慢性阻塞性肺疾病合并肺癌的临床特征

目的探讨慢性阻塞性肺疾病(COPD)合并肺癌的临床特征,总结其具有特征性的临床特点,为临床诊治状况提供合理建议。方法选择78例COPD合并肺癌患者与同时期的156例单纯性COPD患者。调查内容包括患者的临床症状、生活习惯、社会人口学资料、既往病史等。结果 COPD合并肺癌患者的既往支气管炎(21.8%)、肺结核病史率(10.3%)均高于单纯COPD患者(9.0%)、(2.6%);COPD合并肺癌患者的咯血、呼吸困难、消瘦、胸痛、胸腔积液、肺不张、声音嘶哑均显著高于单纯COPD患者,差异有统计学意义(P<0.05);不同性别COPD合并肺癌患者的病理类型比较,差异无统计学意义(χ2=0.298,P=0.862)。结论 COPD合并肺癌多发于老年吸烟患者,以鳞癌比例最高,在患者出现咯血、胸痛、声音嘶哑、消瘦等临床表现或胸部影像检查发现肺不张和(或)胸腔积液时应及时就诊,早期诊断,早期治疗。     

慢性阻塞性肺疾病合并原发性支气管肺癌118例临床特征分析

背景与目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并原发性支气管肺癌的临床特征,以便临床早期诊断COPD合并原发性支气管肺癌患者.方法 回顾性分析我院2013年1月-2016年12月118例COPD合并原发性支气管肺癌患者的临床资料,包括年龄、性别、吸烟史、吸烟指数、临床症状及体征、病理类型、分期、转移部位及肺功能指标,选择同时期的120例单纯性COPD患者作为对照.结果 COPD合并肺癌组患者吸烟率(55.1%)及吸烟指数≥400支/年患者比例(90.8%)均高于单纯COPD组患者(20.8%,48.0%),组间差异有统计学意义(P<0.01);COPD合并肺癌组患者常见症状如咳嗽、咳痰、发热、乏力、呼吸困难发生率与单纯COPD组患者相比无统计学差异(P>0.05),而咯血、消瘦、胸痛、声音嘶哑、胸腔积液、肺不张发生率均显著高于单纯COPD组患者,差异有统计学意义(P<0.01);COPD合并肺癌组患者首次诊断时63.6%为晚期或局部晚期,远处转移以胸膜转移和骨转移多见;两组患者之间第一秒用力呼气容积(forced expiratory volume in one second,FEV1)与用力肺活量(forced vital capacity,FVC)比值(FEV1/FVC)、FEV1占预计值的百分比(FEV1%pre)、肺总量(total lung capacity,TLC)、残气容积(residual volume,RV)与TLC的比值(RV/TLC)无明显差异(P>0.05),但COPD合并肺癌组患者的一氧化碳弥散量(diffusing capacity of carbon monoxide,DLCO)较单纯COPD组患者降低,差异有统计学意义(P<0.05);COPD合并肺癌组患者病理类型以鳞癌最多见(51.7%),其中男性患者以鳞癌(60.7%)为主,而女性患者以腺癌(69.0%)为主.结论 COPD合并原发性支气管肺癌好发于男性吸烟患者,鳞癌发生率高,早期临床表现缺乏特异性,首次诊断时多为晚期或局部晚期,定期对COPD患者行胸部CT检查可以尽早发现肺癌.     

慢性阻塞性肺疾病并发肺癌72例

目的 探讨老年慢性阻塞性肺疾病(COPD)合并肺癌的临床特点.方法 分析临床72例COPD并发肺癌患者的临床资料.结果 COPD和肺癌在发病机制上有相关性,两者并发时给诊断和治疗带来很大的困难.结论 COPD并发肺癌诊断最重要的还是早期的胸部X线摄片及纤维支气管镜检查,痰找癌脱落细胞检查,一旦确诊以营养支持、对症治疗、提高机体免疫力、改善肺功能及生存质量为主.     

