不同类型厂矿接尘工人肺癌病因学研究

为评价游离二化硅是否致肺癌？矽肺是否是肺癌前变基础？选择四类接尘厂矿进行队列和队列内病例对照研究。队列对象６８２８５人。有矽肺６４８７例，肺癌３３０例，配对照１３５８例。根据厂矿历年工业卫生记录和近期对书籍致癌物监测结果，定量评估了每个对象的接尘水平及每个病例对照的积接触量。研究对象追访到１９８９年底，死亡６１９２人，与全国居民亡平均数计算的期望值近似。全死因中癌症是第一死因，但全癌低于国家居民死     

接尘工人和尘肺患者痰细胞表面标记物

目的 探讨接尘工人和尘肺患者痰细胞细胞间黏附因子-1(CD54,又称ICAM-1)、表皮生长因子受体(EGFR)、血小板衍生因子(PDGF)对尘肺早期诊断的意义.方法 选择接尘工人62名为接尘组,非接尘工人51名为非接尘组,22例尘肺患者为尘肺组,健康检查者10例为健康对照组,用呼吸道诱痰技术收集研究对象的痰液,并利用流式细胞技术测定细胞表面标记物CD54、EGFR、PDGF的表达水平.结果 接尘组与非接尘组痰细胞(中性粒细胞、巨噬细胞、淋巴细胞及嗜酸/碱粒细胞)表面标记物CD54、EGFR、PDGF的表达水平比较,差异无统计学意义(P＞0.05).与其他接尘工龄工人比较,接尘工龄10年及以上的工人痰细胞表面CD54、EGFR表达水平明显升高,PDGF表达水平明显降低,差异均有统计学意义(P＜0.05).与健康对照组比较,Ⅰ期、Ⅱ+Ⅲ期尘肺患者痰细胞CD54、EGFR表达水平明显升高,PDGF表达水平明显降低,差异均有统计学意义(P＜0.05).结论 接尘工人和尘肺患者的痰细胞表面CD54、EGFR、PDGF表达水平有改变,可能对早期检测尘肺有重要意义.     

煤矿接尘工人肺癌病理分析及病因学探讨

煤矿接尘工人肺癌病理分析及病因学探讨淮南矿务局第一医院（安徽淮南九龙岗，２３２０３５）柏方川，廖谦和煤矿长期接尘工人发生肺癌是否与粉尘有关，国内外报道颇不一致￣［１～３］，病因至今尚无定论。本文通过５０例接尘煤工尸检病理分析，试图对病因学进行探讨。材...     

钨矿接尘工人肺癌死亡的回顾性队列研究

通过对钨矿3533名男性接尘工人进行16年(1975～1990年)死因回顾性队列调查,累计观察53269人年,标化死亡率为25.75/10万(P<0.01),SMR为3.50(P<0.05),肺癌明显超高;矽肺与非矽肺肺癌标化死亡率为37.66/10万、20.79/10万,矽肺与非矽肺比较,SRR为1.81(P>0.05),肺癌死亡率、标化死亡率均随接尘工龄的延长而超高。     

石棉工人接尘量与肺癌发病关系的研究

对北京市制动密封材料厂的1244名接尘职工(其中13名死于肺癌),用寿命表法和Logistic回归模型进行接尘量与肺癌发病关系的研究表明,肺癌发病概率与累积接尘量之间呈直线相关。若以工作30或40年,死亡概率以12/10万或19/10万计算,则年平均粉尘浓度在0.73 ～1.70mg/m~3(寿命表法,40年)和0.03～2.11mg/m~3(Logistic回归模型,30年)之间,其对应的纤维计数浓度为1.37～1.54f/ml和1.25～1.61f/ml。作者建议作业场所现行石棉最高容许浓度应该进一步降低。     

锡矿工人接尘与矽肺危险度评价

目的探讨粉尘暴露与矽肺危险度之间的接触效应关系。方法选择广西４个锡矿１９６０～１９６５年间工作１年以上的３０１０名接尘工人进行队列研究。用生存分析法统计累积粉尘接触量和矽肺出现的关系。结果追访到１９９４年底,检出矽肺１０１５例（３３．７％）。矽肺平均潜伏期２１．３年。总粉尘浓度７．５ｍｇ／ｍ３（ＴＷＡ）。拟合生存分析模型表明：矽肺发病危险度与累积接尘量的关系适合Ｗｅｉｂｕｌ分布。累积总粉尘接触量低于１０ｍｇ·ｍ－３·ａ－１时,矽肺危险小于１％;累积总粉尘接触量超过２０ｍｇ·ｍ－３·ａ－１时,矽肺累积危险度升高加快;累积总粉尘接触量达１５０ｍｇ·ｍ－３·ａ－１时,矽肺危险超过６８％。接尘时间与接尘量和矽肺危险度呈正相关。结论矽肺危险度与累积接尘量之间存在接触效应关系。     

