切换至 "中华医学电子期刊资源库"
高级检索
中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2020, Vol. 13 ›› Issue (02) : 134 -138. doi: 10.3877/cma.j.issn.1674-6902.2020.02.002

论著

肺癌合并肺栓塞的胸部CT血管造影特点分析
崔永奇1, 郑宇1, 张丽妍1, 陈增爱2,†(), 吴学玲1,†()   
  1. 1. 201112　上海，上海交通大学医学院附属仁济医院南院呼吸科
    2. 201112　上海，上海交通大学医学院附属仁济医院南院放射科
  • 收稿日期:2019-12-11 出版日期:2020-04-25
  • 通信作者: 陈增爱, 吴学玲
  • 基金资助:
    国家自然科学基金资助项目(81270130)

Imaging analysis on pulmonary computed tomography angiography of patients with lung cancer complicated with pulmonary embolism

Yongqi Cui1, Yu Zheng1, Liyan Zhang1, Zengai Chen2,†(), Xueling Wu1,†()   

  1. 1. Department of Respiratory Medicine, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201112, China
    2. Radiology department, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201112, China
  • Received:2019-12-11 Published:2020-04-25
  • Corresponding author: Zengai Chen, Xueling Wu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

崔永奇, 郑宇, 张丽妍, 陈增爱, 吴学玲. 肺癌合并肺栓塞的胸部CT血管造影特点分析[J]. 中华肺部疾病杂志(电子版), 2020, 13(02): 134-138.

Yongqi Cui, Yu Zheng, Liyan Zhang, Zengai Chen, Xueling Wu. Imaging analysis on pulmonary computed tomography angiography of patients with lung cancer complicated with pulmonary embolism[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(02): 134-138.

目的

分析肺癌合并肺栓塞患者胸部CT血管造影(computed tomography angiography, CTA)特点以提高肺癌患者肺栓塞的检出率。

方法

回顾性分析由胸部CTA首次诊断的肺栓塞患者90例，按是否合并肺癌标记为病例组(n＝40)和对照组(n＝50)，分析比较两组之间胸部CTA影像学特点：栓塞部位、肺动脉直径、栓塞程度、是否伴有肺内渗出及胸腔积液等栓塞相关直接及间接征象。

结果

病例组和对照组发生中央型肺栓塞者分别为22例(55%)、15例(30%) (P<0.05)；合并肺内渗出性病灶者分别有14例(35%)、29例(58%) (P<0.05)；合并胸腔积液者分别为19例(47.5%)、13例(26%) (P<0.05)；以上比较差异均具有统计学意义。但合并肺动脉增宽者病例组11例(27.5%)，对照组9例(18%)，P>0.05，差异无统计学意义。肺栓塞严重程度方面对比，两组首先均进行组内非大面积和大面积、非大面积和次大面积栓塞概率两两比较，结果显示两组内非大面积肺栓塞发病率均最高(P<0.05)；其次，进行病例组和对照组组间对比，结果显示两组之间大面积和大面积(P＝0.083)、次大面积和次大面积(P＝0.090)栓塞概率均无统计学差异，而非大面积栓塞的概率病例组高于对照组(P＝0.040)；危险因素方面，病例组发生下肢深静脉血栓者9例(22.5%)，对照组13例(26.0%)，P>0.05。

结论

肺癌合并肺栓塞相比单纯肺栓塞有一些特殊的影像学表现，及时发现这些栓塞征象有助于改善肺癌合并肺栓塞患者预后。

关键词: 支气管肺癌, 肺栓塞, 胸部CT血管造影
Objective

To improve the pulmonary embolism detection rate of the lung cancer patients through analyzing the characteristics of pulmonary computed tomography angiography (CTA) of the patients with lung cancer complicated with pulmonary embolism (PE).

