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

Abstract

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

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.

Figures/Tables 4

References 23

[1]	Barut K, Sahin S, Adrovic A, et al. Idiopathic pulmonary hemosiderosis in a child with recurrent macrophage activation syndrome secondary to systemic juvenile idiopathic arthritis[J]. Case Rep Pediatr, 2017: 5693501.
[2]	Springer DM, Cofta S, Juszkat R, et al. The effectiveness of bronchial artery embolisation in patients with haemoptysis[J]. Adv Respir Med, 2018, 86(5): 220-226. doi: 10.5603/ARM.2018.0035 pmid: 30378649
[3]	Rémy J, Voisin C, Dupuis C, et al. Treatment of hemoptysis by embolization of the systemic circulation[J]. Ann Radiol (Paris), 1974, 17(1): 5-16. pmid: 4820232
[4]	Springer DM, Cofta S, Juszkat R, et al. The effectiveness of bronchial artery embolisation in patients with haemoptysis[J]. Adv Respir Med, 2018, 86(5): 220-226. doi: 10.5603/ARM.2018.0035 pmid: 30378649
[5]	Zheng Z, Zhuang Z, Yang M, et al. Bronchial artery embolization for hemoptysis: a systematic review and meta-analysis[J]. J Interv Med, 2021, 4(4): 172-180. doi: 10.1016/j.jimed.2021.08.003 pmid: 35586385
[6]	Dorji K, Hongsakul K, Jutidamrongphan W, et al. Bronchial artery embolization in life-threatening hemoptysis: outcome and predictive factors[J]. J Belg Soc Radiol, 2021, 105(1): 5. doi: 10.5334/jbsr.2310 pmid: 33598631
[7]	Fu Z, Li X, Cai F, et al. Microspheres present comparable efficacy and safety profiles compared with polyvinyl alcohol for bronchial artery embolization treatment in hemoptysis patients[J]. J Transl Med, 2021, 19(1): 422. doi: 10.1186/s12967-021-02947-7 pmid: 34635108
[8]	Kuang HY, Li Q, Xiang P, et al. Potential factors affected safety and efficacy of transcatheter plug closure for pediatric hemoptysis with anomalous bronchial arteries[J]. J Interv Cardiol, 2019: 5408618.
[9]	吕铁伟, 况虹宇, 易岂建, 等. 儿童血管相关性咯血的规范诊断与治疗[J]. 中华实用儿科临床杂志, 2018, 33(13): 979-982.
[10]	Chiel L, Welsh S, Andren K, et al. Pediatric hemoptysis without bronchiectasis or cardiac disease: etiology, recurrence, and mortality[J]. J Pediatr, 2019, 214: 66-70. doi: 10.1016/j.jpeds.2019.07.049
[11]	Dabó H, Gomes R, Marinho A, et al. Bronchial artery embolisation in management of hemoptysis--a retrospective analysis in a tertiary university hospital[J]. Rev Port Pneumol (2006), 2016, 22(1): 34-38.
[12]	Abid N, Loukil M, Mokni A, et al. Outcomes of bronchial artery embolization for the management of hemoptysis[J]. Tunis Med, 2021, 99(2): 264-268. pmid: 33899197
[13]	Yang J, Liu F, Liang Y, et al. Massive hemoptysis in children[J]. Can Respir J, 2020: 6414719.
[14]	朱紫阳, 覃伟, 余伟, 等. 支气管扩张症伴咯血的血管介入治疗疗效及其复发相关危险因素分析[J]. 中国介入心脏病学杂志, 2021, 29(5): 266-270.
[15]	Bi Y, Zhu Y, Ma X, et al. Development of a scale for early prediction of refractory Mycoplasma pneumoniae pneumonia in hospitalized children[J]. Sci Rep, 2021, 11(1): 6595. doi: 10.1038/s41598-021-86086-5
[16]	Xiao Z, Jiang Y, Gao X, et al. Comparison of the ameliorative effects of Qingfei Tongluo formula and azithromycin on Mycoplasma pneumoniae pneumonia[J]. J Nat Med, 2017, 71(4): 685-692. doi: 10.1007/s11418-017-1098-1
[17]	Fruchter O, Schneer S, Rusanov V, et al. Bronchial artery embolization for massive hemoptysis: long-term follow-up[J]. Asian Cardiovasc Thorac Ann, 2015, 23(1): 55-60. doi: 10.1177/0218492314544310
[18]	Yan HT, Lu GD, Huang XZ, et al. Development of a model to predict recurrence after bronchial artery embolization for non-cancer related hemoptysis[J]. BMC Pulm Med, 2021, 21(1): 419. doi: 10.1186/s12890-021-01790-2
[19]	Tom LM, Palevsky HI, Holsclaw DS, et al. Recurrent bleeding, survival, and longitudinal pulmonary function following bronchial artery embolization for hemoptysis in a U.S. adult population[J]. J Vasc Interv Radiol, 2015, 26(12): 1806-1813. doi: 10.1016/j.jvir.2015.08.019 pmid: 26481824
[20]	Merida-Vieyra J, Aquino-Andrade A, Palacios-Reyes D, et al. Detection of Mycoplasma pneumoniae in Mexican children with community-acquired pneumonia: experience in a tertiary care hospital[J]. Infect Drug Resist, 2019, 12: 925-935. doi: 10.2147/IDR.S193076 pmid: 31118700
[21]	Krafft C, Christy C. Mycoplasma pneumonia in children and adolescents[J]. Pediatr Rev, 2020, 41(1): 12-19. doi: 10.1542/pir.2018-0016
[22]	He J, Liu M, Ye Z, et al. Insights into the pathogenesis of Mycoplasma pneumoniae (Review)[J]. Mol Med Rep, 2016, 14(5): 4030-4036. doi: 10.3892/mmr.2016.5765
[23]	Miyata M, Hamaguchi T. Integrated information and prospects for gliding mechanism of the pathogenic bacterium Mycoplasma pneumoniae[J]. Front Microbiol, 2016, 7: 960.

