间质性肺疾病患者行不同活检方式后出血风险及其出血严重程度的相关因素研究

Risk of Bleeding after Different Biopsy Methods in Patients with Interstitial Lung Disease and the Related Factors of Bleeding Severity

背景现有证据表明,经支气管冷冻肺活检(TBCB)在间质性肺疾病(ILD)诊断中极具潜力,但不同活检方式的诊断效能及安全性鲜见报道。目的比较ILD患者行经支气管镜钳夹活检(TBFB)、TBCB后出血风险及其出血严重程度的相关因素。方法选取2015年3月至2019年2月在湖北医药学院附属太和医院呼吸与危重症医学科就诊的ILD患者729例,排除临床资料不完整的11例患者,最终纳入718例患者,将其随机分为TBFB组和TBCB组,每组359例。TBFB组患者经支气管钳抽取肺组织并进行活检,TBCB组患者经支气管镜低温冷冻抽取肺组织并进行活检。比较两组患者临床资料、肺组织活检情况、术后出血发生率、术后出血严重程度及气胸发生率,TBFB组和TBCB组出血患者出血严重程度的影响因素分析采用单因素分析。结果TBCB组患者凝血酶原时间长于TBFB组,取样数量少于TBFB组,多肺叶活检者所占比例低于TBFB组(P<0.05)。TBCB组患者术后出血发生率高于TBFB组,出血严重程度重于TBFB组(P<0.05)。在TBFB组中,中重度出血患者中服用阿司匹林者所占比例低于轻度出血患者(P<0.05)。在TBCB组中,中重度出血患者中年龄≥65岁、服用阿司匹林者所占比例高于轻度出血患者(P<0.05)。TBCB组患者气胸发生率为6.13%(22/359),高于TBFB组患者的1.67%(6/359)(P<0.05)。结论与TBFB相比,ILD患者行TBCB后出血和气胸发生风险更高;服用阿司匹林可能与ILD患者行TBFB后出血严重程度相关,年龄≥65岁、服用阿司匹林可能与ILD患者行TBFB后出血严重程度相关。

Background Existing evidence confirms that transbronchial cryobiopsy(TBCB)has great potential in the diagnosis of interstitial lung disease(ILD),but the diagnostic efficacy and safety of different biopsy methods are rarely reported.Objective To investigate the risk of bleeding after transbronchial forceps biopsy(TBFB)and TBCB in patients with ILD and the related factors of bleeding severity.Methods A total of 729 ILD patients in the Department of Respiratory and Critical Care Medicine,Taihe Hospital,Hubei University of Medicine from March 2015 to February 2019 were selected,11 patients with incomplete clinical data were excluded,and 718 ILD patients were finally included.They were randomly divided into TBFB group and TBCB group,with 359 cases in each group.Lung tissue was extracted and biopsied by bronchial forceps in TBFB group,and lung tissue was extracted and biopsied by bronchoscopy in TBCB group.The clinical data,lung biopsy,incidence of postoperative bleeding,severity of postoperative bleeding and incidence of pneumothorax were compared between the two groups.The influencing factors of bleeding severity of bleeding patients in TBFB group and TBCB group were analyzed by univariate analysis,respectively.Results The prothrombin time in TBCB group was longer than that in TBFB group,and the number of samples was less than that in TBFB group,and the proportion of patients with multi lobe biopsy was lower than that in TBFB group(P<0.05).The incidence of postoperative bleeding in TBCB group was higher than that in TBFB group,and the severity of bleeding was more serious than that in TBFB group(P<0.05).In TBFB group,the proportion of patients taking aspirin in patients with moderate and severe bleeding was lower than that in patients with mild bleeding(P<0.05).In TBCB group,the proportion of patients with≥65 years old and taking aspirin in patients with moderate and severe bleeding was higher than that in patients with mild bleeding(P<0.05).The incidence of pneumothorax in TBCB group was 6.13%(22/359),which was higher than 1.67%(6/359)in TBFB group(P<0.05).Conclusion Compared with TBFB,ILD patients undergoing TBCB had a higher risk of bleeding and pneumothorax;taking aspirin may be related to the bleeding severity in ILD patients after TBFB.≥65 years old and taking aspirin may be related to the bleeding severity in ILD patients after TBFB.