文章摘要
苗嫚丽,范晓云,丁佩山,王瑞,姜雪勤.孤立性肺结节中Ⅰ期非小细胞肺癌的危险因素分析及其病理不同进展程度的临床特征对比[J].中国临床保健杂志,2019,22(6):753-758.
孤立性肺结节中Ⅰ期非小细胞肺癌的危险因素分析及其病理不同进展程度的临床特征对比
Analysis of risk factors for stage Ⅰ non-small cell lung cancer in solitary pulmonary nodules and comparison of clinical features of pathological progress in different levels
投稿时间:2019-06-19  
DOI:10.3969/J.issn.1672-6790.2019.06.009
中文关键词: 癌,非小细胞肺  孤立性肺结节  危险因素  病理状态,体征和症状
英文关键词: Carcinoma,non-small-cell lung  Solitary pulmonary nodule  Risk factors  Pathological conditions,signs and symptoms 〖FL
基金项目:2016年高校学科(专业)拔尖人才学术资助重点项目(gxbjZD2016036)
作者单位E-mail
苗嫚丽 安徽医科大学第一附属医院老年呼吸与危重症学科,合肥 230022 13956988552@126.com 
范晓云 安徽医科大学第一附属医院老年呼吸与危重症学科,合肥 230022 13956988552@126.com 
丁佩山 安徽医科大学第一附属医院老年呼吸与危重症学科,合肥 230022 13956988552@126.com 
王瑞 安徽医科大学第一附属医院老年呼吸与危重症学科,合肥 230022 13956988552@126.com 
姜雪勤 安徽医科大学第一附属医院老年呼吸与危重症学科,合肥 230022 13956988552@126.com 
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中文摘要:
      目的 分析孤立性肺结节中Ⅰ期非小细胞肺癌的危险因素和病理不同进展程度的临床及影像学特征。方法 回顾性分析行外科手术治疗具有明确病理结果的孤立性肺结节共240例,对各指标进行单因素分析,将具有统计学意义的相关指标进行logistic多因素回归分析得出Ⅰ期非小细胞肺癌的独立危险因素;按病理进展程度分为:良性结节组、原位癌组及浸润性肺癌组,进行组间对比。结果 单因素分析结果:年龄、发热症状、吸烟指数≥400、结节位置及边缘、毛刺征、分叶征、胸膜凹陷征、支气管充气征、血管集束征、钙化征,以上指标在SPN良性组与Ⅰ期非小细胞肺癌组间差异有统计学意义(P<0.05);经logistic多因素回归:年龄、发热、吸烟指数≥400、边缘、血管集束征、钙化征是Ⅰ期非小细胞肺癌的独立危险因素(P<0.05);病理不同进展程度组间比较结果见:年龄、吸烟指数≥400、支气管充气征在良性组与浸润性肺癌组差异有统计学意义(P<0.0167),性别在原位癌组与浸润性腺癌组差异有统计学意义(P<0.0167),发热、血管集束征在良性组与原位癌组及良性组与浸润性肺癌组差异有统计学意义(P<0.0167),结节直径、边缘、分叶征、毛刺征及胸膜凹陷征在良性组与浸润性肺癌组及原位癌组与浸润性肺癌组差异有统计学意义(P<0.0167),钙化征在良性组与原位癌组差异有统计学意义(P<0.0167)。结论 高龄、吸烟指数≥400、边缘不清、血管集束征是判断孤立性肺结节中Ⅰ期非小细胞肺癌的独立危险因素;而CT影像学提示有钙化征象则倾向于良性结节。经组间进一步比较,高龄、吸烟指数≥400及支气管充气征、血管集束多提示为恶性结节,而对于男性患者结节直径较大伴有毛刺征、分叶征或胸膜凹陷征的恶性结节多倾向于浸润性肺癌。
英文摘要:
      Objective To analyze the risk factors and explore the clinical and imaging findings of different pathological progress levels of stage Ⅰ non-small cell lung cancer in solitary pulmonary nodules.Methods A retrospective analysis of 240 cases of solitary pulmonary nodules with clear pathological results was performed.Uni-variate analysis was performed on each index.Logistic multivariate regression analysis was performed on statistically significant indicators to obtain independent risk factors for stage Ⅰ non-small cell lung cancer.Those solitary pulmonary nodules were divided into benign nodule group,carcinoma in situ group and invasive lung cancer group according to pathological progress levels,and were compared between groups.Results Uni-variate analysis results showed that there were statistical differences in patients’age,fever,smoking index ≥400,localization,obscure boundary,spiculation,pleural indentation,vascular convergence sign,air bronchogram and calcification sign between benign nodules and stage Ⅰ non-small cell lung cancer(P<0.05).Logistic multivariate regression analysis showed that patients’age,fever and smoking index ≥400,obscure boundary,vascular bundle sign,calcification were the risk factors of stage Ⅰ non-small cell lung cancer(P<0.05).The comparison between different progress levels of pathological groups:There were significant difference in age,smoking index ≥400 and air bronchogram between the benign group and the invasive lung cancer group(P<0.0167).The gender was significantly different between the carcinoma in situ group and the invasive lung cancer group (P<0.0167).The fever and vascular bundle sign were significantly different between the benign group and the invasive lung cancer group and between the benign group and the invasive lung cancer group (P<0.0167).The nodule diameter,obscure boundary,lobulated sign,spiculation and pleural indentation were statistically significant between the benign group and the invasive lung cancer group and between the carcinoma in situ group and the invasive lung cancer group (P<0.0167).The calcification sign was significantly different between the benign group and the invasive lung cancer group (P<0.0167).Conclusion The age,smoking index ≥400,obscure boundary and vascular bundle sign are independent risk factors for the diagnosis of stage I non-small cell lung cancer in solitary pulmonary nodules,but CT imaging suggests calcification signs tend to be benign nodules.After further comparison between groups showed that the advanced age,smoking index ≥400 and unclear margin,air bronchogram,vascular convergence sign prompt of the patients indicate that the patients are pathologically malignant nodules,while larger nodule diameter malignant nodules with spiculation,lobulation,or pleural indentation in males are more prone to invasive lung cancer.
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