慢性阻塞性肺疾病與肺癌慢性阻塞性肺疾病與肺癌1慢性阻塞性肺疾病(COPD)定義·cOPD是一種可防可治的常見(jiàn)疾病,其特征為持續(xù)存在的氣流受限。氣流受限呈進(jìn)行性發(fā)展,伴氣道和肺對(duì)有害顆粒或氣體所致慢性炎癥反應(yīng)增加。急性加重和伴隨共存疾病(COmorbidity)景響整體疾病的嚴(yán)重程度。心血管疾病、骨質(zhì)疏松、焦慮和憂郁、肺癌、感染、代謝綜合征、糖尿病等(GOLD2019修訂版)慢性阻塞性肺疾病(COPD)定義2COPD和共存疾病(CO-morbidity)·COPD與其他疾病共存發(fā)病機(jī)制重疊對(duì)病情和進(jìn)展相互影響綜合評(píng)估和治療按相關(guān)疾病診治指南同時(shí)進(jìn)行處理COPD和共存疾病(CO-morbidity)3COPD伴隨肺癮·COPD患者肺癌發(fā)病增多(5-6倍)·輕度COPD患者10年內(nèi)發(fā)生肺癌較吸煙而肺功能正常者高3倍重度COPD患者10年內(nèi)發(fā)生肺癌較吸煙而肺功能正常者高10倍。初診肺患者,共存COPD(40%80%),與氣流受限密切相關(guān)·COPD伴隨肺癌預(yù)后差,肺癌為COPD常見(jiàn)死因肺癌病死率伴COPD63%Vs不伴COPD45%肺癌5年生存率伴COPD38%Vs不伴COPD54%COPD是肺癌發(fā)病獨(dú)立危險(xiǎn)因素COPD伴隨肺癮4COPD伴隨肺瘟AirflowRadiographicLungciobstructionemphysemaYesNoIII-IV15154llllYcs324724320None1755851.495

RefcrenceTTTTTTTTTTT0.1OddsratioCOPD伴隨肺瘟5COPD伴隨肺癮TobaccoExposureina"VulnerableIndividualRecurrentGeneticinfectionspredispositionChronicOxidativeinflammationstressAlteredimmunityCOPDLungCancerHypothesizedmechanismsofassociationbetweenchronicobstructivepulmonarydisease(CoPD)andlungcancerCOPD伴隨肺癮6COPD-肺癌發(fā)病機(jī)制·COPD、肺癌發(fā)病危險(xiǎn)因素和發(fā)病機(jī)制重疊遺傳因素(基因)與環(huán)境因素(慢性炎癥反應(yīng))相互作用·COPD與肺癌共存共同致病因子、炎癥細(xì)胞和介質(zhì)高度融合網(wǎng)絡(luò)·coPD導(dǎo)致肺癌發(fā)生—毒素?fù)p傷肺泡上皮、血管內(nèi)皮細(xì)胞、異常增生和修復(fù),體細(xì)胞突變COPD-肺癌發(fā)病機(jī)制7COPD-肺癌發(fā)病異同·吸煙引發(fā)COPD和/或肺癌,或不發(fā)病香煙煙霧顆粒含高濃度氧化劑和自由基(ROS)局部抗氧化和代謝酶滅活多種潛在毒性物質(zhì),抑制R○S產(chǎn)生NF-KB及炎癥相關(guān)基因轉(zhuǎn)活化影響COPD或肺癌發(fā)病coPD-免疫反應(yīng)增強(qiáng),炎癥反應(yīng)持續(xù),基質(zhì)降解,凋亡過(guò)度,血管丟失,組織修復(fù)不全肺癌—DNA損傷發(fā)展,基因不穩(wěn)定,同源細(xì)胞擴(kuò)増,優(yōu)勢(shì)生長(zhǎng)血管新生COPD-肺癌發(fā)病異同8COPD-肺瘟CIGARETTESMOKEROSNF-kBInflammationCOPEStochastic<NORMAL'GeneticGeneactivation/silencingApoptosis++DNADamage/??repaIrMatrixDegradation/??repairGENOMEINSTABILITYClonalExpansionInvasion-angiogenesisIMMUNERESPONSECANCERCOPDCOPD-肺瘟9UNIQUEBIOLOGICALFEATURESOFLUNGCANCERANDCHRONICOBSTRUCTIVEPULMONARYDISEASEHABLEY.UNIQUEBIOLOGICALFEATURESOFLUNGCANCERANDCHRONICOBSTRUCTIVEPULMONARYDISEASEHallmarksofCancerHallmarksofCOPDIncreasedapoptoSelf-sufficiencyofgrowthMatrixdegradationInsensitivitytoantigrowthIneffectivetissuerepairTissueinvasionIntenseimmune/inflammationSustainedangiogenesisLimitlessreplicationimitedangiogenesisDefinitionofabbreviation:COPDchronicobstructivepulmonarydiseaseUNIQUEBIOLOGICALFEATURESOF10慢性阻塞性肺疾病與肺癌-課件11慢性阻塞性肺疾病與肺癌-課件12慢性阻塞性肺疾病與肺癌-課件13慢性阻塞性肺疾病與肺癌-課件14慢性阻塞性肺疾病與肺癌-課件15慢性阻塞性肺疾病與肺癌-課件16慢性阻塞性肺疾病與肺癌-課件17慢性阻塞性肺疾病與肺癌-課件18慢性阻塞性肺疾病與肺癌-課件19慢性阻塞性肺疾病與肺癌-課件20慢性阻塞性肺疾病與肺癌-課件21慢性阻塞性肺疾病與肺癌-課件22慢性阻塞性肺疾病與肺癌-課件23慢性阻塞性肺疾病與肺癌-課件24慢性阻塞性肺疾病與肺癌-課件25慢性阻塞性肺疾病與肺癌-課件26慢性阻塞性肺疾病與肺癌-課件27慢性阻塞性肺疾病與肺癌-課件28慢性阻塞性肺疾病與肺癌-課件29慢性阻塞性肺疾病與肺癌慢性阻塞性肺疾病與肺癌30慢性阻塞性肺疾病(COPD)定義·cOPD是一種可防可治的常見(jiàn)疾病,其特征為持續(xù)存在的氣流受限。