The Clinical Feature Of Pulmonary Malignant Tumor Comorbid With Pulmonary Fungal Disease

Background and purposePrimary lung cancer ranks among the top malignant tumors in the incidence and mortality rate in China and it is still showing a significant upward trend.With the aging of the population and the increase of immunosuppressed populations,the incidence of pulmonary mycosis is also increasing.Among them,in the process of diagnosis and treatment of invasive pulmonary fungal disease,there are characteristics of difficult diagnosis,long course of treatment,many adverse reactions,high cost,high disability rate and high mortality rate,which makes patients face great challenges in terms of economy and quality of life.This is especially true when lung malignancy is accompanied by pulmonary mycosis.Therefore,this study explored the risk factors of pulmonary malignant tumors complicated with pulmonary mycosis at the first Affiliated Hospital of Zhengzhou University,in order to make a suggestion for the diagnosis of pulmonary malignant tumors complicated with pulmonary mycosis.MethodsCheck the Jiahe electronic medical record system and other methods to find all patients with lung malignant tumors from January 2015 to August 2022 in the First Affiliated Hospital of Zhengzhou University,and screen out 65 patients who were initially diagnosed with lung malignancies and pulmonary mycosis as the research group,and through the random number method,the seeds were set to 2000000,and 65 patients with simple lung malignancies were randomly matched as the control group.The complete clinical medical records of the enrolled patients were collected by consulting Realone system and Jiahe electronic medical record system,and the statistical data were analyzed by SPSS 25.0 statistical software.If the normal distribution and variance uniformity are met,two independent samples of t-test are used to represent the mean ± standard deviation(X±S),and the between-group mean comparison is carried out by the t-test;The data for the nonnormal distribution are represented by the median M(P25,P75)(quartile spacing).The counting data is expressed in cases or percentages,and the correlation analysis or comparison between two groups is performed using a χ2 test and,if necessary,a corrected χ2 test or the Fisher exact probability method.The difference between P<0.05 was statistically significant.The exposure factors with statistically different exposure factors were analyzed by binary Logistic regression,and meaningful variables were screened out,and P>0.10 was used as the inclusion criterion and P<0.15 as the exclusion criterion,and the binary Logistic regression method was incorporated for multi-factor analysis,and the stepwise method was used to automatically screen the variables.The inspection level is α=0.05.Results1.There were 65 patients with pulmonary malignant tumor complicated with pulmonary fungal disease,with an average age of 63(56-67)years old,including 53 male patients(82%),12 female patients(18%),42 patients(65%)with smoking history,9 patients(13.9%)with fever symptoms,and 53 patients(82%)with cough symptoms.42 cases(65%)had expectoration,12 cases(18.5%)had chest pain,20 cases(38.5%)had hemoptysis,33 cases(50.8%)had chest tightness,and 23 cases(35.4%)had underlying diseases;Only 1 case(1/46)was positive in G test and all were negative in GM test;The imaging classification showed central type in 52 cases(80%)and peripheral type in 13 cases(20%);Among the infected fungi,34 cases(52.3%)were Aspergillus,2 cases(3%)were Cryptococcus,1 case(1.5%)was Mucor,and 28 cases(43.5%)were untyped fungi;There were 30 cases of squamous cell carcinoma(46%),8 cases of adenocarcinoma(12%),22 cases of small cell carcinoma(34%)and 5 cases of others(8%).2.The proportion of male,smoking history,fever,cough,expectoration,hemoptysis,and chest tightness in the lung malignant tumor group was higher than that in the lung malignant tumor group(P<0.05);There was no significant difference in the underlying diseases and chest pain between the lung malignant tumor patients with pulmonary mycosis and the lung malignant tumor group(P>0.05).3.The absolute value of mononuclear macrophages in peripheral blood of pulmonary malignant tumor combined with pulmonary fungal disease group was higher than that of pulmonary malignant tumor group(P<0.05);The proportion of PCT positive expression in patients with pulmonary malignant tumors complicated with pulmonary mycosis was lower than that in patients with pulmonary malignant tumors(P<0.05);There was no significant difference in white blood cell,hemoglobin,neutrophil,lymphocyte,CRP,NLR and white sphere ratio between lung malignant tumor combined with pulmonary fungal disease group and lung malignant tumor group(P>0.05).4.The proportion of imaging classification as central type in lung malignant tumor complicated with pulmonary mycosis group was higher than that in lung malignant tumor group(P<0.05);There was no statistical significance in the distribution of cumulative lesions in the lung lobe between the pulmonary malignant tumor combined with pulmonary fungal disease group and the pulmonary malignant tumor group(P>0.05).5.The proportion of patients with TNM stage Ⅰ～Ⅱ in the pulmonary malignant tumor group was higher than that in the pulmonary malignant tumor group(P<0.05);There was no statistically significant difference in the occurrence of distant metastasis between the pulmonary malignant tumor combined with pulmonary fungal disease group and the pulmonary malignant tumor group(P>0.05).6.Cough symptoms are significantly correlated with pulmonary mycosis in newly diagnosed patients with pulmonary malignant tumor(P=0.003,OR=4.558,95%CI(1.685-12.330));Previous smoking history and central imaging type are independent risk factors for pulmonary malignant tumor complicated with pulmonary mycosis(P=0.033,OR=2.684,95%CI(1.082-6.660);P<0.001,OR=7.572,95%CI(2.763-20.750));TNM stage Ⅲ～Ⅳ is a protective factor for pulmonary malignant tumor complicated with pulmonary mycosis(P<0.001,OR=0.1119,5%CI(0.033-0.377)).Conclusions1.Patients with pulmonary malignant tumor who had smoking history,whose imaging type was central and whose TNM stage was Ⅰ～Ⅱ,had a higher risk of pulmonary mycosis at the time of initial diagnosis.2.Cough symptoms are significantly correlated with pulmonary mycosis in patients with pulmonary malignant tumor at the initial diagnosis.3.For patients with lung malignant tumor diagnosed for the first time,late TNM staging does not increase the risk of pulmonary mycosis.