| 吴镜强,张晖,刘德情,梁瑞云,杨宏志,方伟军.经导管栓塞治疗肺结核相关大咯血合并肺动脉假性动脉瘤效果及大咯血复发危险因素[J].中国介入影像与治疗学,2025,22(12):780-784 |
| 经导管栓塞治疗肺结核相关大咯血合并肺动脉假性动脉瘤效果及大咯血复发危险因素 |
| Efficacy of transcatheter embolization for treating pulmonary tuberculosis complicated with pulmonary arterial pseudoaneurysm and analysis of risk factors for recurrent massive hemoptysis |
| 投稿时间：2025-08-18 修订日期：2025-11-08 |
| DOI：10.13929/j.issn.1672-8475.2025.12.006 |
| 中文关键词: 结核,肺 肺动脉 动脉瘤,假性 栓塞,治疗性 咯血 |
| 英文关键词:tuberculosis,pulmonary pulmonary artery aneurysm,false embolization,therapeutic hemoptysis |
| 基金项目:广州市科技计划项目（2024A03J0511、2025A03J3606）。 |
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| 中文摘要: |
| 目的 观察经导管栓塞治疗肺结核相关大咯血合并肺动脉假性动脉瘤（PAP）效果，分析其后大咯血复发的危险因素。方法 回顾性分析42例接受经导管栓塞治疗的肺结核合并PAP伴大咯血患者，记录治疗后临床成功率及不良反应。根据随访期间有无需要临床干预的大咯血复发划分复发组与未复发组，以多因素logistic回归分析筛选大咯血复发的独立危险因素。结果 经导管栓塞治疗后，10例（10/42，23.81%）于治疗后0.1～42.7个月、中位时间1.0个月复发大咯血（复发组），32例未复发大咯血（未复发组）；经导管栓塞治疗肺结核合并PAP的临床成功率为76.19%（32/42）。15例（15/42，35.71%）于治疗后3天内出现胸闷、胸痛等轻度不良反应，未见3级及以上不良反应。PAP C/D型及治疗后C反应蛋白（CRP）升高均为治疗后大咯血复发的独立危险因素（OR=16.519、44.327，P均＜0.05）。17例合并肺曲霉菌感染，其中10例接受联合支气管镜下曲霉菌清除治疗者的复发咯血率（1/10，10.00%）低于7例未接受联合治疗者（5/7，71.43%）（P=0.018）。结论 经导管栓塞治疗肺结核相关大咯血合并PAP较为有效且安全；C/D型PAP及治疗后CRP升高均为治疗后大咯血复发的危险因素。 |
| 英文摘要: |
| Objective To observe the efficacy of transcatheter embolization for treating pulmonary tuberculosis complicated with pulmonary arterial pseudoaneurysm （PAP）， and to analyze the risk factors for recurrent massive hemoptysis. Methods Totally 42 patients with pulmonary tuberculosis complicated with PAP and massive hemoptysis were retrospectively enrolled， and the clinical success rate and adverse reactions after transcatheter embolization were recorded. The patients were divided into recurrence group and non-recurrence group according to the presence of recurrent massive hemoptysis requiring clinical intervention during follow-up period or not. Multivariate logistic regression analysis was performed to screen the independent risk factors for recurrent massive hemoptysis after treatments. Results After transcatheter embolization， recurrent massive hemoptysis occurred in 10 cases （recurrence group） 0.1—42.7 months （with a median time of 1.0 month）later but not in 32 cases（non-recurrence group）， and the success rate of transcatheter embolization for treating pulmonary tuberculosis complicated with PAP was 76.19% （32/42）. Mild adverse reactions such as chest tightness and chest pain were noticed in 15 cases （15/42， 35.71%） within 3 days after treatment， while no grade 3 nor higher adverse reactions occurred. PAP type C/D and high C-reactive protein （CRP） level were both independent risk factors for recurrent massive hemoptysis after treatment （OR=16.519， 44.327， both P＜0.05）. Among 17 cases complicated with pulmonary aspergillosis infection， the recurrent hemoptysis rate in 10 cases （1/10，10.00%） underwent combination bronchoscopic aspergillosis debridement therapy was significantly lower than that in 7 cases without combination therapy （5/7，71.43%） （P=0.018）. Conclusion Transcatheter embolization was relatively effective and safe for treating pulmonary tuberculosis complicated with PAP， type C/D PAP and elevated CRP level after treatment were risk factors for recurrent massive hemoptysis. |
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