特发性肺间质纤维化合并肺癌25例临床分析

目的探讨特发性肺间质纤维化合并肺癌的临床特征。方法对我科2008—01～2013—03诊断的特发性肺间质纤维化合并肺癌患者25例的临床表现、胸部CT、病理等临床资料进行回顾性分析，总结其特征。结果25例患者中男23例，女2例，平均（65．6±5．2）岁。24例吸烟患者平均吸烟40．5包／年。25例患者均表现为非特异性呼吸道症状及肺部Vel—ero哕音和杵状指（趾）。胸部CT表现为在双肺网格、蜂窝样基础上出现肺部团块、结节影（22／25），及肺纤维化基础上出现斑片状阴影（3／25）。病理上多为腺癌及鳞癌。肺功能及血气分析为限制性通气功能障碍、弥散功能减低及低氧血症。部分患者肿瘤标志增高。结论老年男性患者，有长期吸烟史，在原有肺间质纤维化基础上出现新症状或原有症状加重，肺部出现团块、结节影或斑片阴影，要高度警惕特发性肺间质纤维化合并肺癌的可能，积极行痰病理、经皮肺活检检查，明确诊断。

Clinic analysis of 25 cases of idiopathic pulmonary fibrosis associated with lung cancer

Objective To explore the clinical features of idiopathic pulmonary fibrosis（IPF） associated with lung cancer. Methods Clinical manifestation, chest CT, pathological data, blood gas analysis, pulmonary function and tumor marker of 25 cases （ 23 male and 2 female） of IPF associated with lung cancer form January 2008 to March 2013 in our hospital were retrospectively analyzed. Results The mean age was （65.6 ＋ 5.2） years. Twenty-four cases had history of smoking with an average of 40.5 packs/years. All the cases showed nonspecific respiratory symptoms, lung Velcro rale and clubbing finger（toe）. The chest CT showed lung mass, nodules （22/25） and patchy shadows （3/25） on the basis of honeycomb and grid shadows. The pathological types were generally adenocareinoma and squamous cell carcinoma. Pulmonary function and blood gas analysis showed the restrictive ventilation dysfunction, impaired diffusion function and hypoxemia. Tumor markers of 15 cases increased. Conclusion In aged male IPF patients with a long history of smoking, the appearance of new symptoms or original symptom aggravation and chest CT showing lung mass, nodules or patches shadows on the basis of honeycomb and grid shadows should be guarded against probably idiopathic pulmonary interstitial fibrosis associated with lung cancer. The patients should positively perform sputum pathology test and percutaneous lung biopsy to make a definite diagnosis.