滑石粉尘作业工人肺癌的流行病学研究

本文对1357名男性滑石工人中死亡的147例工人的死因进行了流行病学分析。采用回顾性队列研究方法,追踪观察15年(1974—1988)。结果表明,全死因、全癌、肺癌均明显高发(SRR分别为2.22、1.63、1.27,P值均小于0.05),全体观察人群肺癌的SRR随Latency的增加呈梯度递增;井上粉碎工肺癌有显著超量(SRR=2.82,P<0.05)。肺癌的相对危险度为2.72;滑石肺的肺癌合计率为2.55％。研究结果表明,滑石工人肺癌与接触滑石粉尘有一定强度的联系。     

接尘与肺癌形态关系的研究

接尘与肺癌形态关系的研究陈卫红陈镜琼近年来，我国的主要死因中，癌症死亡率持续增长，其中肺癌死亡增长最为明显［１］，由于工业的迅速发展，职业因素导致的肿瘤也越来越受到关注，接尘与肺癌关系的研究一直是探讨的热点。为了解厂矿接尘工人肺癌与非接尘工人肺癌在形...     

痰细胞DNA异倍体检测对肺癌的诊断意义

目的 探讨痰细胞DNA异倍体检测在肺癌诊断中的意义.方法 采用全自动图像细胞仪对60例肺癌、25例肺结核、30例急性肺炎和30例健康人痰中脱落细胞DNA进行定量分析,同时与常规痰细胞学和刷检细胞学检测结果进行比较.结果 肺癌患者痰细胞DNA异倍体阳性率为41.7%(25/60),肺结核、急性肺炎患者和健康人均为阴性.全自动图像细胞仪检测肺癌患者痰细胞DNA异倍体阳性率高于常规痰细胞学检测阳性率(18.3%,11/60)(P<0.01),也高于刷检细胞学检测阳性率(35.0%,21/60)(P<0.05).结论 对肺癌患者应用全自动图像细胞仪进行痰细胞DNA异倍体的定量检测是肺癌诊断的一个敏感、特异的方法,可以作为肺癌诊断的辅助技术.     

接尘工人肺癌的病理学调查

本文集中我国各地区1960-1990年接尘工人尸检1000例,以非接尘男性尸检612例做对照,对尘肺肺癌的发病率和病理进行分析研究。结果:(1)接尘工人尸检肺癌发病率为17.2%,比对照组(3.16%)显著超高,占全身各器官癌病之首;(2)石棉肺尸检肺癌率最高(26.92%),矽肺(18.5%)与煤工尘肺(16.79%)相近;(3)职业上,煤矿、金属矿和石棉矿是我国尘肺肺癌的三大主要工种,接尘工龄以11～20年段发病最多(55.1%);(4)病理类型依次为腺癌(含肺泡细胞癌)、鳞癌、未分化癌,其中石棉肺一半以上为腺癌。     

肺癌不同阳性标准痰细胞学筛查方法的灵敏度和特异度分析

目的 探讨改变阳性标准对职业高危人群肺癌痰细胞学筛查灵敏度及特异度的影响.方法 以1992-1999年间至少参加过1次年度性痰细胞学肺癌筛查的云南锡矿工人为研究对象,共9223名.研究对象年龄均40岁以上、井下工龄或冶炼工龄超过10年且无恶性肿瘤史.收集研究对象痰样进行筛查,以筛查阳性且被临床确诊的肺癌患者为真阳性,筛查阴性且在随访期间没有被临床诊断为肺癌的研究对象为真阴性,计算不同阳性标准痰细胞学筛查方法的灵敏度、特异度,并进行受试者工作特征曲线(ROC曲线)分析,利用Hanley和McNeil法计算Z值,比较不同阳性标准ROC曲线下面积的差别.结果 截止到随访终止时间(2001年12月31日),9223名研究对象中共有500例肺癌患者,最常见的细胞类型为鳞癌[55.8%(222/398)],发病部位以中央型肺癌为主[68.5%(316/461)].在筛查过程中,共150例患者有痰细胞学筛查阳性史.阳性标准分别为重度不典型增生及以上、中度不典型增生及以上、轻度不典型增生及以上时,痰细胞学筛查方法灵敏度分别为30.0%(150/500)、36.4%(182/500)、53.0%(265/500);特异度分别为98.9%(8628/8723)、95.1%(8611/8723)、77.9%(7033/8723).3种阳性标准的ROC曲线下面积(由重度到轻度)分别为0.645(95%CI:0.635～0.654)、0.657(95%CI:0.668～0.667)、0.655(95%CI:0.645～0.664);重度与中度、轻度比较,以及中度与轻度比较,差异均无统计学意义(Z值分别为0.780、0.645、0.209,P值均>0.05).结论 随阳性标准的降低,痰细胞学筛查的灵敏度上升而特异度下降,但3种不同阳性标准的准确度并无明显差异.

