17例肺动脉干占位性病变患者的临床分析

doi:10.19983/j.issn.2096-8493.20210168

结核与肺部疾病杂志 ›› 2022, Vol. 3 ›› Issue (2): 102-109.doi: 10.19983/j.issn.2096-8493.20210168

17例肺动脉干占位性病变患者的临床分析

马冉¹, 江倩¹, 顾莹莹², 赵瑾², 王涛¹, 王欣妮¹, 杨新艳¹, 苏小芬¹, 张挪富¹, 刘春丽¹()

¹广州医科大学附属第一医院/广州呼吸健康研究院/呼吸疾病国家重点实验室/国家呼吸系统疾病临床医学研究中心呼吸与危重症医学科,广州 510120
²广州医科大学附属第一医院/广州呼吸健康研究院/呼吸疾病国家重点实验室/呼吸病理中心,广州 510120

收稿日期:2022-01-03 出版日期:2022-06-30 发布日期:2022-04-18
通信作者: 刘春丽 E-mail:chunli@gird.cn
基金资助:
广州医科大学高水平大学临床研究提升计划建设计划书(B185004065);广州呼吸健康研究院2020自主课题研究项目(SKLRD-Z-202110);广州呼吸健康研究院2019自主课题面上研究项目(SKLRD-MS-201901)

Clinical analysis of 17 patients with occupying lesions of the pulmonary artery trunk

MA Ran¹, JIANG Qian¹, GU Ying-ying², ZHAO Jin², WANG Tao¹, WANG Xin-ni¹, YANG Xin-yan¹, SU Xiao-fen¹, ZHANG Nuo-fu¹, LIU Chun-li¹()

¹The First Affiliated Hospital of Guangzhou Medical University/Guangzhou Institute of Respiratory Health/State Key Laboratory of Respiratory Diseases/Department of Respiratory and Critical Care Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
²The First Hospital of Guangzhou Medical University/Guangzhou Institute of Respiratory Health/State Key Laboratory of Respiratory Diseases/Respiratory Pathology Center, Guangzhou 510120, China

Received:2022-01-03 Online:2022-06-30 Published:2022-04-18
Contact: LIU Chun-li E-mail:chunli@gird.cn
Supported by:
High Level Clinical Research Enhancement Program of Guangzhou Medical University(B185004065);Guangzhou Institute of Respiratory Health 2020 Independent Project Research Project(SKLRD-Z-202110);Guangzhou Institute of Respiratory Health 2019 Independent Project General Project(SKLRD-MS-201901)

摘要/Abstract

摘要： 目的分析肺动脉干占位病变的病因构成和临床特征。方法: 收集2012年1月至2021年8月在广州医科大学附属第一医院住院的患者中有病理诊断结果的17例肺动脉干占位性病变的患者。17例患者中,男性8例,女性9例;年龄范围为26~70岁,平均年龄(52.1±15.8)岁。根据病理分为血栓5例、癌栓10例和菌栓2例。癌栓患者包括8例肺动脉肉瘤、1例绒癌肺动脉转移、1例白血病合并肺动脉内髓样肉瘤。菌栓患者包括1例细菌菌栓、1例真菌菌栓。对患者的临床症状、实验室检查结果、影像学特征、治疗转归进行分析。结果: 17例患者从首诊到确诊时间为10.0(4.0,12.0)个月,其中癌栓患者确诊时间为11.5(8.0,12.0)个月;症状主要有气促(94.1%,16/17)、胸痛(82.4%,14/17)、咳嗽(88.2%,15/17)、咳痰(47.1%,8/17)、咯血(29.4%,5/17)。癌栓患者的血小板计数为274.00(217.25,405.00)×10⁹/L,D二聚体为0.71(0.51,0.97)ng/L,纤维蛋白原为6.30(4.95,7.72)g/L;血栓患者分别为156.00(126.50,274.00)×10⁹/L、1.96(1.11,5.02)ng/L、4.31(2.43,6.09)g/L。心电图异常15例,表现为窦性心动过速(35.3%,6/17)、T波低平(64.7%,11/17)、右束支传导阻滞(35.3%,6/17)。心脏彩色多普勒超声显示右心室负荷增加11例。癌栓患者的估测肺动脉收缩压为60.50(44.00,98.00)mmHg(1mmHg=0.133kPa),血栓患者为49.50(32.25,63.75)mmHg。2例菌栓和3例血栓患者预后良好。结论: 临床医师应重视对肺动脉干占位病变进行病因筛查。血小板计数升高可能对鉴别癌栓存在一定价值。

