摘要
目的 探讨不同类型间质性肺疾病患者临床特征、肿瘤标志物水平差异及其发生肺癌影响因素,提高合并肺癌的早期诊断率,避免延误诊断.方法 选取 2020 年 1 月至 2022 年 12 月收治的间质性肺疾病患者 335 例,根据高分辨率CT表现及实验室检查将患者分为特发性肺纤维化(IPF)组 106 例、非特发性肺纤维化(non-IPF)组124 例、结缔组织疾病相关性间质性肺疾病(CTD-ILD)组 105 例.比较 3 组一般资料、肺癌发生率、血清肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、神经元特异性烯醇化酶(NSE)、细胞角蛋白-19 片段抗原21-1(CYFRA21-1)、鳞状细胞癌抗原(SCC)、胃泌素释放肽前体(ProGRP)]水平.采用多因素logistic回归分析影响患者发生肺癌的危险因素.结果 IPF组血清CEA、CA125、NSE、CYFRA21-1 水平高于non-IPF组、CTD-ILD组(P＜0.05),3 组血清SCC、ProGRP水平比较无显著差异(P＞0.05).IPF组肺癌发生率55.66%(59/106)高于non-IPF组18.55%(23/124)和CTD-ILD组23.81%(25/105,P＜0.05).合并肺癌间质性肺疾病患者年龄≥60 岁、吸烟、咳嗽咳痰、咯血占比高于无肺癌患者(P＜0.05).年龄≥60 岁、吸烟、IPF是影响间质性肺疾病患者肺癌发生的危险因素(P＜0.05).结论 IPF患者合并肺癌的比例最高,血清CEA、CA125、NSE、CYFRA21-1 水平也高于non-IPF和CTD-ILD患者.临床须关注具有年龄≥60 岁、吸烟、IPF等危险因素的间质性肺疾病患者,可有效提高合并肺癌的早期诊断率,避免延误诊断.
Abstract
Objective To explore the clinical features,tumor marker levels in patients with different types of intersti-tial lung disease(ILD)and influencing factors of the occurrence of lung cancer,so as to improve the early diagnosis rate of patients combined with lung cancer and avoid delayed diagnosis.Methods A total of 335 patients with ILD admitted from January 2020 to December 2022 were selected.According to the high-resolution CT findings and laboratory examination,the patients were divided into idiopathic pulmonary fibrosis(IPF)group(n=106),non-IPF group(n=124),and connective tissue disease-associated ILD(CTD-ILD)group(n=105).General data,incidence of lung cancer,serum tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),neuron-specific enolase(NSE),cytokeratin-19 fragment antigen 21-1(CYFRA21-1),squamous cell carcinoma antigen(SCC),and pro-gastrin-releasing peptide(ProGRP)]were compared among the three groups.Multivariate logistic regression analysis was used to analyze the risk fac-tors affecting the occurrence of lung cancer.Results The levels of CEA,CA125,NSE and CYFRA21-1 in IPF group were higher than those in non-IPF group and CTD-ILD group(P＜0.05),and there were no significant differences in serum SCC and ProGRP in IPF group(P＞0.05).The incidence of lung cancer in IPF group was 55.66%(59/106),which was higher than that in non-IPF group[18.55%(23/124)]and CTD-ILD group[23.81%(25/105)](P＜0.05).The proportion of patients with ILD≥60 years,smoking,coughing sputum and hemoptysis were higher than those without lung cancer(P＜0.05).Age≥60 years,smoking and IPF were the risk factors for lung cancer in patients with ILD(P＜0.05).Conclusion IPF patients had the highest proportion of lung cancer,and serum CEA,CA125,NSE,and CYFRA21-1 levels were higher than those of non-IPF and CTD-ILD patients.Clinical attention should be paid to patients with ILD with risk factors such as age≥60 years,smoking,and IPF,which can effectively improve the early diagnosis rate of complicated lung cancer and avoid delayed diagnosis.
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