中重度慢性阻塞性肺疾病合并肺癌围手术期肺功能的保护

目的探讨中重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并肺癌围手术期肺功能的变化及处理措施。方法 2004年1月至2011年10月,对26例中重度COPD合并肺癌患者行肺叶切除术15例,肺段切除术6例,肺楔形切除术5例。围手术期给予支气管扩张剂吸入、氧疗、辅助排痰、呼吸康复训练及机械通气等综合治疗。比较术前综合治疗后与术后1个月和3个月时患者的肺功能与血气分析情况。结果 26例患者术前经综合治疗后,MVV、FEV1和FVC均明显改善(P<0.01),PaO2、SpO2上升(P<0.05),PaCO2显著下降(P<0.01)。术后1个月的MVV、FEV1和FVC较术前低(P<0.05),PaCO2较高(P<0.05),PaO2和SpO2已无差异(P>0.05)。3个月时各项指标均已达术前水平(P>0.05)。26例术后死亡2例(7.7%),24例康复出院。结论中重度COPD合并肺癌患者围手术期给予适当的综合治疗能有效改善肺功能,增加手术耐受性,有利于术后肺功能的康复。     

胸外科住院肺癌合并慢性阻塞性肺疾病的调查结果分析

背景与目的 肺癌是慢性阻塞性肺疾病(慢阻肺)重要的合并症,会显著影响慢阻肺患者的预后.慢阻肺也会影响肺癌患者的术后并发症和复发.本研究旨在调查胸外科住院肺癌合并慢阻肺的情况.方法回顾性分析北京大学人民医院胸外科2015年1月-2015年12月收治的原发性非小细胞肺癌患者.通过查阅病历获取患者的性别、年龄、吸烟状况、有害职业史、症状、胸部计算机断层扫描(computed tomography,CT)、术后病理、出院诊断、全套肺功能及支气管舒张试验,当基础肺功能第一秒钟用力呼气容积(forced expiratory volume in one second,FEV1)占预计值<70%时即行支气管舒张试验.结果703例肺癌患者进行了全套肺功能测定,其中67例进行支气管舒张试验,62例(92.5%)符合慢阻肺诊断.接受手术治疗的肺癌患者有677例,其中41例进行支气管舒张试验,38例(92.7%)符合慢阻肺诊断.在接受手术治疗的肺癌患者中合并慢阻肺者年龄≥65岁、男性、有吸烟史和非腺癌的比例高于未合并慢阻肺者,差异有统计学意义(P<0.05);男性和≥65岁者更易合并慢阻肺(OR:2.807-2.374,95%CI:1.101-7.157)(P<0.05).住院前仅有3例(4.3‰)诊断慢阻肺并按慢阻肺规范治疗.出院时仅有5例(7.1‰)诊断慢阻肺.结论在胸外科住院肺癌患者中行常规肺功能及支气管舒张试验可提高肺癌合并慢阻肺的诊断;当前肺癌合并慢阻肺诊断和治疗严重不足,需要引起胸外科医生重视,与呼吸内科医生携手共同防治慢阻肺.     

慢性阻塞性肺疾病与肺癌危险性关系的探讨

目的:分析慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)与肺癌危险性的关系.方法:对西安地区1999年至2001年肺癌组248例及对照组263例进行对照分析.结果:有慢性支气管炎、肺气肿的COPD患者,肺癌发生的CORD值明显升高,分别为2.25和2.33.当FEV1＜70%时,肺癌的OR值为2.28.结论:有COPD病史的患者,肺癌发生的危险性明显增高.肺功能的损伤增加了肺癌发生的危险性.     