关键词: 肺动脉, 肺栓塞, 治疗, 临床研究性

Abstract: Objective: To analyze the etiology and clinical features of occupying lesions of the pulmonary artery trunk. Methods: A retrospective study was conducted in 17 patients with pathologically diagnosed occupying lesions of the pulmonary artery trunk hospitalized at the First Hospital of Guangzhou Medical University from January 2012 to August 2021. Of the 17 patients, 8 were male and 9 were female; their ages ranged from 26 to 70 years, with a mean of (52.1±15.8) years. The etiology was divided into thrombosis (n=5), cancer embolism (n=10), and bacterial embolism (n=2). Of the patients with cancer embolism, 8 were pulmonary artery sarcoma, 1 was pulmonary artery metastasis from choriocarcinoma, and 1 was leukemia with intrapulmonary artery myeloid sarcoma. One case of bacterial embolism and one case of fungal embolism were included in the patients with bacterial embolism. The clinical symptoms, laboratory findings, imaging features, and therapeutic prognosis of the patients were analyzed. Results: Of the 17 patients, the median time interval from first diagnosis to diagnosis was 10.0 (4.0, 12.0) months, and the median time to diagnosis in patients with carcinoma emboli was 11.5 (8.0, 12.0) months. The main symptoms were shortness of breath (94.1%, 16/17), chest pain (82.4%, 14/17), cough (88.2%, 15/17), expectoration (47.1%, 8/17), and hemoptysis (29.4%, 5/17). In patients with cancer thrombosis, platelet count was 274.00 (217.25, 405.00)×10⁹/L, D-dimer was 0.71 (0.51, 0.97) ng/L, and fibrinogen was 6.30 (4.95, 7.72) g/L; in patients with thrombosis, those were 156.00 (126.50, 274.00)×10⁹/L, 1.96 (1.11, 5.02) ng/L and 4.31 (2.43, 6.09) g/L. Abnormal ECG was found in 15 cases, the abnormalities were sinus tachycardia (35.3%, 6/17), T-wave hypoplasia (64.7%, 11/17), and right bundle branch block (35.3%, 6/17). Increased right ventricular load was present on cardiac ultrasound in 11 cases. The estimated PASP was 60.50 (44.00, 98.00) mmHg in patients with cancer embolism and was 49.50 (32.25, 63.75) mmHg in patients with thrombus. The prognosis of 2 patients with bacterial embolism and 3 patients with thrombus were good. Conclusion: Clinicians should pay attention to the etiologic screening of occupying lesions of the pulmonary artery trunk. Elevated platelet counts may be of some value in differentiating carcinoma emboli.

Key words: Pulmonary artery, Pulmonary embolism, Therapies, investigational

中图分类号:

R563.5

马冉, 江倩, 顾莹莹, 赵瑾, 王涛, 王欣妮, 杨新艳, 苏小芬, 张挪富, 刘春丽. 17例肺动脉干占位性病变患者的临床分析[J]. 结核与肺部疾病杂志, 2022, 3(2): 102-109. doi: 10.19983/j.issn.2096-8493.20210168

MA Ran, JIANG Qian, GU Ying-ying, ZHAO Jin, WANG Tao, WANG Xin-ni, YANG Xin-yan, SU Xiao-fen, ZHANG Nuo-fu, LIU Chun-li. Clinical analysis of 17 patients with occupying lesions of the pulmonary artery trunk[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(2): 102-109. doi: 10.19983/j.issn.2096-8493.20210168

