青海西宁地区IPF-LC的病理类型及临床特征分析

Pathological types and clinical characteristics of IPF-LC patients in Xining

目的 分析特发性肺纤维化合并肺癌(idiopathic pulmonary fibrosis-lung cancer, IPF-LC)患者的病理类型及临床特征,IPF-LC的保护及危险因素。方法 选择2014年11月至2022年10月我院收治的IPF患者190例,根据患者是否合并肺癌,分为单纯IPF组144例,IPF-LC组46例。收集两组临床资料、血气分析、影像学检查、血沉(erythrocyte sedimentation rate, ESR)、C反应蛋白(C reactive protein, CRP)水平。结果 单纯IPF组144例中,男95例(65.97%),女49例(34.03%),平均年龄(58.10±11.57)岁;IPF-LC组46例中,男41例(89.13%),女5例(10.87%),平均年龄(63.91±10.12)岁,两组性别和年龄比较差异具有统计学意义(P<0.05)。单纯IPF组平均吸烟指数250年支,IPF-LC组平均吸烟指数700年支,差异具有统计学意义(P<0.05);单纯IPF组与IPF-LC组比较,咯血、胸痛、体重下降及杵状指差异有统计学意义(P<0.05);IPF-LC组中结节团块影分布上叶13例(28.26%)、下叶24例(52.17%)、外周37例(80.43%)。两组动脉血氧分压(alveolar oxygen partial pressure, PaO_(2))、CRP、ESR水平具有统计学差异(P<0.05);PaO_(2)降低是IPF患者合并LC的危险因素(P<0.05)。结论 65岁以上吸烟指数高的男性IPF患者易合并LC;IPF-LC组较单纯IPF组易出现杵状指、咯血、胸痛、体重下降;IPF-LC组CRP、ESR水平高于单纯IPF组,提示慢性炎症介质在IPF-LC的发病过程中发挥作用。IPF-LC的影像学检查发现肿块常发生于纤维化明显区域,肺外周及下叶多见;PaO_(2)是IPF-LC的保护因素。

Objective To analyze the pathological types and clinical characteristics of idiopathic pulmonary fibrosis-lung cancer(IPF-LC)patients,the protection and risk factors of IPF-LC.Methods From November 2014 to October 2022,190 IPF patients admitted to our hospital were divided into simple IPF group(n=144)and IPF-LC group(n=46)according to whether the patients were complicated with lung cancer.The clinical data,blood gas analysis,imaging examination,erythrocyte sedimentation rate(ESR)and C reactive protein(CRP)levels of the two groups were collected.Results Among the 144 cases in the simple IPF group,there were 95 males(65.97%)and 49 females(34.03),with an average age of(58.10±11.57)years;among the 46 cases in the IPF-LC group,there were 41 males(89.13%)and 5 females(10.87%),with an average age of(63.91±10.12)years,with a statistically significant difference in gender and age between the two groups(P<0.05).The average smoking index of the simple IPF group was 250 years,and the average smoking index of the IPF-LC group was 700 years,with a statistically significant difference(P<0.05);there were statistically significant differences in hemoptysis,chest pain,weight loss and clubbing between the simple IPF group and the IPF-LC group(P<0.05);in the IPF-LC group,there were 13 cases(28.26%)of nodular mass shadows in the upper lobe,24 cases(52.17%)in the lower lobe,and 37 cases(80.43%)in the periphery.There were statistically significant differences in arterial oxygen partial pressure(PaO_(2)),CRP and ESR levels between the two groups(P<0.05);decreased PaO_(2) was a risk factor for IPF patients with LC(P<0.05).Conclusion Male IPF patients over 65 years old with high smoking index are more likely to be complicated with LC;The IPF-LC group is more likely to have clubbing,hemoptysis,chest pain,and weight loss than the IPF group alone;the levels of CRP and ESR in the IPF-LC group are higher than those in the IPF group alone,suggesting that chronic inflammatory mediators play a role in the pathogenesis of IPF-LC;the imaging examination of IPF-LC shows that the masses often occur in the area of obvious fibrosis,peripheral lung and lower lobe;PaO_(2) is a protective factor for IPF-LC.