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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) ›› 2025, Vol. 18 ›› Issue (05) : 685 -690. doi: 10.3877/cma.j.issn.1674-6902.2025.05.004

论著

慢性阻塞性肺疾病合并肺癌的临床特征及危险因素分析
高瞻, 唐莎莎, 秦蘅, 王关嵩†(), 张雯†()   
  1. 400037　重庆，陆军（第三）军医大学第二附属医院呼吸疾病研究所
  • 收稿日期:2025-07-15 出版日期:2025-10-25
  • 通信作者: 王关嵩, 张雯
  • 基金资助:
    重庆市科卫联合医学科研项目青年项目(2023QNXM045); 陆军军医大学第二附属医院临床研究专项(2024F030)

Analysis of clinical characteristics and risk factors of chronic obstructive pulmonary disease combined with lung cancer

Zhan Gao, Shasha Tang, Heng Qin, Guansong Wang†(), Wen Zhang†()   

  1. Institute of Respiratory Diseases, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
  • Received:2025-07-15 Published:2025-10-25
  • Corresponding author: Guansong Wang, Wen Zhang
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引用本文：

高瞻, 唐莎莎, 秦蘅, 王关嵩, 张雯. 慢性阻塞性肺疾病合并肺癌的临床特征及危险因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(05): 685-690.

Zhan Gao, Shasha Tang, Heng Qin, Guansong Wang, Wen Zhang. Analysis of clinical characteristics and risk factors of chronic obstructive pulmonary disease combined with lung cancer[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(05): 685-690.

目的

探讨慢性阻塞性肺疾病(chronic obstructive pulmonary diseases, COPD)合并肺癌的临床特征及危险因素，为临床上COPD合并肺癌的预防和诊治提供参考。

方法

选取2022年3月至2024年10月期间我院收治的COPD合并肺癌患者210例为观察组、COPD患者125例为对照组，收集患者的临床资料和检查检验指标，采用单因素和多因素Logistic回归分析。

结果

观察组吸烟者184例(87.62%)，出现血痰者143例(68.09%)，对照组吸烟者89例(71.20%)，发生血痰者仅5例，两组比较有统计学意义(P<0.01)。肺癌家族史、职业暴露、咳嗽、气促、胸痛两组间无统计学差异(P>0.05)。观察组与对照组患者血小板(blood platelet count, PLT)(245.29±91.96)×109/L vs.(213.91±79.21)×109/L，两组比较有显著差异(P<0.01)；肺肿瘤标志物比较，癌胚抗原(carcino-embryonic antigen, CEA)(35.73±170.51) vs. (2.86±1.71)ng/ml、神经元特异性烯醇化酶(neuron-specific enolase, NSE)(20.96±22.86) vs. (11.72±4.64)ng/ml、细胞角蛋白19片段抗原(cellular keratin 19 fragment antigen, CYFRA21-1)(9.76±23.52)vs. (2.24±2.44)ng/ml及胃泌素释放肽前体(pro-gastrin-releasing peptide precursor, Pro-GRP)(206.02±693.48) vs. (47.35±18.14)pg/ml，两组差异有统计学意义(P<0.01)。观察组患者肺CT影像学中出现肺气肿169例、95例(45.24%)为鳞状细胞癌、中央型肺癌141例(67.14%)、诊断肺癌时111例(52.86%)患者TNM分期Ⅲ期；通过行纤维支气管镜活检155例(71.43%)，经皮肺穿刺活检34例(16.19%)；126例(60.00%)患者进行了基因测序。通过多因素Logistic回归分析表明，吸烟史、血痰、PLT≥210.0×109/L、NSE≥13.94 ng/ml及CYFRA21-1≥3.3 ng/ml是COPD合并肺癌发生的危险因素(P<0.05)。

结论

通过对COPD合并肺癌患者的临床特征及危险因素分析，发现吸烟史、血痰、PLT、NSE及CYFRA21-1升高是COPD患者并发肺癌的危险因素，临床早期发现COPD患者中的肺癌高危人群具有临床意义。

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

To investigate the clinical characteristics and risk factors of chronic obstructive pulmonary diseases (COPD) complicated with lung cancer, providing references for its prevention, diagnosis, and treatment in clinical practice.