氣流受限呈進(jìn)行性發(fā)展,伴氣道和肺對(duì)有害顆?；驓怏w所致慢性炎癥反應(yīng)增加。急性加重和伴隨共存疾病(COmorbidity)景響整體疾病的嚴(yán)重程度。心血管疾病、骨質(zhì)疏松、焦慮和憂郁、肺癌、感染、代謝綜合征、糖尿病等(GOLD2019修訂版)慢性阻塞性肺疾病(COPD)定義31COPD和共存疾病(CO-morbidity)·COPD與其他疾病共存發(fā)病機(jī)制重疊對(duì)病情和進(jìn)展相互影響綜合評(píng)估和治療按相關(guān)疾病診治指南同時(shí)進(jìn)行處理COPD和共存疾病(CO-morbidity)32COPD伴隨肺癮·COPD患者肺癌發(fā)病增多(5-6倍)·輕度COPD患者10年內(nèi)發(fā)生肺癌較吸煙而肺功能正常者高3倍重度COPD患者10年內(nèi)發(fā)生肺癌較吸煙而肺功能正常者高10倍。初診肺患者,共存COPD(40%80%),與氣流受限密切相關(guān)·COPD伴隨肺癌預(yù)后差,肺癌為COPD常見(jiàn)死因肺癌病死率伴COPD63%Vs不伴COPD45%肺癌5年生存率伴COPD38%Vs不伴COPD54%COPD是肺癌發(fā)病獨(dú)立危險(xiǎn)因素COPD伴隨肺癮33COPD伴隨肺瘟AirflowRadiographicLungciobstructionemphysemaYesNoIII-IV15154llllYcs324724320None1755851.495

RefcrenceTTTTTTTTTTT0.1OddsratioCOPD伴隨肺瘟34COPD伴隨肺癮TobaccoExposureina"VulnerableIndividualRecurrentGeneticinfectionspredispositionChronicOxidativeinflammationstressAlteredimmunityCOPDLungCancerHypothesizedmechanismsofassociationbetweenchronicobstructivepulmonarydisease(CoPD)andlungcancerCOPD伴隨肺癮35COPD-肺癌發(fā)病機(jī)制·COPD、肺癌發(fā)病危險(xiǎn)因素和發(fā)病機(jī)制重疊遺傳因素(基因)與環(huán)境因素(慢性炎癥反應(yīng))相互作用·COPD與肺癌共存共同致病因子、炎癥細(xì)胞和介質(zhì)高度融合網(wǎng)絡(luò)·coPD導(dǎo)致肺癌發(fā)生—毒素?fù)p傷肺泡上皮、血管內(nèi)皮細(xì)胞、異常增生和修復(fù),體細(xì)胞突變COPD-肺癌發(fā)病機(jī)制36COPD-肺癌發(fā)病異同·吸煙引發(fā)COPD和/或肺癌,或不發(fā)病香煙煙霧顆粒含高濃度氧化劑和自由基(ROS)局部抗氧化和代謝酶滅活多種潛在毒性物質(zhì),抑制R○S產(chǎn)生NF-KB及炎癥相關(guān)基因轉(zhuǎn)活化影響COPD或肺癌發(fā)病coPD-免疫反應(yīng)增強(qiáng),炎癥反應(yīng)持續(xù),基質(zhì)降解,凋亡過(guò)度,血管丟失,組織修復(fù)不全肺癌—DNA損傷發(fā)展,基因不穩(wěn)定,同源細(xì)胞擴(kuò)増,優(yōu)勢(shì)生長(zhǎng)血管新生COPD-肺癌發(fā)病異同37COPD-肺瘟CIGARETTESMOKEROSNF-kBInflammationCOPEStochastic<NORMAL'GeneticGeneactivation/silencingApoptosis++DNADamage/??repaIrMatrixDegradation/??repairGENOMEINSTABILITYClonalExpansionInvasion-angiogenesisIMMUNERESPONSECANCERCOPDCOPD-肺瘟38UNIQUEBIOLOGICALFEATURESOFLUNGCANCERANDCHRONICOBSTRUCTIVEPULMONARYDISEASEHABLEY.UNIQUEBIOLOGICALFEATURESOFLUNGCANCERANDCHRONICOBSTRUCTIVEPULMONARYDISEASEHallmarksofCancerHallmarksofCOPDIncreasedapoptoSelf-sufficiencyofgrowthMatrixdegradationInsensitivitytoantigrowthIneffectivetissuerepairTissueinvasionIntenseimmune/inflammationSustainedangiogenesisLimitlessreplicationimitedangiogenesisDefinitionofabbreviation:COPDchronicobstructivepulmonarydiseaseUNIQUEBIOLOGICALFEATURESOF39慢性阻塞性肺疾病與肺癌-課件40慢性阻塞性肺疾病與肺癌-課件41慢性阻塞性肺疾病與肺癌-課件42慢性阻塞性肺疾病與肺癌-課件43慢性阻塞性肺疾病與肺癌-課件44