Methods

The clinical data of 90 patients with PE primarily diagnosed by pulmonary CTA were retrospectively reviewed. And 40 patients complicated with lung cancer were taken as the case group and 50 patients complicated with no lung cancer were taken as the control group. The imaging features of pulmonary CTA including thrombus location, pulmonary arterial diameter, severity of pulmonary embolism, the combination of intrapulmonary exudation and pleural effusion or not, and other PE direct/indirect signs were analyzed and compared between the two groups.

Results

Central type of PEs occurred in 22 patients (55%) in the case group and 15 patients (30%) in the control group (P<0.05). And 14 patients (35%) were complicated with lung exudative lesions in the case group and 29 patients (58%) in the control group (P<0.05). Moreover, 19 patients (47.5%) had pleural effusion in the case group and 13 patients (26%) in the control group (P<0.05). All the above comparisons showed statistical significant differences. Whereas, there was no significant difference in the widened pulmonary arterial diameter, with 11 patients (27.5%) in the case group and 9 patients (18%) in the control group (P>0.05). As for the severity of PE, we firstly performed the comparison of non-massive and massive PEs together with non-massive and submassive PEs within groups, meanwhile, the results showed that non-massive PEs both accounted for the highest proportion in the two groups (P<0.05). Secondly, the inter-group comparisons of massive and massive PEs (P=0.083) together with submassive and submassive PEs (P=0.090) also were carried out, but the results showed no remarkable differences. However, the patients in the case group had a higher risk to develop non-massive PE, in comparison with the patients in the control group (P=0.040). The risk factor analysis demonstrated that 9 patients (22.5%) in the case group suffered from deep venous thrombosis (DVT) in the lower extremity, in contrast to the 13 individuals (26.0%) in the control group (P>0.05).

Conclusion

Awareness of the special imaging features of PE combined with lung cancer may contribute to improve the prognosis of such patients.

