伴有吸烟史的COPD合并肺结核患者肺动脉炎症特征与罹患肺癌风险的研究

The relationship between pulmonary inflammatory characteristics and lung cancer risk in COPD patients with pulmonary tuberculosis with smoking history

目的分析伴有吸烟史的慢性阻塞性肺疾病(COPD)合并肺结核患者肺动脉炎症特征与罹患肺癌风险。方法选择我院2017年1月~2022年9月接诊的48例因肺癌行肺叶切除术的伴有吸烟史的COPD合并肺结核患者作为观察组,另选同期48例行解剖性部分肺叶切除术且术后病理为良性的肺结节患者作为对照组。检测所有患者肺腺泡肌型动脉的炎性细胞浸润程度,并分析其与罹患肺癌的关系。结果观察组肺腺泡肌型动脉内、中、外膜CD3^(+)总T细胞、CD8^(+)T细胞表达水平均明显高于对照组,差异均有统计学意义(P<0.05);两组肺腺泡肌型动脉内、中、外膜CD4^(+)T细胞、CD20^(+)B细胞表达水平比较,差异均无统计学意义(P>0.05);经多因素Logistic回归分析发现,肺腺泡肌型动脉外膜CD3^(+)总T细胞、CD8^(+)T细胞表达水平均是伴有吸烟史的COPD合并肺结核患者罹患肺癌的独立危险因素(P<0.05);肺腺泡肌型动脉外膜CD3^(+)总T细胞、CD8^(+)T细胞表达水平均随肺癌肿瘤分期增大而升高,在不同肺癌病理分期之间差异均有统计学意义(P<0.05);经ROC曲线分析,肺腺泡肌型动脉外膜CD3^(+)总T细胞联合CD8^(+)T细胞表达水平评估伴有吸烟史的COPD合并肺结核患者罹患肺癌风险的AUC为0.924。结论伴有吸烟史的COPD合并肺结核患者肺动脉出现以CD3^(+)总T细胞、CD8^(+)T细胞浸润其外膜为特征的炎症反应,两者表达水平均可能与肺癌严重程度有关,联合评估患者罹患肺癌风险的效能较好,值得临床予以重视。

Objective To analyze the relationship between pulmonary inflammatory characteristics and lung cancer risk in chronic obstructive pulmonary disease(COPD)patients complicated with pulmonary tuberculosis with smoking history.Methods From Jan 2017 to Sep 2022,48 patients with COPD and pulmonary tuberculosis who underwent lobectomy for lung cancer and smoking history were selected as the observation group,and 48 patients with anatomic partial lobectomy and benign pulmonary nodules during the same period were selected as the control group.The degree of inflammatory cell infiltration in pulmonary alveolar muscular arteries of all patients was examined and its relationship with lung cancer was analyzed.Results The expression levels of CD3^(+)total T cells and CD8^(+)T cells in the intraarterial,middle and outer membrane of pulmonary alveolar muscular arteries in the observation group were significantly higher than those in the control group,with statistical significance(P<0.05).There were no significant differences in the expression levels of CD4^(+)T cells and CD20B cells in the intraarterial,middle and outer membrane of pulmonary alveolar muscular arteries between the two groups(P>0.05).Multivariate Logistic regression analysis showed that the expression levels of CD3^(+)total T cells and CD8^(+)T cells in outer membrane of pulmonary alveolar muscular arteries were independent risk factors for lung cancer in COPD patients with pulmonary tuberculosis with smoking history(P<0.05).The expression levels of CD3^(+)total T cells and CD8^(+)T cells in outer membrane of pulmonary alveolar muscular arteries increased with the increase of lung cancer stage,and there were statistically significant differences among different pathological stages of lung cancer acini muscular artery type outer membrane CD3^(+)total T cells were combined assessment on the level of CD8^(+)T cells expressing in outer membrane of pulmonary alveolar muscular arteries with smoking history of amalgamative tuberculosis lung cancer risk in patients with COPD AUC was 0.924.Conclusion Pulmonary inflammation is characterized by CD3^(+)total T cells and CD8^(+)T cells infiltrating into the membrane of pulmonary artery in COPD patients with smoking history.The expression levels of CD3^(+)total T cells and CD8^(+)T cells may be related to the severity of lung cancer history.The combined evaluation of lung cancer risk in patients with COPD combined with pulmonary tuberculosis is effective and worthy of clinical attention.