老年慢性阻塞性肺疾病合并肺癌筛查评分模型建立及相关血清学标志物研究

Establishment of scoring model for lung cancer screening in elderly chronic obstructive pulmonary disease patients and study of chronic obstructive pulmonary disease-related serological markers

目的探讨老年慢性阻塞性肺疾病(COPD)中肺癌筛查评分模型建立及相关血清学标志物水平。方法本研究为病例对照研究。采用非随机抽样的方法纳入2018年9月至2020年9月山西医科大学第一医院收治的年龄≥60岁, 且第一次诊断为COPD或COPD合并肺癌患者109例, 其中COPD合并肺癌患者55例(COPD合并肺癌组), 单纯COPD患者54例(单纯COPD组)。收集2组患者临床资料, 包括年龄、体质量指数、吸烟史、吸烟指数、肺气肿、病程时间及相关血清学标志物等。采用SPSS 26.0统计软件对上述结果进行统计分析。选取危险因素赋值后建立筛查评分模型并验证。结果 COPD合并肺癌组与单纯COPD组的淋巴细胞计数、中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值差异均有统计学意义(Z值分别为2.53、2.42、2.95, P值均<0.05)。病程时间≥23年、吸烟指数≥55包年、年龄≥73岁、肺气肿是老年COPD合并肺癌的危险因素。建立7分筛查评分模型并进行验证, 发现2组间差异有统计学意义(χ^(2)=35.52, P<0.001)。结论可用7分筛查评分筛选老年COPD人群中患肺癌高危人群, 血清学标志物中淋巴细胞计数、中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值可用于进一步探究COPD患肺癌风险指标。

Objective To explore the establishment of lung cancer screening score model and the level of related serological markers in elderly patients with chronic obstructive pulmonary disease(COPD).Methods This was a case-control study.Totally 109 elderly patients(age≥60 years)in diagnosis of COPD or COPD complicated by lung cancer at the first time were enrolled by non-random sampling,among them,55 patients with COPD complicated by lung cancer(combined group),and 54 patients with simple COPD(simple group);those patients were admitted to First Hospital of Shanxi Medical University from September 2018 to September 2020.Clinical data of patients including age,body mass index,smoking history,smoking index,emphysema,disease duration,and COPD-related serological markers was counted,SPSS 26.0 statistical software was used to analyze the above results.The screening scoring model was established and verified based on the assignment method of risk factor.Results There were statistically significant differences in lymphocyte,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)between the combined group and the simple group(Z values were 2.53,2.42 and 2.95,respectively,all P<0.05).The result showed that the risk factors for COPD complicated by lung cancer was disease duration≥23 years,smoking index≥55 Pack-year,age≥73 years and emphysema.The 7-point score model for screening was established and verified that difference between groups was found to be statistically significant(χ^(2)=35.52,P<0.001).Conclusions The 7-point score model can be used to screen high-risk groups with lung cancer among elderly COPD patients;lymphocyte,NLR and PLR in serological markers can be used to further explore the risk indicators of lung cancer in COPD patients.