临床肺科杂志
臨床肺科雜誌
림상폐과잡지
JOUNAL OF CLINICAL PULMONARY MEDICINE
2015年
4期
606-609
,共4页
间质性肺病%肺癌
間質性肺病%肺癌
간질성폐병%폐암
interstitial lung disease%lung cancer
目的：探讨间质性肺疾病合并肺癌的临床特点和治疗方法,提高对疾病的诊治水平。方法回顾性分析21例间质性肺病合并肺癌患者的一般资料、临床表现、实验室和特殊检查以及治疗方法。结果21例患者中男性17例,女性4例,年龄51~88岁,中位年龄65岁,15例有吸烟史。临床表现主要为咳嗽、咳痰、活动后气急。胸部CT主要表现为两肺纤维条索及网格影、蜂窝肺样改变合并结节、团块影。病理类型为腺癌47．6%,鳞癌23．8%,小细胞癌28．6%。3例以ILD起病的患者在发现肺癌前,100% NSE升高,66．7%CYFRA21-1升高,33．3% CEA 升高。在同时发现 ILD 和肺癌的18例患者中,50% NSE 升高,55．6% CY-FRA21-1升高,66．1% CEA升高,16．7% SCC升高。15例接受含铂双药联合化疗,3例接受手术治疗,3例接受最佳支持治疗。5例在治疗过程中出现肺部感染。结论间质性肺疾病合并肺癌临床处置困难,对于以ILD起病的患者,在随访过程中应密切随访血清肿瘤标记物及胸部CT,使ILD-LC得以早期诊断和治疗。治疗过程中易并发肺部感染及间质性肺疾病急性加重。治疗时应对治疗的风险和获益进行充分的评估,并且给予严密的监测。
目的：探討間質性肺疾病閤併肺癌的臨床特點和治療方法,提高對疾病的診治水平。方法迴顧性分析21例間質性肺病閤併肺癌患者的一般資料、臨床錶現、實驗室和特殊檢查以及治療方法。結果21例患者中男性17例,女性4例,年齡51~88歲,中位年齡65歲,15例有吸煙史。臨床錶現主要為咳嗽、咳痰、活動後氣急。胸部CT主要錶現為兩肺纖維條索及網格影、蜂窩肺樣改變閤併結節、糰塊影。病理類型為腺癌47．6%,鱗癌23．8%,小細胞癌28．6%。3例以ILD起病的患者在髮現肺癌前,100% NSE升高,66．7%CYFRA21-1升高,33．3% CEA 升高。在同時髮現 ILD 和肺癌的18例患者中,50% NSE 升高,55．6% CY-FRA21-1升高,66．1% CEA升高,16．7% SCC升高。15例接受含鉑雙藥聯閤化療,3例接受手術治療,3例接受最佳支持治療。5例在治療過程中齣現肺部感染。結論間質性肺疾病閤併肺癌臨床處置睏難,對于以ILD起病的患者,在隨訪過程中應密切隨訪血清腫瘤標記物及胸部CT,使ILD-LC得以早期診斷和治療。治療過程中易併髮肺部感染及間質性肺疾病急性加重。治療時應對治療的風險和穫益進行充分的評估,併且給予嚴密的鑑測。
목적：탐토간질성폐질병합병폐암적림상특점화치료방법,제고대질병적진치수평。방법회고성분석21례간질성폐병합병폐암환자적일반자료、림상표현、실험실화특수검사이급치료방법。결과21례환자중남성17례,녀성4례,년령51~88세,중위년령65세,15례유흡연사。림상표현주요위해수、해담、활동후기급。흉부CT주요표현위량폐섬유조색급망격영、봉와폐양개변합병결절、단괴영。병리류형위선암47．6%,린암23．8%,소세포암28．6%。3례이ILD기병적환자재발현폐암전,100% NSE승고,66．7%CYFRA21-1승고,33．3% CEA 승고。재동시발현 ILD 화폐암적18례환자중,50% NSE 승고,55．6% CY-FRA21-1승고,66．1% CEA승고,16．7% SCC승고。15례접수함박쌍약연합화료,3례접수수술치료,3례접수최가지지치료。5례재치료과정중출현폐부감염。결론간질성폐질병합병폐암림상처치곤난,대우이ILD기병적환자,재수방과정중응밀절수방혈청종류표기물급흉부CT,사ILD-LC득이조기진단화치료。치료과정중역병발폐부감염급간질성폐질병급성가중。치료시응대치료적풍험화획익진행충분적평고,병차급여엄밀적감측。
Objective To investigate the clinical characteristics and treatments of interstitial lung disease as-sociated with lung cancer ( ILD-LC) , and to improve the treatment of the disease. Methods Their clinical charac-teristics, manifestations, laboratory and imaging examinations and treatments of 21 patients with ILD-LC were retro-spectively analyzed. Results 17 out of 21 patients were male, and 4 were female. The age of the patients ranged from 51 to 88 years old, and the median age was 65 years old. 15 of them had a history of smoking. The clinical manifestations mainly included cough, expectoration and dyspnea after exertion. Computed tomography of chest mainly showed stripe and reticular shadow, honeycombing shadow in both lungs with nodule or mass in single lung. The histology types of lung cancer included adenocarcinoma (47. 6%), squamous cell carcinoma (23. 8%) and small cell carcinoma (28. 6%). 3 cases were diagnosed as ILD at first and then lung cancer after follow-up. The level of NSE, CYFRA21-1 and CEA in serum was increased to 100%, 66. 7% and 33. 3% respectively. 18 cases were diagnosed as ILD and lung cancer at the same time. The level of NSE, CYFRA21-1, CEA and SCC in serum was increased to 50%, 55. 6%, 66. 1% and 16. 7% respectively. 15 patients were treated with platinum doublet chemotherapy, 3 patients underwent surgery and 3 patients received best supportive care. Pneumonia occurred in 5 patients during the treatments. Conclusion To make ILD-LC early diagnosis, ILD patients should be followed-up closely. Serum biomarker and chest CT scan may be necessary to be done regularly as a screening method. Pneumonia and acute exacerbation of ILD may easily occur during the treatments. The risks and the benefits of the treatments should be sufficiently assessed.
