Clinical Characteristics Of Patients With Chronic Obstructive Pulmonary Disease Complicated With Lung Cancer And The Relationship Between Helper T Cell Level And Disease Occurrence

BackgroundChronic obstructive pulmonary disease(COPD)is a chronic respiratory disease with high incidence in the elderly.Epidemiological studies show that COPD ranks fifth in the global economic burden of chronic diseases and third in the mortality rate.Lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world,accounting for the first mortality rate of male malignant tumors and the second mortality rate of female malignant tumors.Among smoking-related diseases,COPD is recognized as the disease with the highest incidence,and lung cancer is the disease with the highest mortality.The incidence of lung cancer in COPD patients is about five times higher than that in normal people.50%～60% of lung cancer patients are complicated with COPD.Lung cancer is one of the main complications and causes of death in COPD patients.ObjectiveTo investigate the relationship between the clinical characteristics of patients with chronic obstructive pulmonary disease(COPD)complicated with lung cancer and the location of lung cancer and emphysema.On the other hand,to explore the relationship between serum helper T cell 17(Th17)related factors and COPD with non-small cell lung cancer.MethodsThe first part: Collect the clinical data of 209 COPD patients with lung cancer,evaluate the degree of emphysema according to the results of chest CT examination,compare the relationship between different phenotypes of COPD patients and the clinical characteristics of lung cancer,and further divide emphysematous COPD patients with lung cancer into two groups: near emphysema group and far emphysema group.The relationship between position and severity of emphysema.The second part: 436 patients with non-small cell lung cancer diagnosed for the first time in the Xinxiang Medical College from January 2016 to June 2018 were selected,including 140 patients with COPD combined with non-small cell lung cancer and 296 patients with simple non-small cell lung cancer.Another 296 healthy persons of the same age in the same period were collected as healthy control group.Fasting peripheral venous blood was collected for 5 ml in the morning.The levels of IL-17 A,IL-17 F,IL-21,IL-22 and TNF-alpha were detected by liquid chip technique.ResultsPart I: There were significant differences in sex,age,BMI value,smoking status,smoking index and pulmonary function between patients with airway obstruction and emphysema(P<0.05).The male proportion,age,smoking rate and smoking index of patients with emphysema were significantly higher than those of patients with airway obstruction,and BMI value was significantly lower than that of patients with airway obstruction(P<0.05).There were significant differences in anatomical and histopathological types between the group near emphysema and the group far from emphysema(P<0.05),and the proportion of central type and squamous cell carcinoma in the group near emphysema was significantly lower than that in the group far from emphysema(P<0.05).There was no significant difference in the degree of emphysema between central type and peripheral type in patients with emphysematous COPD and lung cancer(P>0.05).There was significant difference in the degree of emphysema between different lesions in patients with emphysematous COPD and lung cancer(P<0.01).The severity of emphysema in patients with emphysematous COPD near to emphysema was significantly higher than those far away from emphysema.There was no significant difference between the central and peripheral pulmonary function classifications of emphysematous COPD patients with lung cancer(P>0.05).There was a significant difference in pulmonary function classification between emphysematous COPD patients and lung cancer patients whose lesions were near emphysema and far from emphysema(P<0.01).The proportion of severe pulmonary function near emphysema was significantly higher than that far away from emphysema.Part II: The levels of IL-17 A,IL-17 F,IL-21,IL-22 and TNF-alpha in serum of COPD patients with non-small cell lung cancer and non-small cell lung cancer patients with simple non-small cell lung cancer were significantly higher than those of healthy controls(P<0.05).There was no significant difference in the levels of A,IL-17 F,IL-21,IL-22 and TNF-alpha between COPD with NSCLC and NSCLC alone(P>0.05).Spearman correlation analysis showed that the levels of IL-17 A,IL-17 F,IL-21,IL-22 and TNF-alpha were correlated between the two(P<0.05).The levels of IL-17 A,IL-17 F,IL-21,IL-22 and TNF-alpha in serum of COPD patients with non-small cell lung cancer and non-small cell lung cancer patients with simple non-small cell lung cancer were significantly higher than those of healthy controls(P<0.05),and the levels of IL-17 A,IL-17 F,IL-21,IL-22 and TNF-alpha in serum of COPD patients with non-small cell lung cancer and non-small cell lung cancer patients with simple non-small cell lung cancer were significantly higher than those of healthy controls(P<0.05).-There was no significant difference in the levels of 21,IL-22 and TNF-alpha between COPD with NSCLC and NSCLC alone(P>0.05),but the levels of IL-22 and TNF-alpha in COPD with NSCLC were higher than those in NSCLC alone.Increased serum levels of IL-17 A,IL-17 F,IL-21,IL-22 and TNF-alpha significantly increased the risk of non-small cell lung cancer in smokers(P<0.05).After adjusting for gender,age and smoking status,elevated levels of IL-17 A,IL-17 F,IL-21,IL-22 and TNF-alpha significantly increased the incidence of non-small cell lung cancer in COPD patients with non-small cell lung cancer and non-small cell lung cancer patients alone(P<0.05).There was significant difference in risk(P<0.05).Conclusion1.The main clinical features of COPD patients with lung cancer are male,central squamous cell carcinoma and TNM stage III b～IV.2.COPD patients with lung cancer mainly located away from emphysema,but with the increase of the severity of emphysema,the proportion of patients near emphysema gradually increased,mainly peripheral adenocarcinoma.3.The serum levels of Th17 cell-related factors in patients with COPD combined with non-small cell lung cancer(NSCLC)and patients with NSCLC alone were significantly higher than those in healthy control group,suggesting that whether or not COPD was involved,Th17 cell-related inflammatory reaction was closely related to NSCLC.4.Serum levels of Th17 cytokines are independent risk factors for lung cancer.