Abstract：

Objective To discuss the effect of different positive criteria on the sensitivity and specificity of sputum cytology screening for lung cancer among Yunnan tin miners.Methods 9223 Yunnan tin miners who received at least one annual sputum cytology screening for lung cancer during the period between 1992 and 1999 were recruited in the study.At time of enrollment,all participants were aged over 40 years old,had at least 10 years of employment as an underground miner and(or) smelter,and had not been diagnosed with malignancy.In our study,a true positive was categorized as having at least one prior positive sputum screening and a diagnosis of lung cancer,while a true negative,by our definition,signified negative sputum examinations and no diagnosis of lung cancer during the follow up time.Based on different positive criteria,sensitivity and specificity of sputum cytology were computed and receiver operating characteristic(ROC) curve analysis was conducted.Z statistic was used to test the differences of the area under ROC based on Hanley and McNeil method.Results By the end of following up on December 31,2001,a total 500 lung cancer cases were diagnosed among 9223 participants: most were squamous cell carcinoma (55.8% (222/398)) and central lung cancers (68.5% (316/461)).150 lung cancer cases had a previous positive sputum screening result.When positive criteria were taken as grave atypical metaplasia,moderate atypical metaplasia and slight atypical metaplasia,the corresponding sensitivities were 30.0% (150/500),36.4% (182/500),53.0% (265/500) respectively; while the corresponding specificities were 98.9% (8628/8723),95.1% (8611/8723),77.9% (7033/8723) respectively.The areas under ROC curve according to different positive criterias were 0.645(95%CI: 0.635-0.654),0.657(95%CI: 0.668-0.667),0.655(95%CI: 0.645-0.664) respectively.There were no significant differences found in the comparisons between grave and moderate atypical metaplasia,grave and slight atypical metaplasia,moderate and slight atypical metaplasia(Z statistics were 0.780,0.645,0.209 respectively,all P values>0.05).Conclusion While the standard of positive criteria for diagnosis of lung cancer decreased,the sensitivity of sputum cytology screening increased and the specificity decreased.Since there were no significant differences of accuracy for different positive criteria.     

HPV检测技术初筛巴氏涂片分流应用于农村女性宫颈癌筛查效果

目的 分析人乳头瘤病毒（human papillomavirus,HPV）检测技术初筛巴氏涂片分流应用于农村女性宫颈癌筛查中的效果。方法 2015年对35~64岁农村女性使用HPV检测进行宫颈癌初筛,阳性者采用巴氏涂片法分流,巴氏涂片结果为不明确意义的非典型鳞状细胞（atypical squamous cells of undetermined signification,ASC-US）及以上病变的女性转用阴道镜检查。所有阴道镜下检查异常或不满意处均取活检或宫颈管搔刮术（endocervical canal curettage,ECC）,病理结果为中度子宫颈上皮内瘤变（cervical intraepithelial neoplasia grade 2,CIN2）及以上者转诊进行手术治疗。结果 HPV初筛、巴氏涂片分流策略HPV筛查阳性率为10.65%。CIN2及以上者共150人,全部进行阴道镜检查,实际阴道镜转诊率为3.55%,阴道镜顺应性为100%。经病理诊断,本次筛查分别发现轻度子宫颈上皮内瘤变（cervical intraepithelial neoplasia grade 1,CIN1）、CIN2及以上、重度子宫颈上皮内瘤变（cervical intraepithelial neoplasia grade 3,CIN3）及以上分别为16例（0.38%）、29例（0.69%）、15例（0.36%）,未发现宫颈癌病例。结论 HPV初筛、巴氏涂片分流策略能够降低阴道镜转诊率,宫颈疾病检出率较高,可以在有条件的农村地区使用。但宫颈癌前病变及宫颈癌的检出率较HPV初筛不分流低,需要进一步加强对基层细胞学医生技术水平的规范化培训。     

