Li Yiyao, Xue Peijun, Zhang Ting, Peng Min, Sun Xuefeng, Shi Juhong
Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases Peking Union Medical College Hospital Beijing China.
Chinese Academy of Medical Sciences, Peking Union Medical College Beijing China.
Pulm Circ. 2024 Jul 31;14(3):e12422. doi: 10.1002/pul2.12422. eCollection 2024 Jul.
Hemoptysis is a frequently encountered manifestation in cases of acute pulmonary thromboembolism (PTE), significantly impacting clinical decision-making. Despite its clinical relevance, studies focusing on patients with acute PTE and hemoptysis are notably scarce. In this retrospective study, we examined data from hospitalized patients with acute PTE at Peking Union Medical College Hospital (PUMCH) between January 2012 and October 2020. Among the 896 patients analyzed, 105 (11.7%) presented with hemoptysis. Patients with hemoptysis were younger, had higher RRs, and frequently reported chest pain, predominantly showing a negative sPESI score. A significant association with autoimmune diseases was observed (39.0% vs. 16.1%; < 0.001), along with higher occurrences of pulmonary infections (29.5%), lung cancer (21.0%), and chronic heart failure (16.2%). Hemoptysis in PTE is multifactorial; 51.4% of cases were PTE-related, with 85.2% experiencing mild hemoptysis. Among patients with disease-related hemoptysis (13.3%), 90.9% with massive hemoptysis had underlying diseases, predominantly lung cancer. In 35.2% of cases, the cause of hemoptysis remained undetermined, with vasculitis accounting for 29.7%. Anticoagulation strategies varied with the severity of hemoptysis; 82.9% with mild and only 27.3% with massive hemoptysis received therapeutic-dose anticoagulation. Multivariate analysis identified massive hemoptysis as the most significant determinant of anticoagulation decisions. Patients with massive hemoptysis had the poorest outcomes, with an in-hospital mortality rate of 36.4% and 72.7% receiving reduced or no anticoagulation.
咯血是急性肺血栓栓塞症（PTE）患者中常见的临床表现，对临床决策有重大影响。尽管其具有临床相关性，但针对急性PTE合并咯血患者的研究却极为匮乏。在这项回顾性研究中，我们分析了2012年1月至2020年10月在北京协和医院住院的急性PTE患者的数据。在分析的896例患者中，105例（11.7%）出现咯血。咯血患者更年轻，呼吸频率更高，且经常出现胸痛，主要表现为简化肺栓塞严重程度指数（sPESI）评分阴性。观察到与自身免疫性疾病有显著关联（39.0%对16.1%；P＜0.001），同时肺部感染（29.5%）、肺癌（21.0%）和慢性心力衰竭（16.2%）的发生率更高。PTE患者咯血的原因是多因素的；51.4%的病例与PTE相关，其中85.2%为轻度咯血。在与疾病相关的咯血患者中（13.3%），90.9%的大量咯血患者有基础疾病，主要是肺癌。在35.2%的病例中，咯血原因仍未明确，血管炎占29.7%。抗凝策略因咯血严重程度而异；轻度咯血患者中82.9%接受了治疗剂量的抗凝，而大量咯血患者中只有27.3%接受了治疗剂量的抗凝。多变量分析确定大量咯血是抗凝决策的最重要决定因素。大量咯血患者的预后最差住院死亡率为36.4%，72.7%的患者接受了减少剂量或未接受抗凝治疗。