全胸腔镜手术治疗对肺癌合并慢性阻塞性肺疾病患者预后的影响分析

目的 研究全胸腔镜手术对肺癌合并慢性阻塞性肺疾病(COPD)患者术后恢复和预后的影响.方法 选取128例行全胸腔镜手术治疗的肺癌合并COPD患者(全胸腔镜组)和96例行传统开胸手术治疗的肺癌合并COPD患者(开胸组)的临床资料.比较两组患者的围手术期临床指标(手术时间、术中出血量、切口长度、淋巴结清扫数目、引流量、住院时间、机械通气时间、吸氧时间、胸管留置时间)和术后并发症(肺部感染、切口感染、肺不张、心律失常、发热)的发生情况.结果 全胸腔镜组患者的术中出血量、切口长度、引流量、住院时间、机械通气时间、吸氧时间、胸管留置时间均明显低于开胸组,术后并发症的总发生率明显低于开胸组,差异均有统计学意义(P﹤0.01).结论 肺癌合并COPD患者采用全胸腔镜手术治疗,创伤小,术后恢复快,术后并发症的发生风险低.     

慢性阻塞性肺疾病合并肺癌危险性的X线对照分析

目的:结合胸部的X-线片表现,分析慢性阻塞性肺疾病与肺癌的关系.方法: 265例肺癌患者为病例组和550例非癌症患者为对照组,进行胸部X-线影像对照分析.结果: 肺癌患者胸部X-线影像表现具有慢性支气管炎,肺气肿,肺间质纤维化,矽肺等慢性阻塞性肺疾病的显著高于对照组(P<0.05).慢性阻塞性肺疾病增加了肺癌发生的危险性.结论: 具有慢性阻塞性肺部疾病发生肺癌的危险性明显增高,应定期检查.     

肺癌合并慢性阻塞性肺疾病患者围手术期气道管理现状

肺癌患者均合并不同程度的慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）,而COPD导致的肺功能降低对其能否手术治疗及术后并发症发生具有重要的影响。研究证明围手术期气道管理可以有效改善患者肺功能且减少术后并发症。本文针对近年来气道管理的临床应用现状及进展进行综述,主要有以下几方面：①围手术期气道管理的必要性;②围手术期气道管理的药物治疗现状与特点;③围手术期应用气道管理在改善肺功能中的价值;④围手术期需要气道管理的最佳人群;⑤围手术期气道管理应用存在的问题。     

有慢性阻塞性肺疾病食管癌的外科治疗

 有慢性阻塞性疾病(COPD)的食管癌, 肺功能对手术的选择可作客现判断, 时间肺活量是重要参数, 但不能预测术后肺功能不全, 必须结合具体情况作客观分析, COPD者有过多次自发性气胸, 肺气肿明显, 肺大泡弥散分布, 肺间质纤维化明显, 放射治疗后都易发生急性呼吸衰竭, 术前控制呼吸道感染及支气管痉挛是减少术后并发症的关键, 早期辨认并及时处理各类并发症有助于预防及抢救急性呼吸衰竭, 呼气末正压辅助呼吸加血管扩张剂硝普钠, 在预防及治疗本组急性呼吸衰竭时效果良好。     

氧化应激与肺癌和慢性阻塞性肺病的相关性研究

目的:探讨氧化应激与肺癌(LC)和慢性阻塞性肺病(COPD)的相关性。方法:用病例对照研究方法对COPD患者78例、LC患者68例、LC伴COPD患者28例和其他非LC、COPD住院患者71例作对照,采用酶免疫技术检测8-isoprostane的血清含量,用t检验及ANNOVAL方法对比分析各组间的差异。结果:8-isoprostane在COPD组、LC组和LC伴COPD组的含量分别为154.26±43.58pg/ml、98.53±32.34pg/ml和132.86±46.39pg/ml,均高于对照组85.78±13.47pg/ml(P<0.01);COPD和LC伴COPD组高于LC组,有显著性差异(P<0.01)。结论:COPD及肺癌伴有COPD的患者存在严重的氧化应激,而且这种氧化损伤远远大于非COPD、肺癌的人群和单纯肺癌患者;COPD患者氧化损伤程度强于LC患者。     