图/表 3

表1

图2

表2

17例肺动脉干占位性病变患者辅助检查结果

检查项目	合计(17例)	血栓(5例)	癌栓(10例)	菌栓(2例)
实验室检查
血小板计数[×10⁹/L,M(Q₁,Q₃)]	256.00(160.50,304.00)	156.00(126.50,274.00)	274.00(217.25,405.00)	202.50
D二聚体[ng/L,M(Q₁,Q₃)]	0.96(0.59,2.21)	1.96(1.11,5.02)	0.71(0.51,0.97)	3.67
肌钙蛋白I[ng/ml,M(Q₁,Q₃)]	0.01(0.00,0.02)	0.01(0.01,0.36)	0.01(0.00,0.02)	0.05
氨基末端脑钠肽前体[pg/L,M(Q₁,Q₃)]	0.65(0.10,1.49)	0.44(0.28,6.63)	0.43(0.05,1.50)	0.84
C反应蛋白[mg/L,M(Q₁,Q₃)]	50.60(31.70,84.00)	47.00(23.20,71.50)	73.50(42.60,91.25)	20.21
血红细胞沉降率[mm/1h,M(Q₁,Q₃)]	72.00(42.50,95.00)	35.00(9.50,71.00)	89.00(57.75,113.25)	70.50
白蛋白[g/L,M(Q₁,Q₃)]	34.70(29.40,38.45)	30.10(28.45,37.25)	36.15(30.90,39.50)	27.15
纤维蛋白原[g/L,M(Q₁,Q₃)]	5.60(3.96,6.42)	4.31(2.43,6.09)	6.30(4.95,7.72)	4.51
癌胚抗原[ng/ml,M(Q₁,Q₃)]	1.82(1.34,3.00)	3.82(2.89,4.10)	1.62(1.34,2.42)	1.26
其他辅助检查
心电图异常[例(发生率,%)]	15(88.2)	5/5	8(80.0)	2/2
窦性心动过速[例(发生率,%)]	6(35.3)	1/5	4(40.0)	1/2
肺性P波[例(发生率,%)]	1(5.9)	0/5	1(10.0)	0/2
心电图改变/心电轴右偏[例(发生率,%)]	0(0.0)	0/5	0(0.0)	0/2
T波低平[例(发生率,%)]	11(64.7)	4/5	5(50.0)	2/2
右束支传导阻滞[例(发生率,%)]	6(35.3)	2/5	3(30.0)	1/2
心脏彩色多普勒超声
右心室负荷增加[例(发生率,%)]	11(74.7)	3/5	6(60.0)	2/2
三尖瓣反流束面积[cm²,M(Q₁,Q₃)]	4.35(2.53,8.68)	3.60(2.80,4.05)	7.15(3.83,11.90)	1.50
估测肺动脉收缩压[mmHg,M(Q₁,Q₃)]	48.00(36.00,73.00)	49.50(32.25,63.75)	60.50(44.00,98.00)	28.00
肺动脉CT造影
右室流出道[例(发生率,%)]	2(12.0)	0/5	1(10.0)	1/2
肺动脉干[例(发生率,%)]	8(47.0)	0/5	6(60.0)	2/2
单侧肺动脉[例(发生率,%)]	8(47.0)	4/5	4(40.0)	0/2
双侧肺动脉[例(发生率,%)]	7(41.2)	0/5	6(60.0)	1/2
叶段肺动脉[例(发生率,%)]	11(64.7)	2/5	6(60.0)	0/2
平均CT值[HU,M(Q₁,Q₃)]	46.50(39.25,59.50)	47.00(42.5,65.00)	45.00(36.50,52.00)	81.00
占位不均匀强化[例(发生率,%)]	13(76.5)	2/5	8(80.0)	2/2
肺梗塞[例(发生率,%)]	7(41.2)	3/5	3(30.0)	1/2
淋巴结肿大[例(发生率,%)]	3(17.6)	0/5	2(20.0)	1/2
PET-CT诊断[例(诊断率,%)]	9(52.9)	0/5	8(80.0)	1/2
SUV值[M(Q₁,Q₃)]	8.90(4.35,13.90)	-	8.90(6.60,16.90)	10.90

表2

参考文献 17

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17例肺动脉干占位性病变患者的临床分析

Clinical analysis of 17 patients with occupying lesions of the pulmonary artery trunk

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临床特征	合计(17例)	血栓(5例)	癌栓(10例)	菌栓(2例)
年龄(岁,$\bar{x}$±s)	52.1±15.8	58.8±16.2	48.7±15.5	52.5
女性[例(构成比,%)]	9(52.9)	3/5	5(50.0)	1/2
吸烟史[例(构成比,%)]	3(17.6)	1/5	2(20.0)	0/2
从首诊到确诊时间[月,M(Q₁,Q₃)]	10.0(4.0,12.0)	4.0(1.0,9.0)	11.5(8.0,12.0)	5.5
症状[例(发生率,%)]
晕厥	1(5.9)	1/5	0(0.0)	0/2
气促	16(94.1)	4/5	10(100.0)	2/2
胸痛	14(82.4)	5/5	8(80.0)	1/2
咯血	5(29.4)	2/5	3(30.0)	0/2
咳嗽	15(88.2)	5/5	8(80.0)	2/2
咳痰	8(47.1)	3/5	5(50.0)	0/2
发热	3(17.6)	0/5	2(20.0)	1/2
消瘦	4(23.5)	1/5	3(30.0)	0/2
体征[例(发生率,%)]
P2>A2	7(41.2)	1/5	4(40.0)	2/2
下肢浮肿	2(11.8)	1/5	0(0.0)	1/2
合并症[例(发生率,%)]
下肢深静脉血栓	1(5.9)	1/5	0(0.0)	0/2
肺癌	1(5.9)	1/5	0(0.0)	0/2
先天性心脏病	1(5.9)	0/5	0(0.0)	1/2
高血压	2(11.8)	1/5	1(10.0)	0/2
冠心病	1(5.9)	1/5	0(0.0)	0/2
糖尿病	1(5.9)	0/5	1(10.0)	0/2
阻塞性睡眠呼吸暂停低通气综合征	1(5.9)	0/5	1(10.0)	0/2
丙型肝炎	1(5.9)	0/5	0(0.0)	1/2
外院转诊[例(构成比,%)]	16(94.1)	4/5	10(100.0)	2/2
三级医院转诊[例(构成比,%)]	14(82.4)	2/5	10(100.0)	2/2
转诊前诊断[例(构成比,%)]
肺血栓栓塞	9(52.9)	4/5	5(50.0)	0/2
肺部感染	6(35.3)	1/5	4(40.0)	1/2
肺动脉癌栓	2(11.8)	0/5	1(10.0)	1/2

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