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

Risk factors of hemoptysis volume and postoperative recurrence in children with vascular-related hemoptysis

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 4

References 23

Related Articles 15

Metrics

Comments

Recommended 0

[1]	ZOU Liping. Childhood encephalopathy: a group of diseases associated with various diseases [J]. Journal of Clinical Pediatrics, 2023, 41(9): 641-643.
[2]	ZHANG Weihua, ZOU Liping, REN Haitao, GUAN Hongzhi. Beware of the pitfalls in diagnosis and treatment of autoimmune encephalitis in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 644-649.
[3]	HOU Chi, CHEN Wenxiong, LIAO Yinting, WU Wenxiao, TIAN Yang, ZHU Haixia, PENG Bingwei, ZENG Yiru, WU Wenlin, CHEN Zongzong, LI Xiaojing. Clinical analysis of autoimmune glial fibrillary acidic protein astrocytopathy in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 656-660.
[4]	YANG Yating, CAI Yuehao, FANG Qiong, CHEN Lang, CHEN Qiaobin, LIN Zhi, WU Feifei, LIN Meng. Clinical analysis of idiopathic and symptomatic occipital lobe epilepsy in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 668-673.
[5]	HOU Ruolin, WU Jing, LI Ling. Pediatric autoimmune encephalitis with brain MRI showing meningeal thickening and enhancement [J]. Journal of Clinical Pediatrics, 2023, 41(9): 674-679.
[6]	WU Yuefang, SUN Yanling, WU Wanshui, DU Shuxu, LI Miao, SUN Liming. Analysis of prognostic factors and survival status of group 4 medulloblastoma in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 686-691.
[7]	SUN Juan, LI Haiying, JIA Peisheng, WANG Huaili. Clinical analysis of fulminant myocarditis in 12 children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 692-696.
[8]	Reviewer: WANG Chenhui, Reviser: YANG Hui. Research progress on early screening and diagnosis of Crohn's disease in children [J]. Journal of Clinical Pediatrics, 2023, 41(9): 708-714.
[9]	SHEN Nan, DU Bailu. Strategies for the diagnosis, treatment, and management of invasive fungal infections in children with hematologic neoplasms [J]. Journal of Clinical Pediatrics, 2023, 41(8): 571-577.
[10]	XU Beixue, LIU Quanbo. Clinical analysis of 195 children with invasive pulmonary fungal infection [J]. Journal of Clinical Pediatrics, 2023, 41(8): 584-588.
[11]	CHEN Hongyu, LIU Zihao, WANG Heping, LIAO Cuijuan, LI Li, WANG Wenjian, LAI Jianwei. Role of nontypeable Haemophilus influenzae biofilms in chronic pulmonary infection in children [J]. Journal of Clinical Pediatrics, 2023, 41(8): 589-593.
[12]	KANG Lei, GUO Fang, LI Lifang, BAI Xinfeng, CHENG Caiyun, XU Meixian. Value of metagenomic next-generation sequencing in children with visceral leishmaniasis associated with hemolytic histiocytosis [J]. Journal of Clinical Pediatrics, 2023, 41(8): 594-598.
[13]	SUN Zhicai, LIU Yuling, LI Xiaolin, PAN Xiaofen. Clinical analysis of 15 children with primary nephrotic syndrome complicated with adrenal crisis [J]. Journal of Clinical Pediatrics, 2023, 41(8): 610-612.
[14]	WANG Hongxia, PAN Xiang, LU Jun. Report a case of α-ketoadipic aciduria caused by compound heterozygous variant of DHTKD1 gene [J]. Journal of Clinical Pediatrics, 2023, 41(8): 624-628.
[15]	XI Bixin, HU Qun, LIU Aiguo. Research advances of the bronchiolitis obliterans syndrome following allogeneic hematopoietic stem cell transplant in children [J]. Journal of Clinical Pediatrics, 2023, 41(8): 629-633.