原发性多发肺结节“炎癌转化”机制探讨

Discussion on the mechanism of the"inflammation-cancer transformation"in primary multiple pulmonary nodules

原发性多发肺结节发病率较高。计算机断层成像观察中发现,随时间推移,肺结节会出现增大增多的变化。术后的病理学检查结果包括慢性炎症、腺瘤样改变、原位癌、微浸润癌、浸润癌等多种病理形态。随着病程的延长和外界因素的刺激,多发肺结节存在“炎癌转化”的可能性。湿痰瘀停聚是“炎癌转化”的基础,正气亏耗是“炎癌转化”的关键,气虚阳虚为正气亏耗的根本,情志郁结、湿痰瘀化毒为“炎癌转化”的动力。“炎癌转化”过程中存在正邪交争、湿痰瘀消长,邪长正消,湿痰瘀停聚增多、正气亏耗则结节增大增多、恶性度增加,呈现出炎→不典型性增生→癌的动态过程;正长邪消、湿痰瘀消散吸收则结节消退、癌变进程逆转,急性炎症刺激等外界激惹可加速多发肺结节“炎癌转化”进程。

Primary multiple pulmonary nodules have a high incidence,and the size and number of pulmonary nodules on computed tomography images increase with time.Postoperative pathology of multiple pulmonary nodules shows chronic inflammation,adenomatoid change,carcinoma in situ,microinvasive carcinoma,infiltrating carcinoma,and other forms.There is a possibility of"inflammationcancer transformation"in multiple pulmonary nodules with prolonged time and external irritation.The accumulation of dampness phlegm and blood stasis is the basis of the theory of"inflammation-cancer transformation."Healthy qi deficiency is the key to the"inflammation-cancer transformation."Qi and yang deficiency are the root cause of healthy qi depletion.Emotional depression,dampness,phlegm,and blood stasis transforming into toxins provide the impetus for"inflammation-cancer transformation."There are struggle between healthy qi and evil qi,and waxing and waning of dampness,phlegm and blood stasis in the process of"inflammation-cancer transformation."The dampness phlegm and blood stasis will increase when evil qi increases and healthy qi decreases.In contrast,the size,number,and malignancy of nodules will increase during healthy qi deficiency,showing a dynamic shift from inflammation to atypical adenomatous hyperplasia to cancer.The dampness phlegm and blood stasis will be absorbed as the healthy qi increases and evil qi decreases so that lung cancer can be reversed.External irritation,such as acute inflammatory stimulation,may accelerate the transformation of"inflammation-cancer"in multiple pulmonary nodules.