痰液癌胚抗原、癌抗原125、糖链抗原19-9和细胞角蛋白21-1片段检测对肺癌的诊断价值

目的 检测痰液中癌胚抗原(CEA)、癌抗原125(CA125)、糖链抗原19-9(CA19-9)和细胞角蛋白21-1片段(CYFRA21-1)的含量,探讨痰液中肿瘤标志物检测在肺癌诊断中的意义.方法 采用化学发光免疫分析法检测52例肺癌(肺癌组)和46例肺部良性病变患者(对照组)痰液中CEA、CA125、CA19-9和CYFRA21-1的含量.结果 肺癌组痰液中CEA、CA125、CA19-9和CYFBA21-1的含量分别为(27.6±31.2)μg/L、(76.4±65.2)kU/L、(56.1±31.6)kU/L和(25.2±9.1)μg/L;对照组分别为(6.1±7.5)μg/L、(23.7±7.9)kU/L、(17.3±10.2)kU/L和(1.2±1.7)μg/L,两组比较差异均有统计学意义(P<0.01).肺癌组痰液中CEA、CA125、CA19-9和CYFBA21-1的敏感度分别为42.3%(22/52)、46.2%(24/52)、36.5%(19/52)和51.9%(27,52),四种肿瘤标志物单项在肺癌中的敏感度比较差异均无统计学意义(P>0.05).腺癌CEA阳性率高于鳞癌(x2=4.193,P<0.05),CYFRA21-1阳性率低于鳞癌(x2=4.806,P<0.05).Ⅲ期+Ⅳ期肺癌患者CA125的阳性率较Ⅰ期+Ⅱ期高(x2=5.202,P<0.05).痰液中单项肿瘤标志物的检测阳性率不高,含CYFRA21-1的两项、三项、四项检测组合阳性率明显提高(P

Abstract：

Objective To evaluate the clinical significance of carcinoembryonic antigen (CEA),cancer antigen 125 (CA125),carbohydrate antigen 19-9 (CA19-9) and eytokeratin 21-1 fragment (CYFRA21-1) assays of sputum in patients with lung cancer. Method Fifty-two cases with lung cancer and 46 cases with benign lung diseases underwent detection of CEA ,CA125 ,CA19-9 and CYFRA21-1 in sputum by using the method of chemi-luminescent enzyme immunoassay. Results The levels of CEA,CA125,CA19-9 and CYFRA21-1 in sputum of 52 cases with lung cancer were (27.6±31.2) μg/L, (76.4±65.2)kU/L, (56.1±31.6) kU/L and ( 25.2±9.1 )μg/L respectively. But the levels of those of 46 cases with benign lung diseases were (6.1±7.5)μg/L, (23.7±7.9) kU/L, (17.3±10.2) kU/L and (1.2±1.7)μg/Lrespectively. The levels of these tumor markers in sputum in patients with lung cancer were significantly higher than those in patients with benign lung diseases(P< 0.01 ). The diagnostic sensitivity of CEA,CA125,CA 19-9 and CYFRA21-1 in sputum in 52 cases with lung cancer was 42.3%( 22/52 ), 46.2% (24/52), 36.5%( 19/52 ) and 51.9% (27/52) respectively ( P > 0.05 ). Among the cancer patients, the sensitivity of sputum CEA in patients with adenocareinoma was significantly higher than that in patients with squamons cell carcinoma (X2= 4.193, P < 0.05 ) ; while the sensitivity of sputum CYFRA21-1 in patients with squamous cell carcinoma was significantly higher than that in patients with adenocarcinoma ( X2 = 4.806,P < 0.05 ). The sensitivity of CA125 in advanced lung cancer( Ⅲ +Ⅳ stage) was higher than that in early lung cancer( Ⅰ+Ⅱstage) (X2= 5.202,P < 0.05 ). Compared with the single tumor marker assaying, the combination of CEA,CA 125, CA 19-9 and CYFRA21-1 in sputum could significantly improve the sensitivity and accurate value in the diagnosis of lung cancer (P<0.05). Conclusion To assay CEA,CA125,CA1g-9 and CYFRA21-1 in sputum is valuable in diagnosis of lung cancer, and the combination of CEA,CA125,CA19-9 and CYFRA21-1 in sputum can significantly improve sensitivity and accurate value in the diagnosis of lung cancer.     

