| Background:Among the ten major causes of death in China's urban population,respiratory diseases(mainly COPD)accounted for 13.89%,ranking the first in the country,accounting for 22.04%,ranking first in the country.The number of deaths due to COPD is about one million.At the same time,lung cancer is a serious hazard to human health,in our country,the incidence and mortality of lung cancer has been ranked first in all malignant tumors.It is estimated that the number of new cases of lung cancer is 536407,the annual number of death cases by lung cancer is475768 [1].Young[2] et al suggested that some common factors,such as environmental,genetic and immunological abnormalities could influence the occurrence and development of COPD and lung cancer.In addition,Steven Bozinovski et al pointed out that the oxidative and inflammatory responses induced by COPD may lead to lung cancer through destroying the stability of the genome,inhibiting tumor immune surveillance and promoting tumor growth and migration.At present,the underlying pathogenesis of COPD and lung cancer is not clear,but a large number of epidemiological studies have shown that COPD is an independent risk factor of lung cancer.The prevalence of lung cancer in the COPD group was 2-5 times higher than that in normal population.With the gradual increase in air pollution,long-term exposure to air in the PM2.5 makes the probability of suffering from respiratory diseases still increase.It isnoteworthy that PM2.5 is rich in high concentration in tobacco smoke.Our National Natural Science Fund Project Group(81472169,81071919)members have confirmed that exposure to high concentrations of cigarette smoke PM2.5 can directly induce carcinogenesis of bronchial epithelial cells,and the application of microfluidic technology demonstrated that epidermal growth factor receptor(Epidermal growth factor receptor,EGFR),signal transducer and activator of transcription factor 3(Signal transducer and activator of transcription 3,STAT3)have played an important role in lung cancer induced by COPD.This provide a theoretical basis and technical support for the transformation of a good future in-depth study of COPD to lung cancer.Objective:Investigate the clinical features of chronic obstructive pulmonary disease(COPD)complicated with lung cancer and the incidence of lung cancer in COPD patients.Provide evidence for early detection and diagnosis of lung cancer.Method:Retrospect an analysis of 208 patients with AECOPD and 32 patients complicted with lung cancer who had been admitted to our hospital from January 1st in 2014 to September 1st in 2016 using the random number table method.Record each of the two groups,general information,history of smoking,smoking index,clinical symptoms and signs,laboratory results,pulmonary function test results,pathological type of lung cancer,lung cancer stages,tumor markers and then analyse the results using SPSS16.0 statistical software.Results:Age and gender:there were 32 patients complicted with lung cancer including 16 males,16 females(age 49 ~ 80 years old,mean age64.44±7.582 years old)and 208 patients with AECOPD including 110 males,98 females(age 42 ~ 85 years old,mean age 62.83±7.628 years old).The age and gender of the patients between the two groups had no significant difference(P>0.05)and the patients of the two groups were both aged.2.Smoking history and smoking index:the smoking index(mean748.209 branches of years)of COPD combined with lung cancer group was significantly higher than that of COPD group(mean 376.015 branches of years)(P<0.05).3.Lung function :COPD with lung cancer group compared with the group of AECOPD in pulmonary function,the former FEV1/FVC(%)(mean59.01±9.85)is higher than that of the latter(mean 55.78±11.85)and the difference was statistically significant(P<0.05).The FVC(L)(mean 1.93±0.45)of the former was lower than that of the latter(mean 2.47±0.83),and the difference was statistically significant(P<0.05).4.Clinical symptoms and signs: the datum of comparison of clinical symptoms and signs in patients with COPD combined with lung cancer and AECOPD showed that patients with sputum bloody dyspnea,chest pain,atelectasis and pleural effusion of the former were significantly higher than the latter and the difference was statistically significant(P<0.05).5.Laboratory tests(tumor markers)results:the differences of CEA,NSE,total prostate specific antigen and keratin 19 fragment between different types of lung cancer were statistically significant(P<0.05).The difference among other tumor markers in various types of lung cancer was not statistically significant.6.Pathological types and stages:among the patients with COPD combined with lung cancer,the patients in stage I accounted for 6.3%,thepatients in stage ? accounted for 21.9%,the patients in stage ?accounted for 40.6%,and the patients in stage IV accounted for31.3%.Central lung cancer accounted for 53.1% and peripheral lung cancer accounted for 46.9%.Squamous cell carcinoma accounted for25%.Adenocarcinoma accounted for 46.9% and small cell lung cancer accounted for 28.1%.There were 7 males and 1 females in squamous cell carcinoma,4 males and 11 females in adenocarcinoma and 5 males and 4females in small cell carcinoma.Among the squamous cell carcinoma patients,male patients accounted for 43.8%,significantly higher than those of the female.Among the patients with adenocarcinoma,73.3% of females were significantly higher than those of males,and the difference was statistically significant(P<0.05).The difference was not statistically significant in the comparison of gender in small cell lung cancer patients(P>0.05).7.The prevalence of lung cancer in chronic obstructive pulmonary disease:compare the patients meeting the inclusion criteria with the same period of chronic obstructive pulmonary disease complicated with lung cancer and it can be obtained that in patients with COPD the prevalence rate of lung cancers was 11.4‰.According to the experimental data,the prevalence of lung cancer in COPD patients was 2.85 times higher than that of the normal population which suggests that people with COPD are more likely to have lung cancer.Conclusions:1.The prevalence rate of lung cancer in the COPD group was 11.4per thousand,which was about 2.85 times higher than that in the normal population.2.When COPD patients showing chest pain,sputum with blood,atelectasis,pleural effusion and other clinical manifestations it should behighly alert to the presence of lung cancer.3.Tumor markers CEA,NSE,keratin 19 fragments is of great diagnostic value in adenocarcinoma,small cell carcinoma and squamous cell carcinoma.4.Statistics showed that COPD patients with lung cancer were mostly central type with the stage mainly from ? to IV.The main pathological type is adenocarcinoma,followed by small cell carcinoma and squamous cell carcinoma.At the same time,squamous cell carcinoma was more common in male,and adenocarcinoma was more common in female. |
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