华法林导致老年气管支气管弥漫性钙化1例并文献复习

Warfarin-induced diffuse tracheobronchial calcification in elderly patients:a case report and literature review

目的报道1例长期口服华法林导致弥漫性气管支气管钙化的病例,结合相关文献复习对华法林导致气管支气管钙化的病例特点、作用机制以及新型抗凝药物的替代进行阐述。方法以“tracheobronchial calcification,warfarin”为检索词,在PubMed数据库检索2021年8月之前所有报道,共8篇文献,成年患者以个案报道的3例以及有关华法林导致气管支气管钙化病例对照研究1篇;在万方数据库以“气管支气管(弥漫性)钙化、华法林”为检索词,检索2021年8月之前所有报道的国内病例,检索到相关文献1篇;在中国知网数据库以“气管支气管(弥漫性)钙化、华法林”为检索词,检索到相关文献1篇。结果本文报道1例77岁老年女性患者,口服华法林20年,胸部CT检查示气管、支气管弥漫性钙化,支气管镜显示气管和支气管无结节样凸起。气管支气管钙化在老年患者中较常见,成年患者中由华法林导致的气管支气管弥漫性钙化较少见,女性居多,无特殊临床和影像学特点。结论长期口服华法林可导致气管支气管弥漫性钙化,目前因无明显临床症状未受重视,所以低估了该疾病的患病率,日后需加强临床及放射科医生对此类患者的肺部影像学随访。

Objective To report a case of diffuse tracheobronchial calcification caused by long-term oral warfarin,and describe the case characteristics,mechanism of action and substitution of new anticoagulant drugs based on the review of relevant literature.Methods Take"traceobronchial calibration,warfarin"as the search words,all literatures reported in PubMed Database before August 2021 were searched.There were 8 articles in total,including 3 individual case reports of adult patients and 1 case-control study on warfarin-induced tracheobronchial calcification.Take"tracheobronchial(diffuse)calcification and warfarin"as the search words,all domestic literatures reported in Wanfang Database before August2021 were searched.1 related article was retrieved.Taking"tracheobronchial(diffuse)calcification and warfarin"as the search words in CNKI Database,1 relevant article was retrieved.Results This paper reported a case of a 77 year old female patient who had taken warfarin for 20 years.Chest CT showed diffuse calcification of the trachea and bronchi,and bronchoscopy showed no nodular protrusions in the trachea and bronchi.Tracheobronchial calcification was more common in elderly patients.Diffuse tracheobronchial calcification caused by warfarin was rare in adult patients,mostly in women,without special clinical and imaging features.Conclusion Long-term oral warfarin can cause diffuse tracheobronchial calcification.At present,the prevalence of the disease is underestimated because there are no obvious clinical symptoms.In the future,it is necessary to strengthen the follow-up of lung imaging in such patients by clinicians and radiologists.