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肺结核所致大咯血支气管动脉栓塞术后6个月内复发危险因素分析

Analysis of risk factors for recurrence within 6 months after bronchial artery embolization for massive hemoptysis due to pulmonary tuberculosis.

作者信息

Xu-Dong Jiao, Qi-Fan Wang, Ya-Rong Shi, Yun-Hua Li

机构信息

Department of Radiology, Wuxi Branch of Ruijin Hospital Shanghai Jiao Tong University School of Medicine (Wuxi Xinwu District Xinrui Hospital), Wuxi City, Jiangsu Province, China.

Department of Radiology, Jiangsu Province Changzhou 3rd Hospital, Jiangsu, Changzhou, China.

出版信息

Medicine (Baltimore). 2025 Mar 7;104(10):e41734. doi: 10.1097/MD.0000000000041734.

DOI:10.1097/MD.0000000000041734
PMID:40068037
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11902924/
Abstract

This study aims to investigate the causes and risk factors of recurrence within 6 months after transcatheter bronchial artery embolization for massive hemoptysis in pulmonary tuberculosis. A retrospective observational study was conducted on the clinical data of 237 patients with pulmonary tuberculosis and massive hemoptysis who relapsed within 6 months after bronchial artery embolization. Univariate analysis was first conducted to screen for risk factors with statistical significance, and then multivariate logistic regression analysis was performed to infer the risk factors that might lead to the recurrence of hemoptysis. Twenty-four relapsed within 6 months after the operation, and the recurrence rate was 10.1% (24/237). Logistic multivariate regression analysis revealed that 6 risk factors were included in the regression model. The strength of the effect was as follows: postoperative lesion progression (odds ratio [OR] = 4.429, 95% confidence interval [CI]: 2.833-7.283), number of feeding arteries (OR = 2.592, 95% CI: 1.457-4.741), combined bronchiectasis (OR = 2.324, 95% CI: 1.912-5.682), presence of cavitation (OR = 1.933, 95% CI: 1.406-2.451), systemic-to-pulmonary shunt (OR = 1.596, 95% CI: 1.044-2.409), and lesion lobe distribution (OR = 1.056, 95% CI: 1.006-1.128). Postoperative lesion progression, a large number of feeding arteries, combined bronchiectasis, presence of cavities, existence of a systemic-to-pulmonary shunt, and wide lesion distribution are independent risk factors for postoperative recurrence.

摘要

本研究旨在探讨肺结核大咯血经导管支气管动脉栓塞术后6个月内复发的原因及危险因素。对237例肺结核大咯血患者支气管动脉栓塞术后6个月内复发的临床资料进行回顾性观察研究。首先进行单因素分析以筛选具有统计学意义的危险因素,然后进行多因素logistic回归分析以推断可能导致咯血复发的危险因素。术后6个月内24例复发,复发率为10.1%(24/237)。logistic多因素回归分析显示回归模型纳入6个危险因素。作用强度如下:术后病变进展(比值比[OR]=4.429,95%置信区间[CI]:2.833 - 7.283)、供血动脉数量(OR=2.592,95% CI:1.457 - 4.741)、合并支气管扩张(OR=2.324,95% CI:1.912 - 5.682)、有空洞形成(OR=1.933,95% CI:1.406 - 2.451)、体肺分流(OR=1.596,95% CI:1.044 - 2.409)及病变肺叶分布(OR=1.056,95% CI:1.006 - 1.128)。术后病变进展、大量供血动脉、合并支气管扩张、有空洞、存在体肺分流及病变分布广泛是术后复发的独立危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3bb/11902924/a03551909871/medi-104-e41734-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3bb/11902924/f6c49f9acb97/medi-104-e41734-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3bb/11902924/a03551909871/medi-104-e41734-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3bb/11902924/f6c49f9acb97/medi-104-e41734-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3bb/11902924/a03551909871/medi-104-e41734-g002.jpg

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本文引用的文献

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Which Is the Best Way to Treat Massive Hemoptysis? A Systematic Review and Meta-Analysis of Observational Studies.治疗大量咯血的最佳方法是什么?一项观察性研究的系统评价和荟萃分析。
J Pers Med. 2023 Nov 26;13(12):1649. doi: 10.3390/jpm13121649.
2
Massive Hemoptysis and Pulmonary Thromboembolism in a Patient with Pulmonary Tuberculosis: A Therapeutic Conundrum Managed with Bronchial Artery Embolization.肺结核患者出现大咯血和肺血栓栓塞症:支气管动脉栓塞治疗的难题
Kathmandu Univ Med J (KUMJ). 2022 Oct-Dec;20(80):522-525.
3
Risk factors for the recurrence in pulmonary tuberculosis patients with massive hemoptysis.
肺结核大咯血患者复发的危险因素。
Clin Respir J. 2023 Jul;17(7):663-671. doi: 10.1111/crj.13653. Epub 2023 Jul 5.
4
CIRSE Standards of Practice on Bronchial Artery Embolisation.经导管支气管动脉栓塞术 CIRSE 实践标准
Cardiovasc Intervent Radiol. 2022 Jun;45(6):721-732. doi: 10.1007/s00270-022-03127-w. Epub 2022 Apr 8.
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Bronchial Angioembolization for Management of Hemoptysis Due to Pulmonary Tuberculosis.支气管血管栓塞术治疗肺结核咯血
Tanaffos. 2021 Feb;20(2):134-139.
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Outcomes of bronchial artery embolization for the management of hemoptysis.支气管动脉栓塞术治疗咯血的疗效。
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Bronchial artery embolization: A gratifying life-saving procedure.支气管动脉栓塞术:一种令人满意的救生程序。
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8
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Wideochir Inne Tech Maloinwazyjne. 2020 Sep;15(3):478-487. doi: 10.5114/wiitm.2019.89832. Epub 2019 Nov 18.
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