肺肿瘤血栓性微血管病1例并文献复习

Pulmonary Tumor Thrombotic Microangiopathy: 1 Case Report and Review of the Literatures

目的:提高临床医生对肺肿瘤血栓性微血管病(PTTM)的早期的识别和诊断。方法:报道我科的1例临床诊断PTTM病例,对截止到2022年9月国内外文献报道的中国PTTM病例进行回顾性分析。结果:连同本例在内共20篇27例国内的PTTM病例报道。原发肿瘤中,最多的是胃癌(51.9%),最常见的临床症状为渐进性加重的呼吸困难(88.9%),90%的病例肺动脉CTA未见肺栓塞,心脏彩色超声提示中位肺动脉压为66.6 (64.71) mmHg。结论:PTTM是一种极少见的肿瘤相关并发症,预后极差,主要表现为进行性呼吸困难及干咳,绝大多数伴有肺动脉高压,CTPA为阴性,确诊依靠病理,但因疾病进展快,多无法耐受有创检查导致确诊困难。生前早期诊断及治疗是改善预后的关键。

Objective: To improve the early identification and diagnosis of lung tumor thrombotic microangi-opathy (PTTM) by clinicians. Methods: Reported a clinical diagnosis of PTTM case in our department, and conducted a retrospective analysis of Chinese PTTM cases reported in domestic and foreign lit-erature up to September 2022. Results: Together with this case, 20 cases were reported on 27 do-mestic PTTM cases. Among the primary tumors, the most frequent was gastric cancer (51.9%), the most common clinical symptoms were progressive dyspnea (88.9%), pulmonary CTA in 90% of cases without pulmonary embolism, and cardiac color ultrasound suggested a median pulmonary artery pressure of 66.6 (64.71) mmHg. Conclusion: PTTM is a rare tumor-related complication with a very poor prognosis, mainly manifested as progressive dyspnea and dry cough, the vast majority of which are accompanied by pulmonary hypertension, negative CTPA, relying on pathology, but due to the rapid progress of the disease, it is difficult to tolerate invasive examination. Early diagno-sis and treatment in life is the key to improving the prognosis.