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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2021, Vol. 14 ›› Issue (03) : 265 -271. doi: 10.3877/cma.j.issn.1674-6902.2021.03.001

论著

慢性阻塞性肺疾病合并肺癌临床特征分析
白莹1, 马娟1, 吕欣1, 明宗娟1, 张秋红1, 王煜1, 李维1, 杨侠1, 杨拴盈1,†()   
  1. 1. 710004　西安，西安交通大学第二附属医院呼吸与危重症医学科
  • 收稿日期:2020-11-13 出版日期:2021-06-25
  • 通信作者: 杨拴盈
  • 基金资助:
    国家自然科学基金资助项目(81672300); 陕西省重点研发计划(2018ZDXM-SF-042)

Analysis of clinical features and risk factors of COPD patients with lung cancer

Ying Bai1, Juan Ma1, Xin Lyu1, Zongjuan Ming1, Qiuhong Zhang1, Yu Wang1, Wei Li1, Xia Yang1, Shuanying Yang1,†()   

  1. 1. Respiratory and Critical Care Medicine Department, The Second Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710004, China
  • Received:2020-11-13 Published:2021-06-25
  • Corresponding author: Shuanying Yang
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引用本文：

白莹, 马娟, 吕欣, 明宗娟, 张秋红, 王煜, 李维, 杨侠, 杨拴盈. 慢性阻塞性肺疾病合并肺癌临床特征分析[J]. 中华肺部疾病杂志(电子版), 2021, 14(03): 265-271.

Ying Bai, Juan Ma, Xin Lyu, Zongjuan Ming, Qiuhong Zhang, Yu Wang, Wei Li, Xia Yang, Shuanying Yang. Analysis of clinical features and risk factors of COPD patients with lung cancer[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(03): 265-271.

目的

分析慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)合并肺癌患者的临床特征，以及COPD患者发生肺癌的危险因素，为COPD中的肺癌高危人群筛查提供思路，以提高肺癌的早期诊断率。

方法

回顾性分析西安交通大学第二附属医院2017年3月至2019年12月收治的195例COPD合并肺癌患者(COPD合并肺癌组)和同期住院的189例单纯COPD患者(COPD组)。

结果

COPD合并肺癌组≥60岁患者比例、吸烟患者比例、吸烟指数≥400年支患者比例、男性患者比例均高于COPD组(均为P<0.05)；与COPD组相比，COPD合并肺癌组咯血、胸痛、胸腔积液、乏力、体重减轻发生率均显著增加；COPD合并肺癌组动脉血pH、FEV1、GOLD分级≤Ⅱ级患者比例高于COPD组(P<0.05)；COPD合并肺癌组外周静脉血白细胞计数(WBC)、血小板计数(PLT)、中性粒细胞计数(NEUT)、嗜酸性粒细胞计数(EO)、嗜酸性粒细胞百分比(EO%)、凝血酶原时间(PT)、国际正常化比值(INR)、纤维蛋白原(FIB)、纤维蛋白降解产物(PFDP)、C反应蛋白(CRP)均高于COPD组(均为P<0.05)；COPD合并肺癌确诊方式以气管镜活检为主，病变部位以右肺为主，肿瘤解剖学位置以中央型肺癌为主，病理类型男性以鳞癌为主，女性以腺癌为主，TNM分期以Ⅲ/Ⅳ期为主，初次确诊时大部分患者已发生转移；COPD组患者接受吸入糖皮质激素(ICS)治疗的比例显著高于COPD合并肺癌组(P<0.05)；吸烟、EO升高和FIB含量增高是COPD患者发生肺癌的危险因素；吸入ICS治疗是其保护性因素。

结论

COPD患者应该坚持规律吸入ICS治疗；当COPD患者在疾病进程中出现咯血、胸痛、胸腔积液、乏力、体重减轻等情况和/或无其他原因PLT、EO、凝血指标、CRP升高时，需要警惕合并肺癌的发生。

关键词: 肺疾病, 慢性阻塞性, 支气管肺癌, 临床特征, 危险因素
Objective

To analyze the clinical characteristics of patients with COPD who are more likely to develop lung cancer, and the cancer risk factors conferred by COPD. Therefore, we can get a better understanding of the mechanisms linking the two diseases and the implementation of lung cancer screening in high risks population of patients with COPD which potentially result in more timely early diagnosis and treatment.

