中国人群特发性肺纤维化伴肺癌的Meta分析

Meta-analysis of Idiopathic Pulmonary Fibrosis Associated with Lung Cancer in Chinese Population

目的系统评价中国人群中特发性肺纤维化伴肺癌(idiopathic pulmonary fibrosis associated with lung cancer,IPF-LC)的临床特点。方法检索PubMed、Web of Science、Medline、Scopus、中文期刊全文数据库(CNKI)、万方数据库、重庆维普数据库,筛选符合纳入标准的文献。利用Meta分析的方法对纳入的国内外有关研究中国人群IPF-LC的19篇文献进行分析。用Stata 14.0软件对纳入分析的各种因素进行敏感性和异质性检验,根据结果采用随机或者固定效应模型进行率及均值的合并,并计算95%CI。结果中国IPF-LC患者发病平均年龄为68.3岁(67.0~69.6岁),男性发病率为0.86(0.81~0.91),吸烟率为0.90(0.86~0.93),吸烟指数为832支/年(716~948支/年)。肺部CT显示肺癌为周围性肺癌的合并发病率为0.84(0.78~0.89),且多发于肺纤维化明显区域为0.79(0.64~0.91)。肿瘤标记物显示癌胚抗原(CEA)及糖类抗原CA199升高的合并发生率分别为0.61(0.47~0.78)、0.55(0.35~0.87),神经元特异性烯醇化酶(NSE)的平均值为22.44 ng/mL(16.90~27.98 ng/mL),糖类抗原CA125为77.24 U/mL(52.04~102.43 U/mL);目前暂无最佳治疗方案,确诊后的患者平均生存时间只有10.8月(7.9~13.7月)。结论中国IPF-LC患者的生存时间短,男性、高龄、吸烟为其发病的危险因素,CEA、CA199、CA125、NSE等标记物的升高可能为发病的预测因素,定期复查肺部CT对早期诊断有重要的意义。

Objective To systematically evaluate the clinical characteristics of idiopathic pulmonary fibrosis associated with lung cancer IPF-LC in Chinese population.Methods Databases(including PubMed,Scopus,CNKI etc.)were searched to screen the literatures that met the inclusion criteria,and a meta-analysis was used to analyze the included 19 literatures related to IPF-LC of Chinese population at home and abroad.Stata14.0 software was used to test the sensitivity and heterogeneity of various factors included in the analysis.According to the results,random or fixed effect models were used to combine the rates and mean values,and 95%CI was calculated.Results The average age of onset of IPF-LC in China was 68.3 years old(67.0-69.6 years old),the combined incidence rate of male was 0.86(0.81-0.91),the smoking rate was 0.90(0.86-0.93),and the smoking index was 832 cigarettes per year(716-948 cigarettes per year).Lung CT showed that the combined rate of peripheral lung cancer was 0.84(0.78-0.89)and that of lung fibrosis was 0.79(0.64-0.91).Tumor markers showed that the combination rates of carcinoembryo antigen(CEA)and carbohydrate antigen 199(CA199)increase were 0.61(0.47-0.78)and 0.55(0.35-0.87),respectively.The mean values of neuron-specific enolase(NSE)and carbohydrate antigen 125(CA125)were 22.44 ng/mL(16.90-27.98 ng/mL)and 77.24 U/mL(52.04-102.43 U/mL).There is no optimal treatment,and survival time after diagnosis was only 10.8 months(7.9-13.7 months).Conclusion The survival time of patients with IPF-LC in China was short.Male,old age and smoking were risk factors for the onset of IPF-LC,and the increase of markers such as CEA,CA199,CA125 and NSE may be predictive factors for the onset.Regular review of pulmonary CT is of great significance for early diagnosis.