Mossi Francesca, Maroldi Roberto, Battaglia Giuseppe, Pinotti Gianpaolo, Tassi Gianfranco
Cattedra di Radiologia, Università degli Studi di Brescia, Brescia, Italy.
Radiol Med. 2003 Jan-Feb;105(1-2):48-55.
To identify the risk factors related to relapse of haemoptysis in patients treated with arterial embolisation.
Eighty-eight patients with haemoptysis (60 M, 28 F; average age 58.9) were examined by bronchial arteriography: 64/88 were subsequently embolised. The clinical and angiographic parameters, immediate and long-term results were analysed. Follow-up ranged from 8 days to 104 months. No major complications were observed.
Patients treated with embolisation (64/88= 72.7%) were divided into two groups. Group 1 (23/64= 35.9%) included patients with relapse of haemoptysis and Group 2 (41/64=64.1%) patients without recurrence during follow-up. In all 64 patients with haemoptysis, embolisation succeeded in stopping the haemorrhage, long-term efficacy was observed in 64.1%; when the treatment was repeated, secondary success was 68.75%. Recurrence after embolisation was correlated to chronic lung disease (p=0.04) especially to pulmonary tuberculosis or mycetoma (p=0.007) and to systemic-pulmonary shunts (p=0.02). The absence of a history of massive haemoptysis was related to a greater likelihood of non-recurrence (p=0.0035). Moreover, complicated tuberculous lesions (Log-rank test p=0.0027), chronic lung disease (p=0.0272) and systemic-pulmonary shunts (p=0.0406) were predictive of an earlier relapse (Kaplan Meier curves and Log-rank test). Comparison of tuberculosis and/or mycetoma with systemic-pulmonary shunting showed the greater impact of infectious lesions on early recurrence.
Embolisation of abnormal vascularisation, which can be repeated in cases of failure, proved successful in patients with haemoptysis showing definitive or long-term resolution of the clinical picture in about 70% of cases. Patients with tuberculosis or mycetoma with systemic-pulmonary shunting and haemodynamic alterations have a higher risk of early recurrence.
确定接受动脉栓塞治疗的咯血患者复发的相关危险因素。
对88例咯血患者（60例男性，28例女性；平均年龄58.9岁）进行支气管动脉造影检查：其中64/88例随后接受了栓塞治疗。分析临床和血管造影参数、近期和远期结果。随访时间为8天至104个月。未观察到重大并发症。
接受栓塞治疗的患者（64/88 = 72.7%）分为两组。第1组（23/64 = 35.9%）包括咯血复发患者，第2组（41/64 = 64.1%）为随访期间未复发的患者。在所有64例咯血患者中，栓塞成功止血，远期疗效为64.1%；重复治疗时，二次成功率为68.75%。栓塞后复发与慢性肺部疾病（p = 0.04）相关，尤其是与肺结核或肺真菌瘤（p = 0.007）以及体肺分流（p = 0.02）相关。无大量咯血病史与复发可能性较小相关（p = 0.0035）。此外，复杂的结核病变（对数秩检验p = 0.0027）、慢性肺部疾病（p = 0.0272）和体肺分流（p = 0.0406）可预测更早复发（Kaplan Meier曲线和对数秩检验）。肺结核和/或肺真菌瘤与体肺分流的比较显示感染性病变对早期复发的影响更大。
对异常血管进行栓塞，在治疗失败时可重复进行，在约70%的咯血患者中可成功实现临床症状的明确或长期缓解。患有肺结核或肺真菌瘤并伴有体肺分流和血流动力学改变的患者早期复发风险较高。
