儿童血管相关性咯血影响咯血量及术后复发高危因素分析

doi:10.12372/jcp.2023.22e0415

摘要/Abstract

摘要： 目的总结儿童血管相关性咯血的临床特点，分析影响咯血量的高危因素，并探讨接受介入治疗后咯血复发的潜在原因。方法回顾性分析2012年1月至2020年1月接受介入治疗的血管相关性咯血患儿的临床资料。患儿依据咯血量大小分为大咯血组与非大咯血组，依据术后咯血是否复发分为复发组与非复发组，并进行logistic多因素回归分析，对影响咯血量及术后咯血复发的因素进行统计和分析。结果共纳入41例血管相关性咯血患儿，男19例、女22例，中位年龄为8.9（6.9~11.2）岁。胸部血管增强CT检查提示32例患儿异常血管定位在右肺，以右肺下叶为主，3例为双肺，1例为左肺，5例未发现异常血管。二分类logistic回归分析发现，异常血管内径大、肺炎支原体（MP）感染是影响咯血量大小的独立危险因素（P<0.05），而异常血管数量多是咯血复发的独立危险因素（P<0.05）。结论儿童血管相关性咯血中影响咯血量的高危因素是异常血管内径以及MP感染，介入封堵异常血管是儿童血管相关性咯血安全有效的治疗方法，异常血管数量为介入术后复发的重要预测因子。

关键词: 咯血, 血管畸形, 咯血量, 复发, 儿童

Abstract: Objective To summarize the clinical characteristics of children with vascular-related hemoptysis, in order to find the risk factors of hemoptysis volume and recurrence. Methods The clinical data of children with vascular-related hemoptysis who received interventional therapy from January 2012 to January 2020 were retrospectively analyzed. According to the hemoptysis volume, children were divided into massive hemoptysis group and non-massive hemoptysis group. According to the clinical outcome, they were divided into relapsed group and non-relapsed group. Logistic multivariate regression analysis was used to analyze the factors affecting the hemoptysis volume and the recurrence of postoperative hemoptysis. Results A total of 41 children (19 boys and 22 girls) with vascular-related hemoptysis were included, and the median age was 8.9 (6.9-11.2) years. Chest vascular enhancement CT showed that abnormal blood vessels were located in the right lung in 32 cases, mainly in the lower lobe of the right lung. Abnormal blood vessels were found in both lungs in 3 cases, in the left lung in 1 case, and no abnormal blood vessels were found in 5 cases. Binary logistic regression analysis showed that large abnormal blood vessel diameter and Mycoplasma pneumoniae (MP) infection were independent risk factors for hemoptysis (P<0.05), while increased abnormal blood vessels were independent risk factors for the recurrence of hemoptysis (P<0.05). Conclusions The high risk factors affecting the hemoptysis volume in children with vascular-related hemoptysis are abnormal vascular diameter and MP infection. Interventional occlusion of abnormal blood vessels is a safe and effective treatment method, and the number of abnormal blood vessels is an important predictor of postoperative recurrence.

Key words: hemoptysis, vascular malformation, hemoptysis volume, recurrence, child

谢磊, 吕铁伟. 儿童血管相关性咯血影响咯血量及术后复发高危因素分析[J]. 临床儿科杂志, 2023, 41(1): 42-47.

XIE Lei, LYU Tiewei. Risk factors of hemoptysis volume and postoperative recurrence in children with vascular-related hemoptysis[J]. Journal of Clinical Pediatrics, 2023, 41(1): 42-47.

