Tsoumakidou Maria, Chrysofakis Georgios, Tsiligianni Ioanna, Maltezakis Georgios, Siafakas Nikolaos M, Tzanakis Nikolaos
Department of Thoracic Medicine, University of Crete, Medical School, Heraklion, Crete, Greece.
Respiration. 2006;73(6):808-14. doi: 10.1159/000091189. Epub 2006 Jan 27.
The clinical presentation of hemoptysis often raises a number of diagnostic possibilities.
This study was designed to evaluate the relative frequency of different causes of hemoptysis and the value of chest radiography, computed tomography (CT) scanning and fiber-optic bronchoscopy in the evaluation of a Greek cohort population.
We prospectively followed a total of 184 consecutive patients (137 males/47 females, 145 smokers/39 nonsmokers) admitted with hemoptysis between January 2001 and December 2003 to the University Hospital of Heraklion. Follow-up data were collected on August 2005.
The main causes of hemoptysis were bronchiectasis (26%), chronic bronchitis (23%), acute bronchitis (15%) and lung cancer (13%). Bronchiectasis was significantly more frequent in nonsmokers (p < 0.02). Among nonsmokers, patients with moderate/severe bleeding or a history of tuberculosis were more likely to have bronchiectasis (OR 8.25; 95% CI 1.9-35.9, p = 0.007 and OR 16.5; 95% CI 1.7-159.1, p = 0.007, respectively). Nonsmokers with normal or abnormal X-rays were equally likely to have bronchiectasis (OR 2.5; 95% CI 0.66-9.39, p = 0.2). Lung cancer was only found in smokers. Smokers with normal X-rays were less likely to have lung cancer compared to smokers with abnormal X-ray (OR 5.4; 95% CI 1.54-19.34, p = 0.004). There were no smokers with normal CT and lung cancer. Follow-up data were collected in 91% of patients. Lung cancer did not develop in any patient assumed to have hemoptysis of another origin than lung cancer on initial evaluation.
Bronchiectasis is the main diagnosis in patients admitted with hemoptysis to a Greek University Hospital and it is more frequent among nonsmokers with moderate/severe bleeding and/or previous tuberculosis infection. Nonsmokers with moderate/severe hemoptysis and/or a history of tuberculosis should be evaluated with high-resolution CT. Smokers with hemoptysis are at increased risk for lung cancer and need to be extensively evaluated with chest CT and bronchoscopy.
咯血的临床表现常常引发多种诊断可能性。
本研究旨在评估希腊一组人群中咯血不同病因的相对频率以及胸部X线摄影、计算机断层扫描（CT）和纤维支气管镜检查在评估中的价值。
我们前瞻性地跟踪了2001年1月至2003年12月期间因咯血入住伊拉克利翁大学医院的184例连续患者（137例男性/47例女性，145例吸烟者/39例非吸烟者）。2005年8月收集随访数据。
咯血的主要病因是支气管扩张（26%）、慢性支气管炎（23%）、急性支气管炎（15%）和肺癌（13%）。支气管扩张在非吸烟者中更为常见（p<0.02）。在非吸烟者中，中度/重度出血或有结核病史的患者更易患支气管扩张（比值比8.25；95%可信区间1.9 - 35.9，p = 0.007；比值比16.5；95%可信区间1.7 - 159.1，p = 0.007）。X线正常或异常的非吸烟者患支气管扩张的可能性相同（比值比2.5；95%可信区间0.66 - 9.39，p = 0.2）。肺癌仅在吸烟者中发现。与X线异常的吸烟者相比，X线正常的吸烟者患肺癌的可能性较小（比值比5.4；95%可信区间1.54 - 19.34，p = 0.004）。没有CT正常且患肺癌的吸烟者。91%的患者收集到了随访数据。在初始评估中被认为咯血病因不是肺癌的患者中，没有患者发展为肺癌。
支气管扩张是希腊大学医院收治的咯血患者的主要诊断，在有中度/重度出血和/或既往结核感染的非吸烟者中更为常见。有中度/重度咯血和/或结核病史的非吸烟者应进行高分辨率CT评估。咯血的吸烟者患肺癌的风险增加，需要通过胸部CT和支气管镜进行全面评估。
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