Involvement of Circulating Cell-Free Mitochondrial DNA and Proinflammatory Cytokines in Pathogenesis of Chronic Obstructive Pulmonary Disease and Lung Cancer

Objective: Circulating cell-free mitochondrial DNA (cf-MtDNA) has been reported in patients with chronic obstructive pulmonary disease (COPD) and lung cancers. However, inter-relationships among the three biological events have not been well-characterized. Therefore, our investigation was conducted to better understand the role of cf-MtDNA on pathogenesis of the two diseases. Methods: Plasma samples were collected from 64 non-small cell lung cancer (NSCLC) patients (before therapy), 45 patients with COPD and 62 healthy individuals. cf-MtDNA copy numbers were detected using quantitative real-time polymerase chain reaction (qRT-PCR) and cytokines were determined using a human ELISA kit. Results: Our data indicate that smoking statuses of the patients and controls were significantly associated with increased cf-MtDNA in plasma samples. Furthermore, NSCLC patients had significantly higher cf-MtDNA copy numbers than COPD patients (p < 0.03) and normal controls (p < 0.02), together with elevated proinflammatory cytokines over the controls (p < 0.05). Our  study shows that the copy numbers for the NSCLC patients were positively associated with their subsequent metastasis but inversely associated with their overall survival.  Conclusion: Our study indicates certain lung injury (e.g., from cigarette smoking) was responsible for the release of cf-MtDNA and proinflammatory cytokines into plasmas among our patients and controls. The increase in cf-MtDNA copy numbers was significantly associated with the development of both COPD and NSCLC, with increase in interleukin 6, and from our 5-year follow-up, with poor prognosis among the NSCLC patients. Therefore, with further validation, cf-MtDNA can be considered for use as diagnostic and prognostic biomarkers for NSCLC.     

The Relationship between Serum Uric Acid Levels and Early Mortality in Chronic Obstructive Pulmonary Disease Cases during Exacerbation

Aim:In this study, it was aimed to compare the levels of serum uric acid and uric acid/creatinine ratios in patients with COPD during an attack or in stable COPD, and to show whether serum uric acid and uric acid/creatinine ratios are associated with early mortality in COPD patients during an acute attack.Materials and Methods:In this study, COPD acute attack (n=155) and stable COPD (n=30) patients were evaluated. The data of these patients were obtained from patient files and computer records. COPD diagnosis and severity assessment were made according to the GOLD 2006 guideline. Participants’ age, gender, body mass index, pulmonary function test, arterial blood gas, uric acid, creatinine values and comorbidity information were recorded in the previously prepared Case Data Form. In 2012, when we conducted this study, gold 2006 was taken as the guideline for spirometry measurement, but spirometric measurements determined with reference values determined according to age, height and gender, and FEV1/FVC measurement <70% as diagnostic criteria in acute attack after bronchodilator were the guidelines used later, gold 2017. It is also compatible with gold2020 and gold2021 spirometry criteria.Results:It was determined that the uric acid (p<0.001) and uric acid/creatinine (p<0.001) levels of the patients in the acute attack group were significantly higher than the levels of the patients in the stable group. The attack group was divided into two subgroups according to certain cut-off points for uric acid (>6 mg/dl for women and >7 mg/dl for men) and uric acid/creatinine ratio (median value 7.10). Since the upper limit of the uric acid value measured in the blood is 6 mg/dl in women and 7-8 mg/dl in men, the cut-off points for uric acid (>6 mg/dl for women and >7 mg/dl for men) were determined in our study. According to this categorization, it was determined that there was no statistically significant relationship between uric acid level (odds ratio 2.985 [95% confidence interval 0.61814,151]) and early mortality risk.Conclusion:The results of this study showed that the uric acid and uric acid/creatinine levels in the attack group were higher than the levels in the stable group, but these parameters were not associated with early mortality.