45例肺动静脉畸形的特点及病灶分布对动脉血氧分压的影响

Characteristics of 45 patients with pulmonary arteriovenous malformations and the effect of lesion distribution on partial arterial oxygen pressure

目的:分析肺动静脉畸形(PAVM)的临床及影像特点,并探讨病灶的分布对动脉血氧分压(PaO2)的影响。方法:回顾分析首都医科大学附属北京安贞医院2003年1月至2017年1月,确诊的45例PAVM患者的临床及影像资料。结果:45例患者中男性21例,女性24例;年龄2~70岁;最常见的临床症状是呼吸困难(29/45),最常见的体征为口唇发绀(27/45);7例缺失动PaO2数据,38例PaO2 31.20~88.40 mmHg(1 mmHg=0.133 kPa),平均PaO2(57.80±14.13)mmHg。HGB 79~254 g/L,平均HGB(169.65±38.32)g/L;病灶分布于肺下叶最常见(71.1%),单发病灶者14例中有PaO2数据者12例,平均PaO2(63.06±16.79)mmHg,多发病灶者31例中有PaO2数据者26例,平均PaO2(55.37±12.32)mmHg,两组之间差异无统计学意义(P=0.120)。单侧单发、单侧多发、双侧多发及弥漫型分布各组之间的PaO2的差异亦无统计学意义(P=0.254)。结论:PAVM发病率低,大部分患者无症状或临床及影像特点不特异,容易误诊。未见到病灶的不同分布对PaO2产生影响。

Objective: The clinical and imaging characteristics of pulmonary arteriovenous malformations were analyzed, and the effect of the distribution of lesions on arterial blood oxygen pressure(PaO2) was explored. Methods: The clinical and imaging datas of 45 pulmonary arteriovenous malformation(PAVM) patients diagnosed from January 2003 to January 2017 in Beijing Anzhen Hospital affiliated were retrospectively analyzed. Results: Of the 45 patients, 21 were male and 24 were female, aged 2 to 70 years. The most common clinical symptom is dyspnea(29/45), and the most common sign is cyanosis of the lips(27/45). PaO2 data were missing in 7 cases, and PaO2 was 31.20-88.40 mmHg(1 mmHg=0.133 kPa) in 38 cases, with an average PaO2(57.80±14.13) mmHg. HGB(Hemoglobin, HGB) range is 79-254 g/L, and average HGB is(169.65±38.32) g/L. Lesions were most common in the lower lobe(71.1%). PaO2 data were found in 12 cases of 14 patients with a single lesion, with an average PaO2(63.06±16.79) mmHg. 26 cases of PaO2 data were reported in 31 patients with multiple lesions, with an average PaO2(55.37±12.32) mmHg. There was no significant difference in PaO2 between the two groups(P=0.120). There were also no significant differences in PaO2 between the groups of unilateral single, multiple unilateral, multiple bilateral, and diffuse distribution(P=0.254). Conclusions: The incidence of PAVM is low, and most patients are asymptomatic or clinical and imaging characteristics are not specific, which is easy to be misdiagnosed. No difference in the distribution of the lesions was observed to affect PaO2.