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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
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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
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