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参考文献 23

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项目	大咯血组(n=18)	非大咯血组(n=23)	统计量	P
男性[n(%)]	10(55.6)	9(39.1)	χ²=1.10	0.295
年龄[M(P₂₅~P₇₅)]/岁	8.8(7.3~10.8)	9.6(6.0~11.8)	Z=0.36	0.723
体重[M(P₂₅~P₇₅)]/kg	24.5(21.5~31.5)	30.0(19.0~38.0)	Z=0.67	0.503
白细胞计数[M(P₂₅~P₇₅)]×10⁹·L^-1	7.1(5.4~8.5)	6.9(5.6~9.7)	Z=0.32	0.753
血红蛋白[M(P₂₅~P₇₅)]/g·L^-1	107.5(102.0~114.8)	117.0(114.0~122.0)	Z=3.56	0.001
中性粒细胞绝对值[M(P₂₅~P₇₅)]×10⁹·L^-1	4.3(2.7~6.3)	4.6(3.4~7.2)	Z=0.97	0.331
MP-PA≥1:320[n(%)]	12(66.7)	8(34.8)	χ²=4.11	0.043
胸部CTA异常血管走向[n(%)]			-	0.423¹⁾
右肺	14(77.7)	18(78.3)
左肺	1(5.6)	0(0.0)
双肺	2(11.1)	1(4.3)
无异常	1(5.6)	4(17.4)
异常血管数量[M(P₂₅~P₇₅)]/支	2.0(1.0~3.0)	2.0(1.0~2.0)	Z=1.73	0.083
异常血管内径[M(P₂₅~P₇₅)]/cm	2.7(1.9~4.7)	1.9(1.5~2.8)	Z=2.00	0.046
手术时间[M(P₂₅~P₇₅)]/h	1.3(1.0~1.9)	0.8(0.6~1.2)	Z=3.23	0.001
住院时间[M(P₂₅~P₇₅)]/d	9.0(5.0~12.0)	12.0(10.0~14.0)	Z=2.16	0.031

项目	偏回归系数	标准误	χ²值	P	OR(95%CI)
MP-PA≥1:320	1.63	0.76	4.65	0.031	5.10(1.16~22.44)
异常血管内径	0.58	0.28	4.45	0.035	1.79(1.04~3.08)
常量	-2.69	1.01	7.11	0.008	0.068

项目	复发组(n=13)	非复发组(n=28)	统计量	P
男性[n(%)]	7(53.8)	12(42.9)	χ²=0.43	0.737
年龄[M(P₂₅~P₇₅)]/岁	9.0(8.1~12.9)	8.9(6.0~10.5)	Z=1.15	0.260
体重[M(P₂₅~P₇₅)]/kg	30.0(24.3~39.5)	24.0(17.5~35.4)	Z=1.64	0.102
白细胞计数[M(P₂₅~P₇₅)]×10⁹·L^-1	7.0(5.3~8.9)	7.1(5.8~9.5)	Z=0.48	0.648
血红蛋白[M(P₂₅~P₇₅)]/g·L^-1	111.0(93.5~117.0)	115.0(109.0~121.5)	Z=2.19	0.029
中性粒细胞绝对值×10⁹·L^-1	4.4(2.9~6.5)	4.6(2.9~6.7)	Z=0.35	0.730
MP-PA≥1:320[n(%)]	10(76.9)	10(35.7)	χ²=6.03	0.020
胸部CTA异常血管走向[n(%)]			-	1.000¹⁾
右肺	11(84.6)	21(75.0)
左肺	0(0.0)	1(3.6)
双肺	1(7.7)	2(7.1)
无异常	1(7.7)	4(14.3)
异常血管数量[M(P₂₅~P₇₅)]/支	2.0(2.0~2.5)	1.0(1.0~2.0)	Z=2.40	0.029
异常血管内径[M(P₂₅~P₇₅))]/cm	2.8(2.1~4.5)	2.0(1.6~3.0)	Z=1.71	0.090
咯血量[M(P₂₅~P₇₅)]/mL·kg^-1·24h^-1	3.7(2.7~3.8)	2.5(1.4~3.7)	Z=1.43	0.159
手术时间[M(P₂₅~P₇₅)]/h	1.0(0.7~1.8)	1.1(0.6~1.4)	Z=0.34	0.750
住院时间[M(P₂₅~P₇₅)]/d	9.0(6.0~12.5)	11.5(9.0~14.0)	Z=1.35	0.186

项目	偏回归系数	标准误	χ²值	P	OR(95%CI)
血红蛋白	-0.08	0.05	2.33	0.127	0.93(0.84~1.02)
MP-PA≥1:320	1.42	0.95	2.27	0.132	4.15(0.65~26.47)
异常血管数量	1.34	0.65	4.27	0.039	3.81(1.07~13.56)
常量	4.32	5.83	0.55	0.458	75.45