中国综合临床
中國綜閤臨床
중국종합림상
Clinical Medicine of China
2015年
12期
1102-1106
,共5页
目的 回顾性分析原发性肺动脉肉瘤(PAS)和肺血栓栓塞症(PTE)的临床特点,比较二者异同,提高对PAS的早期识别能力.方法 对经手术病理明确诊断的10例PAS患者的临床资料进行分析,并随机选取10例PTE患者作为对照组,比较临床特点.结果 (1)两组患者活动性胸闷气短、间断性晕厥、心悸、胸痛、咳嗽、体质量下降主要临床表现比较差异均无统计学意义(P均＞0.05).(2)PAS患者低氧血症PaO2＜80 mmHg 2例(20.0％),而PTE患者PaO2＜80 mmHg 8例(80.0％),两组比较差异有统计学意义(x2=7.200,P=0.023).(3) Wells评分:PAS组以低危为主(80.0％与10.0％),PTE组以中、高危为主(90.0％与20.0％),两组比较差异有统计学意义(P值分别为0.005、0.001).(4)两组ECG、UCG、X线、肺通气/灌注特征比较差异均无统计学意义(P均＞0.05).(5)PAS组与PTE组LDH(100％与0)、CRP(100％与0),比较差异均有统计学意义(x2=10.796,P=0.003;x2=15.000,P=0.000).PAS组较PET组ESR增快(75％与0),两组比较差异有统计学意义(x2=1.400,P=0.011).PAS组则无一例D-Dimer＞500 μg/L,而PTE组患者D-Dimer均＞500 μg/L(10例,100％),差异有统计学意义(x2=17.000,P=0.000).(6) PAS组合并深静脉血栓(DVT)1例(12.5％),PTE组6例(60.0％),两组比较差异有统计学意义(x2=10.568,P=0.001).(7)从CT肺血管造影(CTPA)看,PAS组主肺动脉干(85.7％与0)、左肺动脉干(85.7％与10.0％)、右肺动脉干(100％与10.0％)以及双肺动脉干(85.7％与10.0％)多见充盈缺损,和PTE组比较差异有统计学意义(x2=13.247,P=0.001;x2=9.746,P=0.004;x2=13.388,P=0.000;x2=9.746,P=0.004).结论 从临床症状、ECG、UCG、X线、肺通气/灌注显像上不能区分PAS和PTE,极易将PAS误诊为PTE;通过血气分析有无低氧血症、Wells评分、LDH、CRP、ESR、D-Dimer、DVT、CTPA有助于早期识别PAS.
目的 迴顧性分析原髮性肺動脈肉瘤(PAS)和肺血栓栓塞癥(PTE)的臨床特點,比較二者異同,提高對PAS的早期識彆能力.方法 對經手術病理明確診斷的10例PAS患者的臨床資料進行分析,併隨機選取10例PTE患者作為對照組,比較臨床特點.結果 (1)兩組患者活動性胸悶氣短、間斷性暈厥、心悸、胸痛、咳嗽、體質量下降主要臨床錶現比較差異均無統計學意義(P均＞0.05).(2)PAS患者低氧血癥PaO2＜80 mmHg 2例(20.0％),而PTE患者PaO2＜80 mmHg 8例(80.0％),兩組比較差異有統計學意義(x2=7.200,P=0.023).(3) Wells評分:PAS組以低危為主(80.0％與10.0％),PTE組以中、高危為主(90.0％與20.0％),兩組比較差異有統計學意義(P值分彆為0.005、0.001).(4)兩組ECG、UCG、X線、肺通氣/灌註特徵比較差異均無統計學意義(P均＞0.05).(5)PAS組與PTE組LDH(100％與0)、CRP(100％與0),比較差異均有統計學意義(x2=10.796,P=0.003;x2=15.000,P=0.000).PAS組較PET組ESR增快(75％與0),兩組比較差異有統計學意義(x2=1.400,P=0.011).PAS組則無一例D-Dimer＞500 μg/L,而PTE組患者D-Dimer均＞500 μg/L(10例,100％),差異有統計學意義(x2=17.000,P=0.000).(6) PAS組閤併深靜脈血栓(DVT)1例(12.5％),PTE組6例(60.0％),兩組比較差異有統計學意義(x2=10.568,P=0.001).(7)從CT肺血管造影(CTPA)看,PAS組主肺動脈榦(85.7％與0)、左肺動脈榦(85.7％與10.0％)、右肺動脈榦(100％與10.0％)以及雙肺動脈榦(85.7％與10.0％)多見充盈缺損,和PTE組比較差異有統計學意義(x2=13.247,P=0.001;x2=9.746,P=0.004;x2=13.388,P=0.000;x2=9.746,P=0.004).結論 從臨床癥狀、ECG、UCG、X線、肺通氣/灌註顯像上不能區分PAS和PTE,極易將PAS誤診為PTE;通過血氣分析有無低氧血癥、Wells評分、LDH、CRP、ESR、D-Dimer、DVT、CTPA有助于早期識彆PAS.
