PTB合并肺癌患者的临床特征及预后影响因素

肺结核(PTB)和肺癌都是影响人类健康的重大疾病。近年来两种疾病并发的情况逐渐增多，两种疾病的相关性也日益受到临床医生的关注。但PTB合并肺癌的早期、准确诊断仍是临床工作一大难题，两者并发的发病机制、预后情况尚缺乏确切的定论。笔者通过文献综述，将单独PTB、单独肺癌以及PTB合并肺癌三种情况的临床特征（发病情况、临床表现、影像特点、病理类型）及预后进行比较，总结PTB合并肺癌相别于单独疾病的临床特征、预后情况，以及预后影响因素，并且对2种疾病并发的发病机制进行综合分析，从而为临床工作中对PTB合并肺癌的诊疗提供指导。综合结论： PTB并发肺癌的发生率为0.2％~2.7％，60岁以上患者发生率相对更高，达10.0％~15.0％，其中大部分均为先有PTB后有肺癌。三组患者PTB年龄最轻，合并组与肺癌无明显差异。三组患者症状均可表现为咳嗽、痰中带血、胸闷、消瘦、乏力，但合并组患者痰血、消瘦的比例明显高于单独疾病组。合并组影像学检查与PTB组比较，肿块和毛刺状结节比例较高，空洞和斑片影比例较低，伴有淋巴结肿大比例较高；合并组与肺癌组比较，肿块、弥散性结节和斑片影比例较低。PTB合并肺癌病理学类型以鳞癌最多见，其次为腺癌。合并组中肺癌分期多为Ⅲ~Ⅳ期，可能与患者出现明显症状才到医院就诊或诊断延误有关。合并组预后情况较单独PTB及肺癌组差，合并组中PTB是否为活动期、肿瘤的病理学类型、TNM分期、结核与肿瘤病灶在肺内的分布情况、吸烟、年龄等均是影响合并组预后的因素。

Clinical features and prognostic factors of PTB patients with lung cancer

Pulmonary tuberculosis (PTB) and lung cancer are major diseases that affect human health. In recent years, the incidence of the two diseases has gradually increased, and the relevance of the two diseases is increasingly concerned by clinicians. However, the early and accurate diagnosis of lung cancer with PTB is still a major problem for clinical work, and the exact pathogenesis and prognosis of the two are still lacking. Through the literature review, the authors compare the clinical features (incidence, clinical manifestations, imaging features, pathological types) and prognosis of the three conditions of PTB alone, lung cancer alone and PTB with lung cancer, and then sums up the PTB patients with lung cancer different from the individual diseases in the clinical features, prognosis, and prognostic factors, and also comprehensively analyze the pathogenesis of the concurrence of the two diseases, so as to provide the guidance for the diagnosis and treatment of lung cancer with PTB.Conclusion: There are data showing that the incidence of PTB complicated with lung cancer is 0.2%-2.7%, and the incidence of patients over 60 years of age is relatively high, up to 10.0%-15.0%, and most of which are PTB being prior to lung cancer. In the age of the patients of the three groups, the age of the PTB group was the lightest, but there was no significant difference between the combined group and lung cancer group. The symptoms of the patients of the three groups could be expressed as cough, sputum blood, chest tightness, weight loss, fatigue, but the proportion of the patients with blood stasis and weight loss in the combined group was significantly higher than that of the patients in the single disease group. Compared with the PTB group, the combined group had a higher proportion of masses and burr-like nodules, a lower proportion of cavities and patches, and a high proportion of lymph nodes; compared with the lung cancer group, the combined group had lower proportions of masses,diffuses nodules and patches. The pathological type of lung cancer with PTB was most common in squamous cell carcinoma, followed by glandular cancer. The staging of lung cancer in the combined group was mostly III-IV, which may be related to the patient's apparent symptoms before going to the hospital or delaying the diagnosis. The prognosis of the combined group was worse than that of the PTB alone and the lung cancer group. In the combined group,the prognostic factors include whether PTB was active, the pathological type of tumor, the TNM stage, the distribution of tuberculosis and tumor in the lung, smoking, age, etc.