【摘要】 目的 研究肺癌患者的气道高反应性和肺通气功能情况，并探讨其易感因素，为肺癌患者肺通气功能的临床评估提供依据。 方法 对2010年4月-2011年4月收治的40例肺癌患者（A组）进行术前肺功能检测及气管激发试验，选取同期的健康体检者40例做对照组（B组），并采用logistic逐步回归分析肺癌患者的气道高反应性的易感因素。 结果 ①A组患者的用力肺活量、第1秒用力呼气容积（forced expiratory volume in one second，FEV1）、最高呼气流量（peak expiratory flow，PEF）以及最大呼气中期流量均小于B组，且差异有统计学意义（P=0.000）；②A组的FEV1估计异常人数和PEF估计异常人数均多于B组（Plt;0.05）；③A组组胺气道激发试验阳性者多于B组（χ2=5.000，P=0.025），且A组PD20FEV1低于对照组[分别为（4.69±0.82）、（8.32±1.43）μmol/L；t=13.930，P=0.000]；④logistic逐步回归分析表明影响A组患者的气道高反应性的因素为年龄、分型、TNM分期、病史、吸烟。 结论 肺癌气道反应性增高，且肺功能下降，由于肺癌气道高反应性的易感因素较多，因此需对合并因素较多者进行及时的预防，防止由于气道阻力增加和气道狭窄引起的胸闷、咳嗽、喘息和呼吸困难等症状。【Abstract】 Objective To learn the condition of bronchial hyper-reactivity and pulmonary function in patients with lung cancer, and explore the risk factors for bronchial hyper-reactivity in order to provide clinical reference for pulmonary function evaluation in patients with lung cancer. Methods Forty patients with lung cancer treated in our hospital from April 2010 to April 2011 (research group) took pulmonary function and tracheal stimulation tests before operation, and in the meanwhile, 40 healthy people were chosen as controls. The logistic regression analysis was employed to analyze the risk factors for bronchial hyper-reactivity. Results The forced vital capacity, forced expiratory volume in one second (FEVl), peak expiratory flow (PEF) and maximal mid expiratory flow in the research group patients were all significantly lower than those in the control group patients (P=0.000). The number of patients with estimated FEVl and PEF abnormality in the research group was more than that in the control group (P=0.05). The number of patients positive in histamine bronchial provocation test in the research group was more than that in the control group (χ2=5.000, P=0.025), and the PD20FEV1 level of the research group was lower than that of the control group [(4.69±0.82) and (8.32±1.43) μmol/L; t=13.930, P=0.000]. Logistic regression analysis showed that the risk factors for bronchial hyper-reactivity in patients with lung cancer were age, type, TNM stage, history of lung cancer, and smoking. Conclusions The airway reactivity elevates and the lung cancer pulmonary function decreases in lung cancer patients. Because there are many risk factors, prevention should be taken for patients with combined risk factors to avoid the occurrence of chest distress, cough, gasp and dyspnea caused by increased airway resistance and stricture.
Objective To investigate the tumor suppressor genes of phlegm DNA in smokers, and analyze the correlation between methylation level of tumor suppressor gene promoter and chronic mucus hypersecretion (CMH). Methods The study recruited the patients who were admitted in the respiratory department during 2013-2016 in this hospital, including 700 cases of urban smokers and 380 cases of rural smokers. Eleven genes commonly silenced by promoter methylation in lung cancer and associated with cancer risk were selected. Methylation specific PCR (MSP) was used in the sputum sample of 700 individuals in the urban smokers cohort. Replication was performed in 380 individuals from the rural smokers cohort. Results CMH was significantly associated with an overall increased number of methylated genes, with SULF2 methylation demonstrating the most consistent association. The association between SULF2 methylation and CMH was significantly increased in males but not in females both in the urban and rural groups (OR=2.73, 95%CI 1.53-4.93, P=0.001; OR=2.96, 95%CI 1.47-5.94, P=0.002, respectively). Furthermore, the association between methylation and CMH was more obvious among 139 male former smokers with persistent CMH compared with current smokers (SULF2, OR=3.64, 95%CI 1.57-8.35, P=0.002). Conclusion These findings demonstrate that especially male former smokers with persistent CMH have markedly increased promoter methylation of lung cancer risk genes and potentially could be at increased risk for lung cancer.
目的:探讨电子支气管镜在肺癌诊断中的价值。方法:对233例支气管镜下诊断肺癌的患者进行分析。结果:电子支气管镜下肺癌的诊断率为63.49%,其中中央型肺癌的诊断率为72.85%,周围型肺癌的诊断率为27.63%,该组病例以老年人多见, 肿瘤多位于叶支气管,右肺57.51%, 左肺42.49%,病理类型为鳞癌45.92%, 小细胞癌22.75%, 腺癌24.03%。电子支气管镜下主要特征:鳞癌以管内增殖型改变为主,表现为新生物形成,阻塞管腔,伴有糜烂、充血、水肿,小细胞癌以增殖型和浸润型为主,可见气管内新生物形成及节结样改变。腺癌以管内增殖型和肿块压迫管腔为主,可见管内新生物形成或支气管呈缝隙样狭窄,甚至闭塞。结论:与周围型肺癌相比电子支气管镜检查对中心型肺癌诊断的准确率较高, 其检查方法简单, 创伤性小, 是正确指导临床医生选择合理治疗方法的一种较好的辅助检查技术。
Objective To investigate the current level of resourcefulness and its impact on work engagement among lung cancer patients who have returned to work after video-assisted thoracoscopic surgery (VATS) lung resection. Methods A sample of middle-aged and young lung cancer patients who underwent VATS lung resection at the Department of Thoracic Surgery, West China Hospital of Sichuan University, between March and September 2023 and had returned to work were selected as the study subjects. Data were collected using a general information questionnaire, the Resourcefulness Scale, and the Utrecht Work Engagement Scale (UWES). Univariate analysis and multiple stepwise regression analysis were used to examine the current status of patients’ resourcefulness upon returning to work and its influence on work engagement. Results A total of 219 patients were included in the study, comprising 60 males and 159 females, with a mean age of (43.18±7.55) years. The patients' score for resourcefulness in returning to work was (107.58±14.42) points, and the total score for work engagement was (64.80±12.72) points. A significant positive correlation was observed between the resourcefulness score and the work engagement score (P<0.001). Multiple stepwise regression analysis revealed that factors such as job nature, average monthly household income, postoperative complications, and individuals' level of resourcefulness all significantly influenced the degree of patients' work engagement (all P<0.05).Conclusion The resourcefulness level and work engagement of patients returning to work after VATS lung resection need to be improved.