Methods

A retrospective study was performed in 195 patients with COPD and lung cancer who were admitted in the Respiratory and Thoracic surgery of the Second Affiliated Hospital of Xi′an Jiaotong University between March 2017 and December 2019. Additionally, in the same time another cohort consisting of 189 hospitalized COPD patients without lung cancer were recruited as negative control set.

Results

the percentage of older population (≥60 years) and male patients in COPD patients with lung cancer (COPD/LC) was significantly higher than that in COPD-only group, and the categorical analysis of smoking populations and subgroup of HSI ≥400 revealed considerably larger numbers in COPD/LC group than those in COPD-only group (all P<0.05); The prevalence of a range of symptoms was notably higher in COPD/LC group than those in COPD-only group, including hemoptysis, chest pain, pleural effusion, fatigue, and weight loss (all P>0.05); The pH value and FEV1 value of COPD/LC group was apparently higher than that of COPD-only group, and compared to COPD-only set, COPD/LC group exhibited larger population of patients with GOLD grade Ⅱ (all P<0.05); The values of a set of laboratory tests were clearly elevated in COPD/LC group than those in COPD-only group, including WBC, PLT, NEUT, EO, EO%, PT, INR, FIB, PFDP and CRP (all P<0.05); There were mainly effective ways we performed to diagnose COPD patients with lung cancer is bronchoscopy. the main lesion distribution of 195 COPD/LC patients was in the right lung. the main tumor sub-location was central-type lung cancer. The mainly histopathological type in male was SCC, and in female was AC. the mainly TNM staging system of lung cancer are stage Ⅲ/Ⅳ. In addition, 131 out of 195 COPD/LC patients were found distant metastasis at the time of initial diagnosis with lung cancer; The proportion of patients receiving ICS treatment in COPD-only group was significantly higher than that in COPD/LC group (P<0.01); the potential lung cancer risk factors in COPD patients included smoking, higher eosinophil count, as well as elevated levels of fibrinogen, and the protective factors was inhalation of ICS.

Conclusions

COPD patients should adhere to regular inhaled ICS treatment. The COPD patients with a history of hemoptysis, chest pain, pleural effusion, fatigue and weight loss during the illness, or with symptoms such as elevated platelet, eosinophil count, blood coagulation index, and CRP, may be at increased risks of becoming lung cancer and do need to be altered.

Key words: Chronic obstructive pulmonary disease, Bronchogenic carcinoma, Clinical features, Risk factors
表1 COPD合并肺癌组和COPD组年龄、性别和吸烟状况[n(%)]
临床资料 分　组 检验统计量 P值
COPD合并肺癌组(n＝195) COPD组(n＝189)
年龄 整体 63.76±7.27 67.04±10.39 t＝0.358 0.72
  <60岁 22(11.3) 37(19.6) χ2＝5.078 0.024
  ≥60岁 173(88.7) 152(80.4)    
吸烟 是 147(75.4) 93(49.2) χ2＝28.063 <0.01
否 48(24.6) 96(50.8)    
吸烟指数 整体 925.04±574.68 812.56±525.43 t＝1.496 0.136
  <400年支 21(14.3) 28(30.1) χ2＝8.776 0.003
  ≥400年支 126(85.7) 65(69.9)    
性别 男 176(90.3) 133(70.4) χ2＝24.149 <0.01
女 19(9.7) 56(29.6)    
表2 COPD合并肺癌组和COPD组临床表现[n(%)]
临床表现 分　组 χ2值 P值
COPD合并肺癌组(n＝195) COPD组(n＝189)
           