Key words: Bronchogemc carcinoma, Pulmonary embolism, Pulmonary computed tomography angiography
表1 病例组和对照组计数资料比较
观察指标 例数 中央型肺栓塞 合并肺内渗出性病灶 合并胸腔积液 合并肺动脉增宽
肺癌合并肺栓塞组 40 22 14 19 11
单纯肺栓塞组 50 15 29 13 9
  χ2值   5.737 4.712 4.483 1.160
  P值   0.017 0.030 0.034 0.281
图1 肺栓塞胸部CTA图像；注：蓝色箭头为肿瘤原发灶；红色箭头为栓塞部位
1
Ekici A, Ileri S, Aslan H, et al. Troublesome cough as the sole manifestation of pulmonary embolism[J]. Respir Med Case Rep, 2019, 28: 100861.
2
Zuin M, Rigatelli G. Complete heart block as presenting symptom of massive pulmonary embolism in an elderly patient[J]. J Geriatr Cardiol, 2017, 14(9): 593-594.
3
Doherty S. Pulmonary embolism an update[J]. Aust Fam Physician，2017, 46(11): 816-820.
4
Rybstein MD, DeSancho MT. Hypercoagulable states and thrombophilias：risks relating to recurrent venous thromboembolism[J]. Semin Intervent Radiol, 2018, 35(2): 99-104.
5
Torre LA, Siegel RL, Jemal A. Lung cancer statistics[J]. Adv Exp Med Biol, 2016, 893: 1-19.
6
Ma L, Wen Z. Risk factors and prognosis of pulmonary embolism in patients with lung cancer[J]. Medicine (Baltimore), 2017, 96(16): e6638.
7
Hua X, Han SH, Wei SZ, et al. Clinical features of pulmonary embolism in patients with lung cancer: A meta-analysis[J]. Plos One, 2019, 14(9): e223230.
8
钱桂生. 肺癌不同病理类型发病率的变化情况及其原因[J/CD]. 中华肺部疾病杂志(电子版), 2011, 4(1): 1-5.
9
任成山，白　莉，钱桂生. 慢性阻塞性肺疾病合并肺癌临床特征及新理念[J/CD]. 中华肺部疾病杂志(电子版), 2015, 8(2): 137-142.
10
Li G, Li Y, Ma S. Lung cancer complicated with asymptomatic pulmonary embolism: clinical analysis of 84 patients[J]. Technol Cancer Res Treat, 2017, 16(6): 1130-1135.
11
Albrecht MH, Bickford MW, Nance JJ, et al. State-of-the-art pulmonary CT angiography for acute pulmonary embolism[J]. AJR Am J Roentgenol, 2017, 208(3): 495-504.
12
Abdelwahab HW, Arafa S, Bondok K, et al. Relationship between clot burden in pulmonary computed tomography angiography and different parameters of right cardiac dysfunction in acute pulmonary embolism[J]. Cardiovasc J Afr, 2019, 30: 1-4.
13
Wittram C, Maher MM, Yoo AJ, et al. CT angiography of pulmonary embolism: diagnostic criteria and causes of misdiagnosis[J]. Radiographics, 2004, 24(5): 1219-1238.
14
Gouin B, Blondon M, Jimenez D, et al. Clinical prognosis of nonmassive central and noncentral pulmonary embolism: A registry-based cohort study[J]. Chest, 2017, 151(4): 829-837.
15
中华医学会呼吸病学分会. 肺血栓栓塞症的诊断与治疗指南(草案)[J]. 中国临床医生，2002, 30(4): 26-30.
16
Soffker G, Kluge S. [Pulmonary embolism][J]. Dtsch Med Wochenschr，2015, 140(2): 89-96.
17
Jia D, Li X L, Zhang Q, et al. A decision tree built with parameters obtained by computed tomographic pulmonary angiography is useful for predicting adverse outcomes in non-high-risk acute pulmonary embolism patients[J]. Respir Res, 2019, 20(1): 187-191.
18
Li Y, Shang Y, Wang W, et al. Lung cancer and pulmonary embolism: what is the relationship? a review[J]. J Cancer, 2018, 9(17): 3046-3057.
19
Maia R, Neves I, Morais A, et al. Venous and lung thromboembolism in the context of lung cancer: clinical manifestations, risk factors and prognosis[J]. Acta Med Port, 2019, 32(10): 647-653.
20
Menditto VG, Mei F, Postacchini L, et al. Pulmonary embolism: a retrospective comparative study between patients with atypical vs typical clinical presentation[J]. Recenti Prog Med, 2019, 110(2): 93-97.
21
Hasenberg U, Paul T, Feuersenger A, et al. Cancer patients and characteristics of pulmonary embolism[J]. Eur J Radiol, 2009, 69(3): 478-482.
22
金琼英，胡红杰，陈　彬，等. 恶性肿瘤合并肺栓塞的CT肺动脉造影及临床表现分析[J]. 实用放射学杂志，2012, 28(6): 869-872.