低剂量螺旋CT和痰液基薄层细胞学联合筛查社区肺癌高危人群的研究

目的 评价低剂量螺旋CT（low-dose computed tomography, LDCT）和痰液基薄层细胞学检测（thinprep cytologic test, TCT）对社区肺癌高危人群的联合筛查效果。方法 对2013年8月~2014年9月在社区招募符合本研究高危人群定义的3 708名东莞本地居民进行肺癌筛查。肺癌高危人群定义为符合下列任何一项的40岁以上者：20包年以上的吸烟史,肺癌家族史,肺部既往病史,职业接触史或被动吸烟史。发现至少一个直径≥4 mm 非钙化结节为LDCT筛查的阳性结果;细胞学重度不典型增生或镜检可见癌细胞为TCT检查的阳性结果。结果 LDCT肺部结节的检出率为12.59%（467/3 708）。经病理证实,LDCT筛查阳性人群中共确诊肺癌56例,检出率为1.51%（56/3 708）。TCT的阳性检出率为1.91%（71/3 708）。TCT阳性人群中共确诊肺癌36例,肺癌检出率为0.97%（36/3 708）。本次联合筛查共确诊肺癌58例,非小细胞肺癌41例,其中0～Ⅰ 期22例,早期诊断率为53.66%（22/41）。结论 LDCT和TCT联合筛查肺癌高危人群有助于提高肺癌的早期诊断率和检出率,降低筛查的假阳性比例。     

大便隐血定量检测仪和胶体金试纸用于人群结直肠癌筛查的比较

目的 比较大便隐血定量检测仪和胶体金试纸用于人群结直肠癌筛查的效果.方法 于2011年以随机整群抽样方法在浙江省海宁市许巷镇取9000名40 ～ 74岁调查对象,分别用大便隐血定量检测仪和胶体金试纸两种方法,按产品说明,对调查对象同一次大便用不同的采便管采两个样本进行检测.以定量检测仪测得血红蛋白浓度≥100 ng/ml,以及胶体金试纸条检测带显色为隐血阳性标准.对筛选出的阳性者行结肠镜检查,对病变患者行病理诊断.比较两种方法检测隐血阳性率及一致性,以及结直肠癌和腺瘤的阳性预测值和人群检出率.结果 9000名对象中最终有6475(71.9％)名调查对象按要求同时送检了两份大便样品.定量检测仪和胶体金试纸阳性例数分别为319(4.9％)例和146(2.3％)例,其中双阳性患者45例(Kappa值=0.168,95％ CI:0.119 ～0.217);阳性者中分别有184(57.7％)例和89(61.0％)例完成结肠镜检查.自动定量检测仪对结直肠癌、进展期腺瘤、非进展期腺瘤的阳性预测值与胶体金试纸的差异无统计学意义(P＞0.05),但自动定量检测仪检出的结直肠癌和进展期腺瘤例数(26例,人群检出率为0.402％)大于胶体金试纸法检出例数(10例,人群检出率为0.154％),差异有统计学意义(x2=7.131,P＜0.01).结论 大便隐血定量检测仪用于筛检结直肠癌和进展期腺瘤的效果可能优于胶体金试纸,但尚需进一步证实.     

云锡矿工慢性支气管炎与肺癌关系的队列研究

目的探讨云锡矿工既往慢性支气管炎与肺癌的关系。方法利用前瞻性队列研究方法,分析云锡矿工肺癌高危人群慢性支气管炎与肺癌死亡危险的关系。结果1992—1999年,共9 295名云锡矿工进入队列,随访至2001年底,共443例肺癌死亡。慢性支气管炎可增加肺癌死亡危险性,调整危险比(HR)为1.5(95%CI:1.3～1.8),慢性支气管炎与肺鳞癌呈显著正相关,与腺癌和小细胞癌症的关联则无显著性。分层分析结果表明,两者关联仅在吸烟者中差异具有显著性。结论慢性支气管炎可能是云锡矿工肺癌死亡的危险因素之一,其致肺癌的危险应引起重视并加以控制。     

