| 韩书阁,郭云岭,冯晓英.高危职业暴露与肺癌临床特征的相关性分析[J].中国肿瘤,2018,27(10):807-812. |
| 高危职业暴露与肺癌临床特征的相关性分析 |
| Association Between High-risk Occupational Exposure and Clinical Characteristics of Lung Cancer |
| 投稿时间：2018-03-23 |
| DOI：10.11735/j.issn.1004-0242.2018.10.A012 |
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| 中文关键词: 肺肿瘤 职业暴露 |
| 英文关键词:lung neoplasms occupational exposure |
| 基金项目: |
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| 摘要点击次数: 1684 |
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| 中文摘要: |
| 摘 要：［目的］ 探讨高危职业暴露与肺癌临床特征的相关性。［方法］ 收集352例肺癌患者的临床资料，根据患者是否正在从事或曾经从事过煤焦油、石矿等相关职业10年以上，将患者分为职业暴露组（72例）和非职业暴露组（280例）。分析职业暴露对肺癌相关临床特征因素的影响。［结果］ 暴露组患者的病理类型以鳞状细胞癌为主，共30例（41.7%），非暴露组以腺癌为主，共122例（43.5%），差异具有统计学意义（P＜0.05）。暴露组（Ⅰ＋Ⅱ期）与非暴露组（Ⅰ＋Ⅱ期）的首发症状类型、肺外病变、伴随疾病类型均无明显差异（P＞0.05）。暴露组共10例患者（13.9%）出现肺外病变，包括肥大性肺性骨关节病4例，血液改变3例，肌无力2例，皮肌炎1例。非暴露组共18例患者（6.4%）出现肺外病变，包括肥大性肺性骨关节病6例，异位内分泌综合征5例，肌无力3例，血液改变、皮肌炎各2例。与非暴露组（Ⅲ＋Ⅳ期）患者相比，暴露组（Ⅲ＋Ⅳ期）患者的首发症状、伴随疾病类型明显不同，差异具有统计学意义（P＜0.05）。暴露组患者以发热、淋巴结肿大等为首发症状的比例较高，伴随疾病以呼吸系统疾病为主；非暴露组患者首发症状以呼吸系统症状最常见，伴随疾病以心血管疾病为主。暴露组患者的影像学表现以外周型为主，主要表现为阻塞性肺气肿、肺不张等；非暴露组患者影像学类型则较为分散多样。分层处理后发现，暴露组（Ⅰ＋Ⅱ期）与非暴露组（Ⅰ＋Ⅱ期）、暴露组（Ⅲ＋Ⅳ期）与非暴露组（Ⅲ＋Ⅳ期）的影像学类型构成相似，差异无统计学意义（P＞0.05）。［结论］ 高危职业暴露对肺癌患者的临床特征有一定的影响。此类患者更易出现肺外病变、伴发呼吸系统疾患，确诊时往往临床分期更晚，治疗更为困难。 |
| 英文摘要: |
| Abstract：［Purpose］ To explore the association between high-risk occupational exposure and clinical characteristics of lung cancer. ［Methods］ The clinical data of 352 patients with lung cancer were reviewed，among whom 72 cases had history of occupational exposure to coal tar and stone ore for more than 10 years(exposure group) and the remaining 280 cases had no exposure history(non-exposure group) . The effect of occupational factors on the clinical characteristics of lung cancer was analyzed. ［Results］ There was mainly squamous cell carcinoma(41.7%，30/72) in the exposure group，and adenocarcinoma(43.5%，122/280) in non-exposure group(P<0.05). There were no significant differences in initial symptoms，extrapulmonary lesions and the type of comorbidities between the exposure group(Ⅰ+Ⅱ) patients and the non exposed group patients(Ⅰ+Ⅱ)(P>0.05). In the exposure group，10 patients(13.9%) had extrapulmonary lesions，including 4 cases of hypertrophic pulmonary osteoarthropathy，3 cases of hematological changes，2 cases of myasthenia and 1 cases of dermatomyositis. In non-exposed group，18 patients(6.4%) had extrapulmonary lesions，including 6 cases of hypertrophic pulmonary osteoarthropathy，5 cases of ectopic endocrine syndrome，2 cases of dermatomyositis，3 cases of hematological changes and 3 cases of myasthenia. Compared with the non-exposed group(Ⅲ+Ⅳ) patients，the initial symptoms and the types of comorbidities in the exposed group were significantly different(P<0.05). The incidence of fever，lymph node enlargement and the complicated respiratory diseases was higher in the exposed group；while the incidence of respiratory symptoms and complicated cardiovascular disease was higher in non-exposure group. The imaging manifestations of patients in the exposure group were mainly peripheral type，including obstructive emphysema and atelectasis；while the imaging types of the non exposed group were more scattered and diverse. But there were no significant differences in imaging manifestations between exposure group(Ⅰ+Ⅱ) and non-exposure group(Ⅰ+Ⅱ)，between exposure group(stage Ⅲ+Ⅳ) and non-exposure group(Ⅲ+Ⅳ)(P>0.05). ［Conclusion］ High risk occupational exposure has certain influence on the clinical characteristics of lung cancer patients. Such patients are more prone to extrapulmonary lesions，accompanied by respiratory diseases. |
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