23
Kiris T, Yazici S, Koc A, et al. Prognostic impact of pleural effusion in acute pulmonary embolism[J]. Acta Radiol, 2017, 58(7): 816-824.
24
Sendama W, Musgrave KM. Decision-making with D-Dimer in the diagnosis of pulmonary embolism[J]. Am J Med, 2018, 131(12): 1438-1443.
25
Rawat N, Mathur N, Rawat K, et al. Correlation of D-Dimer level with the presence and severity of pulmonary embolism on computed tomography pulmonary angiography[J]. J Assoc Physicians India, 2018, 66(10): 40-41.
26
Faghihi LT, Sheikh M, Naderian M, et al. The association between the pulmonary arterial obstruction index and atrial size in patients with acute pulmonary embolism[J]. Radiol Res Pract, 2019, 2019: 6025931.
27
Tonelli A R, Johnson S, Alkukhun L, et al. Changes in main pulmonary artery diameter during follow-up have prognostic implications in pulmonary arterial hypertension[J]. Respirology, 2017, 22(8): 1649-1655.
28
Caro-Dominguez P, Compton G, Humpl T, et al. Pulmonary arterial hypertension in children: diagnosis using ratio of main pulmonary artery to ascending aorta diameter as determined by multi-detector computed tomography[J]. Pediatr Radiol, 2016, 46(10): 1378-1383.
29
Kasper W, Geibel A, Tiede N, et al. Distinguishing between acute and subacute massive pulmonary embolism by conventional and Doppler echocardiography[J]. Br Heart J, 1993, 70(4): 352-356.
30
Park DY, Khorana AA. Risks and benefits of anticoagulation in cancer and noncancer patients[J]. Semin Thromb Hemost, 2019, 45(6): 629-637.
31
Becattini C, Cohen AT, Agnelli G, et al. Risk stratification of patients with acute symptomatic pulmonary embolism based on presence or absence of lower extremity DVT: systematic review and Meta-analysis[J]. Chest, 2016, 149(1): 192-200.
32
Cordeanu EM, Lambach H, Heitz M, et al. Pulmonary embolism and coexisting deep vein thrombosis: a detrimental association？[J]. J Clin Med, 2019, 8(6): e899.
[1] 李霞, 周鸿. 肺癌乳腺转移合并肺栓塞1例[J]. 中华乳腺病杂志(电子版), 2024, 18(03): 189-191.
[2] 吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[3] 张璇, 高杨, 房雅君, 姚艳玲. 保护性机械通气在肺癌胸腔镜肺段切除术中的临床应用[J]. 中华肺部疾病杂志(电子版), 2024, 17(04): 563-567.
[4] 陶银花, 张红杰, 王亚岚, 陈莲, 张珺. 间歇式气压治疗预防肺癌化疗下肢深静脉血栓的临床分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(04): 605-608.
[5] 任甜甜, 张玉慧, 祁玲霞, 朱梅冬, 胡佳. 多学科疼痛管理对胸腔镜肺叶切除术后胸痛及应激反应的影响分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(04): 630-633.
[6] 林建琴, 孔令敏, 陆银凤, 陈勇, 金凤, 叶磊, 陈方梅. PERMA模式对肺癌患者治疗获益感及生活质量的影响分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(04): 634-638.
[7] 殷国青, 曾莉, 贺斌峰, 孙芬芬. Rab26负性调控Nrf2增强肺癌耐药细胞对奥希替尼的敏感性[J]. 中华肺部疾病杂志(电子版), 2024, 17(03): 349-355.
[8] 邓世君, 刘晓青, 刘权兴. 信息化管理在肺癌围手术期中的临床应用[J]. 中华肺部疾病杂志(电子版), 2024, 17(03): 466-468.
[9] 吕欣谕, 李雯, 王娟侠, 邹维, 王艳, 雷杰. 围手术期肺康复训练在胸腔镜肺叶切除术中疗效分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 256-259.
[10] 赵信燕, 岳晓霞, 曹瑞玲, 张惠丽, 李向杰. 急性肺栓塞影像学及临床特征分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 296-299.
[11] 陈羽霞, 柏佩梅, 芦遥遥. 综合干预对肺癌化疗患者的影响[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 307-309.
[12] 胡航, 陈婷婷, 孙健, 孙云浩, 仇丽敏. 三维重建技术在单操作孔胸腔镜肺段切除术的临床应用[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 310-312.
[13] 陈杨, 李茜, 杨中华. 慢性阻塞性肺疾病急性加重期合并VTE抗凝治疗的研究进展[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 316-319.
[14] 张剑, 卢从华, 李江华, 林采余, 吴迪, 王治国, 聂乃夫, 何勇, 李力. 根据转录组学分析奥希替尼获得性耐药机制的研究[J]. 中华肺部疾病杂志(电子版), 2024, 17(02): 195-200.
[15] 周帅, 张庆海, 王新, 马晓艳, 孙建霞, 王海波, 张继红. 静脉-动脉体外膜肺氧合辅助下溶栓治疗急性高危肺栓塞一例[J]. 中华重症医学电子杂志, 2024, 10(03): 298-302.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号