同煤总医院煤工尘肺并发肺癌病例的危险因素、临床表现和CT征象

Risk factors,clinical features,and CT characteristics of coal workers’pneumoconiosis complicated with lung cancer in Tongmei General Hospital

目的探究煤工尘肺(CWP)并发肺癌(LC)的风险因素及对比单纯CWP与并发LC的临床表现和螺旋CT特征。方法收集2010年1月—2019年1月在同煤集团总医院就诊的322例CWP患者资料,分析CWP并发LC发生的危险因素,观察并对比单纯CWP及并发LC患者的临床表现及螺旋CT特征。结果322例CWP患者共确诊LC 122例,合并率为31.1%。单因素分析提示,患者吸烟状况和CWP分期在两组间比较,差异有统计学意义(P<0.05)。多因素分析结果表明,吸烟状况(OR=1.8,95%CI:1.4~2.4,P<0.01)和CWP分期(OR=1.9,95%CI:1.4~2.6,P<0.01)是CWP并发LC的危险因素;分层分析提示,随着吸烟状况和CWP分期等级的增加,CWP并发LC的风险也随之增加。单纯CWP临床表现常为咳嗽、声嘶、喘鸣和胸疼;而CWP并发LC还常伴有进行性呼吸困难、咯血和发热。螺旋CT征象显示,对比单纯CWP,CWP并发LC的患者在支气管征象、分叶、钙化、毛刺、肺门和纵隔淋巴结方面存在差异。CWP并发LC常表现为支气管截断、支气管血管集束征、分叶和毛刺等CT征象发生率均高于单纯CWP,而钙化发生率却低于单纯CWP患者。中心型LC的常见征象包括纵隔淋巴结、肺门肿块、支气管截断、肺门淋巴结、支气管管壁增厚、支气管血管集束征、分叶、毛刺、肺内结节与团块及胸膜牵拉等,周围型LC的常见征象包括支气管血管集束征、分叶、毛刺、肺内结节与团块、纵隔淋巴结及肺门淋巴结等,转移性LC可见肺内结节与团块、纵隔淋巴结、分叶、毛刺、胸膜牵拉及支气管血管集束征。结论吸烟状况和CWP分期是CWP并发LC的危险因素;单纯CWP和CWP并发LC在临床表现和螺旋CT征象上存在差异;积极控制CWP患者进展和吸烟对于预防CWP并发LC具有重要意义,积极关注临床表现和螺旋CT特征有助于早期诊断。

Objective To investigate the risk factors of coal workers’pneumoconiosis(CWP)complicated with lung cancer(LC),compare the clinical features and spiral CT characteristics between simple CWP and CWP complicated with LC.Methods The data of 322 CWP patients who were treated in the Tongmei Group General Hospital from January 2010 to January 2019 were collected.The risk factors of CWP complicated with LC were analyzed.The clinical features and spiral CT characteristics of simple CWP and CWP complicated with LC were observed and compared.Results Totally 122 cases of LC were diagnosed among 322 CWP cases,with the complicated rate of 31.1%.Univariate analysis showed that there were statistically significant differences in smoking status and CWP stage between two groups(P<0.05).Multivariate analysis showed that smoking status(OR=1.8,95%CI:1.4-2.4,P<0.01)and CWP stage(OR=1.9,95%CI:1.4-2.6,P<0.01)were risk factors for LC in CWP patients.Hierarchical analysis suggested that the risk of CWP complicated with LC increased with the increase of smoking status and CWP stage.The clinical feathers of simple CWP are usually cough,hoarseness,wheezing,and chest pain,while CWP complicated with LC is often accompanied by progressive dyspnea,hemoptysis,and fever.Spiral CT signs showed that patients with CWP and LC had differences in bronchial signs,lobulation,calcifications,burrs,hilar and mediastinal lymph nodes compared with simple CWP.The incidence rates of CT signs,such as bronchus truncation,bronchus vascular bundle sign,lobulation and burr,in patients with CWP and LC were higher than those in patients with simple CWP,while the incidence rate of calcifications was lower than that in patients with simple CWP.The common signs of central type LC on spiral CT included mediastinal lymph nodes,hilar masses,bronchial truncation,hilar lymph nodes,bronchial wall thickening,bronchovascular convergence,lobulation,burr,intrapulmonary nodules/masses,and pleural stretch.The common signs of peripheral LC included bronchovascular convergence,lobulation,burrs,and pulmonary nodules/masses,mediastinal lymph nodes,and hilar lymph nodes.The metastatic LC showed pulmonary nodules/masses,mediastinal lymph nodes,lobulation,burr,pleural stretch,broncho-vascular convergence sign.Conclusion Smoking status and CWP stage are risk factors for CWP complicated with LC.Simple CWP and CWP combined with LC have differences in clinical manifestations and spiral CT signs.Actively controlling the progression of CWP patients and smoking are of great significance in preventing CWP complicated with LC,and positive attention to clinical manifestations and spiral CT features is helpful for early diagnosis.