Methods

A total of 210 COPD patients with lung cancer (observation group) and 125 COPD patients without lung cancer (control group) admitted to our hospital from March 2022 to October 2024 were selected. Clinical data and laboratory indicators were collected. Univariate and multivariate logistic regression analyses were performed to identify the clinical features and risk factors associated with COPD complicated with lung cancer.

Results

In the observation group, 184 patients (87.62%) were smokers, and 143 (68.09%) presented with hemoptysis, whereas in the control group, 89 patients (71.20%) were smokers, and only 5 exhibited hemoptysis. The differences between the two groups were statistically significant (P<0.01). No significant differences were observed in family history of lung cancer, occupational exposure, cough, dyspnea, or chest pain between the two groups (P>0.05). A significant difference was noted in platelet count (PLT) between the observation group and the control group: (245.29 ± 91.96)×109/L vs. (213.91±79.21)×109/L (P<0.01). Comparisons of lung tumor markers revealed statistically significant differences between the two groups (P<0.01): carcinoembryonic antigen (CEA) (35.73±170.51 vs. 2.86±1.71 ng/ml), neuron-specific enolase (NSE) (20.96±22.86 vs. 11.72±4.64)ng/ml, cytokeratin 19 fragment antigen (CYFRA21-1) (9.76±23.52 vs. 2.24±2.44)ng/ml, and pro-gastrin-releasing peptide (Pro-GRP) (206.02±693.48 vs. 47.35±18.14)pg/ml. Among the observation group, 169 patients exhibited emphysema on lung CT imaging. Histopathological analysis indicated that 95 cases (45.24%) were squamous cell carcinoma, 141 cases (67.62%) had central-type lung cancer, and 111 patients (52.86%) were at TNM stage Ⅲ at diagnosis. Diagnosis was confirmed via fiberoptic bronchoscopic biopsy in 155 patients (71.43%) and percutaneous lung biopsy in 34 patients (16.19%). Genetic testing was performed in 126 diagnosed patients (60%). Multivariate logistic regression analysis identified smoking history, hemoptysis, PLT ≥ 210.0×109/L, NSE≥13.94 ng/ml, and CYFRA21-1≥3.3 ng/ml as risk factors for COPD complicated with lung cancer (P0.05).

Conclusion

Analysis of clinical characteristics and risk factors in COPD patients with lung cancer revealed that smoking history, hemoptysis, elevated PLT, NSE, and CYFRA21-1 levels are significant risk factors. These findings have clinical implications for the early identification of high-risk lung cancer populations among COPD patients.

