Wong Catherine Mee-Ming, Lim Kim Hatt, Liam Chong-Kin
Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, 50603 Kuala Lumpur, Malaysia.
Respirology. 2003 Mar;8(1):65-8. doi: 10.1046/j.1440-1843.2003.00437.x.
In southeast Asia, pulmonary tuberculosis (TB) is the most frequently presumed diagnosis for haemoptysis. This study was designed to assess the causes of haemoptysis, the diagnostic yield of causes in different diagnostic modalities and the distribution of older patients.
All patients presenting to the University of Malaya Medical Centre, Kuala Lumpur, Malaysia with haemoptysis were recruited prospectively and evaluated.
One hundred and sixty patients were evaluated for haemoptysis; 71 (44.4%) were aged 60 years or more. Significantly more patients smoked in the older age group (P = 0.002). The main causes of haemoptysis in the older patients were bronchogenic carcinoma (49.3%), pneumonia (11.3%), bronchiectasis (8.6%), cryptogenic (5.6%) and active TB (4.2%). Significantly more older patients had carcinoma (P < 0.001), while the younger patients more often had TB (P < 0.001). Chest pain was significantly more common in the older patients (P = 0.025), particularly in patients with carcinoma. Bronchoscopy alone or combined with CT of the thorax was significantly more diagnostic in the older patient (P = 0.006).
Bronchogenic carcinoma is the commonest cause of haemoptysis in patients aged 60 years and above. Presumptive anti-TB therapy should not be encouraged despite the regional high prevalence of TB.
在东南亚，咯血最常被推测诊断为肺结核。本研究旨在评估咯血的病因、不同诊断方式下病因的诊断率以及老年患者的分布情况。
前瞻性招募并评估所有前往马来西亚吉隆坡马来亚大学医学中心就诊的咯血患者。
对160例咯血患者进行了评估；71例（44.4%）年龄在60岁及以上。老年组吸烟患者明显更多（P = 0.002）。老年患者咯血的主要病因是支气管源性癌（49.3%）、肺炎（11.3%）、支气管扩张（8.6%）、隐源性（5.6%）和活动性肺结核（4.2%）。老年患者患癌的比例明显更高（P < 0.001），而年轻患者患肺结核的比例更高（P < 0.001）。胸痛在老年患者中明显更常见（P = 0.025），尤其是患癌患者。单独支气管镜检查或联合胸部CT在老年患者中的诊断价值明显更高（P = 0.006）。
支气管源性癌是60岁及以上患者咯血最常见的病因。尽管该地区肺结核患病率较高，但不应鼓励进行经验性抗结核治疗。