云锡矿工肺癌组织DAPK基因表达及其甲基化异常

目的探讨云锡矿工肺癌组织DAPK基因的蛋白表达及其甲基化异常。方法收集云锡矿工肺癌组织50例及10例正常肺组织。采用免疫组化检测DAPK蛋白表达,采用原位细胞凋亡检测法检测细胞凋亡,采用甲基化特异性聚合酶链反应检测DAPK基因启动子甲基化。结果50例癌组织中,38?PK蛋白表达阴性,36%检测到DAPK基因启动子异常甲基化,DAPK蛋白表达与细胞凋亡有关(P<0·05),DAPK基因启动子异常甲基化与DAPK蛋白表达呈负相关(P<0·05)。结论①云锡矿工肺癌组织中DAPK基因表达减少或缺失;②云锡矿工肺癌发生发展可能与DAPK基因异常甲基化有关。     

Risk factors and early detection of lung cancer in a cohort of Chinese tin miners

PURPOSE: To examine risk factors and establish a biologic specimen and data bank for the study of early markers of lung cancer.

METHODS: We designed a dynamic cohort using an ongoing lung cancer screening program among radon- and arsenic-exposed tin miners in Yunnan China. Through the first four years of the study, 8,346 miners aged 40 years and older with over 10 years of occupational exposure have been enrolled, risk factors have been assessed, annual sputum and chest radiographs have been obtained, and numerous biologic specimens have been collected.

RESULTS: A total of 243 new lung cancer cases have been identified through 1995. Radon and arsenic exposures are the predominant risk factors, but lung cancer risk is also associated with chronic bronchitis and silicosis, as well as a number of measures of exposure to tobacco smoke, including early age of first use, duration, and cumulative exposure. Tumor and sputum samples are being examined for early markers of lung cancer.

CONCLUSION: A cohort of occupationally-exposed tin miners with an extensive biologic specimen repository has been successfully established to simultaneously study the etiology and early detection of lung cancer.     

Relation of arsenic exposure to lung cancer among tin miners in Yunnan Province, China.

The relation of mining and smelting exposure to arsenic and lung cancer was studied among tin miners in Yunnan Province in the People's Republic of China. Interviews were conducted in 1985 with 107 living tin miners who had lung cancer and an equal number of age matched controls from among tin miners without lung cancer to obtain information on risk factors for lung cancer including detailed history of employment and tobacco use. Occupational history was combined with industrial hygiene data to estimate cumulative arsenic exposure. Similar methods were also used to estimate radon exposure for simultaneous evaluation in this analysis. The results indicate that subjects in the highest quarter of cumulative arsenic exposure have a relative risk of 22.6 compared with subjects without exposure after adjusting for tobacco and radon exposure, and a positive dose response relation was observed. Simultaneous evaluation of arsenic and tobacco exposure indicates a greater risk for arsenic, whereas simultaneous assessment of arsenic and radon exposure suggests radon to be the greater risk. There is no evidence of synergism between arsenic and tobacco exposure. Among arsenic exposed individuals, cases of lung cancer have longer duration but lower average intensity of arsenic exposure than controls, indicating that duration of exposure to arsenic may be more important than intensity in the aetiology of lung cancer. Finally, risk of lung cancer among workers exposed to arsenic only in mining is only slightly less than for miners whose exposure to arsenic was limited to smelting, although risks are highest when workers were exposed to both mining and smelting.     

肺癌骨转移单光子发射计算机断层显像术放射性核素骨显像特点分析

目的 分析肺癌核素骨显像的影像特征,评估单光子发射计算机断层显像术(SPECT)放射性核素骨显像诊断肺癌骨转移的临床价值.方法 177例确诊为肺癌的患者进行99mTc-MDP骨显像检查,对骨转移的症状、部位、数量与病理类型进行回顾性分析.结果 肺癌骨转移发生率为45.8%(81/177),其中多发性骨转移69例,占骨转移者的85.2%(69/81).腺癌骨转移发生率为69.0%(40/58),鳞癌为41.3%(19/46),小细胞癌为32.5%(13/40),未分化癌为27.3%(9/33),腺癌骨转移发生率与其他类型癌骨转移发生率比较差异有统计学意义(P＜0.05);共发现转移灶526处,部位以胸部为最多,共212处(40.3%),其他依次为脊柱168处(31.9%)、盆腔73处(13.9%)、四肢62处(11.8%)、颅骨11处(2.1%).结论 肺癌骨转移以多发病灶较为常见,部位以胸部、脊柱多发.腺癌骨转移发生率最高.肺癌患者应常规进行放射性核素骨显像,这对疾病的分期、治疗方案的选择、预后评估均有重要意义.