咳嗽 有 187(95.9) 184(97.4) 0.623 0.430
无 8(4.1) 5(2.6)    
咳痰 有 181(92.8) 182(96.3) 2.243 0.134
无 14(7.2) 7(3.7)    
咯血 有 62(31.8) 11(5.8) 42.058 <0.01
无 133(68.2) 178(94.2)    
胸闷 有 83(42.6) 92(48.7) 1.446 0.229
无 112(57.4) 97(51.3)    
气短 有 152(77.9) 180(95.2) 24.504 <0.01
无 43(22.1) 9(4.8)    
胸痛 有 52(26.7) 17(9.0) 20.335 <0.01
无 143(73.3) 172(91.0)    
胸腔积液 有 63(32.3) 20(10.6) 26.738 <0.01
无 132(67.7) 169(89.4)    
发热 有 32(16.4) 24(12.7) 1.062 0.303
无 163(83.6) 165(87.3)    
乏力 有 48(24.6) 27(14.3) 6.516 0.011
无 147(75.4) 162(85.7)    
体重减轻 有 66(33.8) 16(8.5) 36.814 <0.01
无 129(66.2) 173(91.5)    
表3 COPD合并肺癌组和COPD组血气分析、肺功能及GOLD分级
项目及GOLD分级 组　别 检验统计量 P值
COPD合并肺癌组(n＝195) COPD组(n＝189)
血气分析 pH 7.43±0.04 7.42±0.04 t＝2.172 0.031
  PaO2(mmHg) 71.36±16.69 71.98±57.07 t＝-0.141 0.888
  PaCO2(mmHg) 39.07±7.10 40.35±7.62 t＝-1.649 0.100
  SaO2(%) 93.58±5.08 93.32±5.39 t＝0.431 0.667
肺功能指标 FEV1(L) 1.48±0.50 1.24±0.54 t＝4.204 <0.01
  FVC(L) 2.89±4.64 2.43±0.79 t＝1.212 0.226
  TLC(L) 5.39±4.34 4.80±1.08 t＝1.426 0.155
  RV(L) 2.39±0.78 2.37±0.89 t＝0.180 0.857
GOLD分级       χ2＝4.929 0.026
  ≤Ⅱ级(Ⅰ+Ⅱ级) 104(65) 80(52.6)    
  >Ⅱ级(Ⅲ+Ⅳ级) 56(35) 72(47.4)    
表4 COPD合并肺癌组和COPD组外周血液指标
观察项目 组　别 检验统计量 P值
COPD合并肺癌组 COPD组
血常规 WBC(×109/L) 7.60±4.30 6.72±2.72 t＝2.358 0.019
  RBC(×1012/L) 4.28±0.55 4.82±5.75 t＝-1.303 0.193
  HB(g/L) 130.86±18.09 135.32±18.41 t＝-2.395 0.017
  PLT(×109/L) 221.77±87.64 200.64±67.92 t＝2.633 0.009
  NEUT(%) 70.60±11.55 69.35±12.42 t＝1.022 0.307
  NEUT(×109/L) 5.60±4.20 4.75±2.56 t＝2.383 0.018
  LYMP(%) 19.34±8.74 21.76±9.54 t＝-2.591 0.01
  LYMP(×109/L) 1.30±0.57 1.44±1.00 t＝-1.729 0.085
  EO%a(%) 1.50(0.60，3.43) 1.20(0.10，2.70) u＝-3.196 0.001
  EOa(×109/L) 0.1(0.04，0.24) 0.07(0.01，0.17) u＝-3.614 0.00
凝血六项 TT(s) 16.93±2.96 18.48±2.95 t＝-5.006 0.00
  PTa(s) 11.60(10.70，13.40) 10.50(9.90，12.10) u＝-6.164 0.00
  APTT(s) 30.36±5.90 30.19±6.50 t＝0.260 0.795
  INR 1.05±0.30 0.98±0.15 t＝3.094 0.002
  D-Da(μg/L) 440.00(265.00，740.00) 402.50(232.50，647.50) u＝-0.721 0.471
  FIB(g/L) 386.23±132.50 323.50±114.17 t＝4.501 0.00
  PFDPa(mg/L) 1.99(1.09，4.35) 1.5(0.73，2.67) u＝-2.824 0.005
炎症指标 CRPa(μg/l) 2.13(0.38，5.35) 0.64(0.31，3.23) u＝-2.259 0.024
  PCTa(ng /ml) 0.07(0.05，0.12) 0.05(0.05，0.13) u＝-1.653 0.098
其他 血尿酸(μmol/l) 261.90±80.61 276.51±97.21 t＝-1.061 0.290
表5 COPD合并肺癌危险因素Logistic回归分析
变　量 B SE Wald P值 OR 95%CI
吸烟 1.112 0.432 6.621 0.010 3.042 (1.304～7.097)
FEV1值 1.253 0.388 10.398 0.001 3.500 (1.634～7.493)
嗜酸性粒细胞计数 2.560 1.169 4.791 0.029 12.935 (1.307～128.004)
FIB 0.004 0.002 6.132 0.013 1.004 (1.001～1.008)
吸入ICS治疗 -1.947 0.525 13.747 <0.01 0.143 (0.51～0.399)
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