71~9.00);the incidence of fatigue,night sweat and hemoptysis had no statistical difference between the two groups(P=0.06;P<0.65).The imaging findings showed that the incidence of patchy shadow decreased,the OR(95%CI)was 0.11(0.03~0.43),and the incidence of void decreased,the OR(95%CI)was 0.29(0.21~0.40).The incidence of mass shadow increased,the OR(95%CI)was 7.20(5.12-10.12);the incidence of atelectasis increased,the OR(95%CI)was 9.59(3.21-28.69);there was no significant difference in the incidence of satellite focus between the two groups(P=0.2).ConclusionsSmoking history is a risk factor for pulmonary tuberculosis patients with lung cancer in China.The clinical symptoms are similar to those of simple pulmonary tuberculosis.However,the possibility of pulmonary cancer should be vigilant in elderly patients with pulmonary tuberculosis and carcinogenic factors.The imaging manifestations have their own characteristics,which have certain implications for diagnosis.