结缔组织病合并肺栓塞13例临床分析

Clinical characteristics of pulmonary embolism in patients with connective tissue disease: an analysis of 13 cases

目的对结缔组织病(CTD)合并肺栓塞患者的临床资料进行分析,以期指导临床早期诊断和治疗。方法回顾性分析2013年1月—2014年12月杭州邵逸夫医院及宁波市第一医院CTD合并肺栓塞13例患者的临床表现、影像学改变、治疗及预后。结果 13例CTD患者中类风湿性关节炎4例;系统性红斑狼疮3例;干燥综合征3例;原发性抗磷脂综合征1例,自身免疫性溶血性贫血合并抗磷脂综合征1例;风湿性多肌痛1例。13例患者中出现呼吸困难9例,胸痛6例,咯血与发热均为4例。5例患者有下肢浮肿,其中2例为单侧下肢浮肿。11例患者行CT肺动脉造影(CTPA)检查,其中1例为肺动脉主干充盈缺损,2例为叶及以下肺动脉充盈缺损,其他8例患者为段及以下肺动脉充盈缺损。5例患者行放射性核素肺通气/血流灌注(V/Q)检查,均表现为段及以下放射性稀疏缺损区与肺通气显像不匹配。除肺血管病变,13例患者中有12例存在其他肺部影像学改变,其中渗出表现5例,纤维条索灶4例,支气管扩张4例,间质性改变2例,胸腔积液或胸膜增厚6例。13例患者均进行了经胸心脏彩超检查,其中6例出现轻到重度肺动脉高压。12例患者进行了下肢静脉彩超检查,发现5例存在下肢深静脉血栓形成,1例存在浅静脉血栓形成。13例患者均接受了抗凝治疗,30天全因死亡率为0。结论 CTD患者出现新发呼吸困难等症状或胸部影像改变需警惕肺栓塞。

Objective To analyze the clinical characteristics of connective tissue disease （CTD） in patients with pulmonary embolism, and provide the basis for the early diagnosis and treatment. Methods We retrospectively reviewed the clinical data of 13 hospitalized patients with connective tissue disease and pulmonary embolism from January,2013 to December,2014. The clinical manifestations, imaging features, treatments and prognosis of these patients were described. Results Among the 13 patients, the rheumatoid arthritis （4 cases）, systemic lupus erythematosus （ 3 cases）, Sjogren＇ s syndrome（ 3 cases）, primary antiphospholipid syndrome （ 1 case） , autoimmune hemolytic anemia with antiphospholipid syndrome（ 1 case） and Polymyalgia Rheumatica （1 case） were combined. The main manifestations included dyspnea （9 cases） , chest pain（6 cases）,hemoptysis （4 cases） and fever（4 cases）. Five cases were with extremity swelling, and 2 of them had unilateral lower limb swelling. CT pulmonary angiography performed in 11 cases showed that the complications included pulmonary artery trunk filling defect（ 1 case） ,lobar pulmonary artery filling defect （ 2 cases ）, segmental pulmonary artery filling defect （8 cases ）. Five cases underwent radionuclide pulmonary ventilation/perfusion （V/Q） examination, and the results showed that all of them were with pulmonary segment perfusion ventilation mismatch. Twelve cases were with other radiological changes, including effusion （ 5 cases ）, fibrosis （ 4 cases ） , bronchiectasis （ 4 cases ）, interstitial lung disease （2 cases） and pleural effusions/pleural thickening（6 cases）. The transthoracic echocardiography inn 13 cases showed that 6 cases were with mild to severe pulmonary hypertension. Twelve cases underwent lower extremity venous ultrasound examination, and the results showed that 5 cases were with deep venous thrombosis, 1 case with superficial venous thrombosis. All patients received anticoagulant therapy and the 30 days all-cause mortality was 0. Conclusion The symptoms such as dyspnea and chest imaging changes in the patients with connective tissue disease indicate the pulmonary embolism.