Key words: Chronic obstructive pulmonary disease, Lung cancer, Clinical characteristics, Risk factors
表1 两组患者临床资料结果比较[n(%)]
临床资料 变量 观察组(n＝210) 对照组(n＝125) χ2/t值 P值
吸烟史 有 184(87.62) 89(71.20) 4.773 0.029
  无 26(12.38) 36(28.80)    
肺癌家族史 有 6(2.86) 3(2.40) 1.288 0.256
  无 204(97.14) 122(97.60)    
职业暴露 有 81(38.57) 41(32.70) 0.137 0.712
  无 129(61.43) 84(67.20)    
气促、喘息 有 114(54.29) 103(82.40) 0.651 0.420
  无 96(45.71) 22(17.60)    
咳嗽 有 181(86.19) 116(92.80) 0.341 0.559
  无 29(13.81) 9(7.20)    
血痰 有 143(68.09) 5(4.00) 78.679 0.001
  无 67(31.91) 120(96.00)    
胸痛 有 28(13.33) 6(4.80) 2.378 0.123
  无 182(86.67) 119(95.20)    
表2 两组血生化及肿瘤标志物结果比较[(±s)]
检测指标 观察组(n＝210) 对照组(n＝125) t/Z P值
WBC(×109/L) 7.29±3.14 8.21±3.08 －0.690 0.490
PLT(×109/L) 245.29±91.96 213.91±79.21 5.631 0.000
RBC(×1012/L) 4.41±2.97 4.08±0.79 1.045 0.297
Hb(g/L) 126.02±17.46 121.67±20.26 1.557 0.121
D-二聚体(g/L) 0.42±1.16 0.58±1.38 －0.173 0.863
CEA(ng/ml) 35.73±170.51 2.86±1.71 6.338 0.001
CA153(U/ml) 20.08±32.39 10.75±6.64 0.540 0.589
NSE(ng/ml) 20.96±22.86 11.72±4.64 9.514 0.001
CYFRA21-1(ng/ml) 9.76±23.52 2.24±2.44 6.763 0.000
Pro-GRP(pg/ml) 206.02±693.48 47.35±18.14 12.729 0.000
SCC-Ag(ng/ml) 3.13±6.54 1.50±1.97 0.729 0.466
表3 COPD合并肺癌患者肺CT及病理类型比较[n(%)]
临床资料 例(%) 化疗＋免疫(n＝110) 化疗(n＝23) 靶向(n＝14) 其他(n＝9) 未治(n＝54) P值
病理类型[n(%)]             0.000
肺鳞状细胞癌 95(45.24) 53(48.18) 13(56.52) 1(7.14) 2(22.22) 26(48.14)  
肺腺癌 68(32.38) 32(29.09) 6(26.09) 13(92.86) 4(44.44) 13(24.08)  
小细胞肺癌 32(15.24) 21(19.09) 2(8.69) 0(0) 3(33.34) 6(11.11)  
其他类型 15(7.14) 4(3.64) 2(8.69) 0(0) 0(0) 9(16.67)  
肿瘤分期             0.001
Ⅰ期 8(3.81) 2(1.82) 2(8.69) 0(0) 1(11.11) 3(5.56)  
Ⅱ期 10(4.76) 3(2.73) 4(17.39) 0(0) 1(11.11) 2(3.70)  
Ⅲ期 111(52.86) 63(57.27) 12(52.18) 6(42.86) 6(66.67) 24(44.44)  
Ⅳ期 81(38.57) 42(38.18) 5(21.74) 8(57.14) 1(11.11) 25(46.30)  
肺气肿             0.000
有 169(80.48) 88(80.00) 15(65.22) 13(92.86) 7(77.78) 46(85.18)  
无 41(19.52) 22(20.00) 8(34.78) 1(7.14) 2(22.22) 8(14.82)  
肿瘤位置             0.001
中央型 141(67.14) 78(70.91) 16(69.57) 7(50.00) 4(44.44) 36(66.67)  
周围型 69(32.86) 32(29.09) 7(30.43) 7(50.00) 5(55.56) 18(33.33)  
表4 观察组患者发生的多因素Logistic回归分析
临床资料及指标 β SE Waldχ2 P值 OR 95%CI
吸烟史 5.300 0.863 37.712 0.001 200.274 36.901~1 086.949
血痰 4.896 0.992 24.347 0.000 133.725 19.127~934.907
PLT(≥210.0×109/L) 1.487 0.651 5.222 0.022 4.424 1.236~15.842
CEA(≥7.2 ng/ml) 0.451 0.830 0.296 0.587 1.570 0.309~7.993
NSE(≥13.94 ng/ml) 2.239 0.941 5.658 0.017 9.381 1.483~59.345
CYFRA21-1(≥3.3 ng/ml) 1.610 0.783 4.226 0.040 5.002 1.078~23.215
Pro-GRP(≥45.5 pg/ml) 1.031 1.523 0.458 0.499 2.803 0.142~55.494
常数项 －6.370 1.428 19.903 0.001 － －
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