목적 회고성분석원발성폐동맥육류(PAS)화폐혈전전새증(PTE)적림상특점,비교이자이동,제고대PAS적조기식별능력.방법 대경수술병리명학진단적10례PAS환자적림상자료진행분석,병수궤선취10례PTE환자작위대조조,비교림상특점.결과 (1)량조환자활동성흉민기단、간단성훈궐、심계、흉통、해수、체질량하강주요림상표현비교차이균무통계학의의(P균＞0.05).(2)PAS환자저양혈증PaO2＜80 mmHg 2례(20.0％),이PTE환자PaO2＜80 mmHg 8례(80.0％),량조비교차이유통계학의의(x2=7.200,P=0.023).(3) Wells평분:PAS조이저위위주(80.0％여10.0％),PTE조이중、고위위주(90.0％여20.0％),량조비교차이유통계학의의(P치분별위0.005、0.001).(4)량조ECG、UCG、X선、폐통기/관주특정비교차이균무통계학의의(P균＞0.05).(5)PAS조여PTE조LDH(100％여0)、CRP(100％여0),비교차이균유통계학의의(x2=10.796,P=0.003;x2=15.000,P=0.000).PAS조교PET조ESR증쾌(75％여0),량조비교차이유통계학의의(x2=1.400,P=0.011).PAS조칙무일례D-Dimer＞500 μg/L,이PTE조환자D-Dimer균＞500 μg/L(10례,100％),차이유통계학의의(x2=17.000,P=0.000).(6) PAS조합병심정맥혈전(DVT)1례(12.5％),PTE조6례(60.0％),량조비교차이유통계학의의(x2=10.568,P=0.001).(7)종CT폐혈관조영(CTPA)간,PAS조주폐동맥간(85.7％여0)、좌폐동맥간(85.7％여10.0％)、우폐동맥간(100％여10.0％)이급쌍폐동맥간(85.7％여10.0％)다견충영결손,화PTE조비교차이유통계학의의(x2=13.247,P=0.001;x2=9.746,P=0.004;x2=13.388,P=0.000;x2=9.746,P=0.004).결론 종림상증상、ECG、UCG、X선、폐통기/관주현상상불능구분PAS화PTE,겁역장PAS오진위PTE;통과혈기분석유무저양혈증、Wells평분、LDH、CRP、ESR、D-Dimer、DVT、CTPA유조우조기식별PAS.
Objective To investigate the clinical characteristics of pulmonary artery sarcoma (PAS) and pulmonary thromboembolism(PTE), to improve doctors' awareness and the early diagnosis of PAS.Methods The clinical data of 10 PAS cases confirmed with biopsy were retrospectively analyzed,and 10 cases with PTE were selected as control group.Results (1) Main clinical manifestations of the two groups were chest tightness, shortness of breath, intermittent syncope, palpitations, chest pain and cough, and there were no statistical significance differences between the two groups (P＞0.05).(2)There were 2 cases (20.0％) PaO2 ＜80 mmHg in patients with PAS.However, there were 8 cases (80.0％)PaO2 ＜ 80 mmHg in control group.The two groups had statistically significant difference (x2 =7.200, P =0.023).(3) Wells score : the cases with PAS was in low risk (80.0％ and 10.0％),however, the cases of control group was in medium and high risk(90.0％ and 20.0％).The two groups had statistically significant difference (P =0.005, 0.001).(4) The two groups had no statistically significant difference in ECG, UCG, X-ray, lung ventilation/perfusion (P＞ 0.05).(5) There had statistically significant difference in terms of LDH and CRP between PAS and PET group (100％ vs.0, x-2 =10.796,P=0.003;100％ vs.0, x2 =15.000, P =0.000).There was faster ESR in PAS group than control group,and the two groups had statistically significant difference (75％ vs.0, x2=1.400, P =0.011).There was no case of D-Dimer＞500 μg,/L in PAS group, while 10 cases in control group, and the two groups had significant statistical difference (x2 =17.000, P =0.000).(6) There was 1 case (12.5％) with DVT in PAS group, 6 cases (60.0％) in PTE group, and the two groups had significant statistical difference (x2=10.568, P =0.001).(7) The CTPA in PAS group showed filling defect in the main pulmonary artery trunk (85.7％ vs.0) ,left pulmonary artery (85.7％ vs.10.0％) ,right pulmonary artery(100％ vs.10.0％) and both left and right pulmonary artery (85.7％ vs.10.0％), the two groups had significant statistical difference (x2 =13.247, P =0.001;x2 =9.746, P=0.004;x2 =13.388, P =0.000;x2 =9.746, P =0.004).Conclusion PAS and PTE can' t be distinguished from the clinical symptoms, ECG, UCG, X-ray,lung ventilation/perfusion imaging.PAS is easily misdiagnosed as PTE.More attention should be given.PAS can be identified early through the blood gas analysis, hypoxemia,Wells score, LDH, CRP, ESR, D-Dimer, DVT and CTPA.
