体-肺分流在大咯血患者中的发病率及病因探讨

Study of the incidence and etiology of systemic-pulmonary shunt in patients with severe haemoptysis

目的:分析支气管动脉-肺循环瘘(体-肺分流)在大咯血患者中的发病率,并探讨体-肺分流形成的原因。方法:回顾性搜集本院494例大咯血患者的病例资料,根据病因分为三组,肺慢性炎症组、肺血管病变组和肺恶性肿瘤组。分析各组CT图像,并计算不同组别的体-肺分流发病率和平均每例患者异常支气管动脉或非支气管动脉的体动脉系统的数目,并进行统计学分析。结果:肺慢性炎症组、肺血管病变组和肺恶性肿瘤组的体-肺分流发生率分别为93.0%、75.0%和11.4%。三组的体-肺分流发病率差异具有统计学意义(P<0.001,P<0.001,P=0.014)。结论:肺慢性炎症组的体-肺分流发生率最高,提示慢性炎症可能是体-肺分流形成的最重要原因之一。对于大咯血患者,在除外明确的肺血管病变后,临床应重点关注肺慢性炎症的诊断和治疗。

Objective：To analyze the incidence of bronchial artery-pulmonary fistula（systemic-pulmonary shunt）and to discuss the etiology in patients with severe haemoptysis.Methods：The clinical material of 494 patients with severe haemoptysis in our hospital were recruited,which were classified into 3groups according to different etiology,including chronic infection of lung,pulmonary vascular lesion and pulmonary malignancy.The CT images of these different groups were analyzed,the incidence of systemic-pulmonary shunt,the average number of abnormal bronchial artery or other systemic artery（non-bronchial artery）per each patient were calculated and analyzed statistically.Results：The incidence of systemic-pulmonary shunt in the group of chronic infection of lung,pulmonary vascular lesion and malignant pulmonary tumor was 93.0%,75.0% and 11.4%,respectively,with significant statistical differences（P〈0.001,P〈0.001,P=0.014respectively）.Conclusion：The incidence of systemic-pulmonary shunt in chronic infection of lung is the highest among all 3groups,which indicates that chronic infection of lung might be the most important cause of systemic-pulmonary shunt.For patients with severe hemoptysis,as obvious pulmonary vascular lesion has been excluded,the clinicians should concentrated to the diagnosis and treatment of chronic infection of lung.