肺结核病变表现与咯血责任血管相关性的CT血管成像评价

Association between CT findings of pulmonary tuberculosis lesions and offending vessels of hemoptysis：an analysis based on CT angiography

摘要:

目的：通过分析肺结核伴咯血患者的胸部CT表现与咯血责任血管来源之间的关系，提高依据胸部CT血管成像（CT angiography，CTA）寻找咯血责任血管的能力。方法：回顾性分析2013年6月至2018年10月间64例肺结核伴咯血患者的临床、数字减影血管成像（digital subtraction angiography，DSA）及CTA资料，着重分析肺部结核病灶表现、邻近胸膜受累情况及其与咯血责任血管来源间的相互关系，总结肺结核不同胸部CT表现与咯血责任血管间的相关性。结果：结合DSA确诊的咯血责任血管，64例患者CTA检查均可见病理性扩张的支气管动脉（bronchial arteries，BA），其中41例合并有非支气管性体动脉（non-bronchial systemic artery，NBSA）分支参与供血，最常见的NBSA为肋间动脉（37例，40.2%），其次为锁骨下动脉（22例，23.9%）。64例患者中，肺部病变以增殖、渗出、纤维化为主者，胸膜无/轻度增厚、明显增厚者以及病灶与胸膜无/轻度粘连、紧密粘连者分别为17例（26.6%）、15例（23.4%）、32例（50%），26例（40.6%）、38例（59.4%）及25例（39.1%）、39例（60.9%），其中各组中伴有病理性NBSA者分别为6例（35.3%）、6例（40.0%）、29例（90.6%），4例（15.4%）、37例（97.4%）及2例（8.0%）、39例（100%），差异均具有统计学意义（P＜0.01）。病灶的累及范围及其内有无支气管扩张与咯血责任血管来源无显著相关性。结论：肺结核患者胸部CT表现与咯血责任血管来源紧密相关，对于肺部病灶以纤维化为主，邻近胸膜明显增厚且二者紧密粘连者，CTA除要评价BA外，还需进一步全面评估有无NBSA供血。

Abstract:

Objective：To investigate the association between chest computed tomography（CT） findings of pulmonary tuberculosis lesions and the source of offending vessels of hemoptysis in patients with pulmonary tuberculosis and hemoptysis，and to improve the ability of chest computed tomography angiography（CTA） in search for offending vessels of hemoptysis. Methods：A retrospective analysis was performed for the clinical data，digital subtraction angiography（DSA） findings，and CTA findings of 64 patients with pulmonary tuber－culosis and hemoptysis who were treated from June 2013 to October 2018，with focuses on the CT findings of pulmonary tuberculosis lesions，the involvement of the adjacent pleura，and the association of pulmonary and pleural lesions with the source of offending ves－sels of hemoptysis. The association between chest CT findings of pulmonary tuberculosis lesions and offending vessels for hemoptysis was analyzed. Results：With reference to the offending vessels of hemoptysis identified by DSA，all 64 patients had pathologically di－lated bronchial arteries（BA） on CTA，among whom 41 also had involvement of the branches of non-bronchial systemic artery（NBSA） in hemoptysis. The most common NBSA involved was the intercostal artery found in 37 patients（40.2%），followed by the subclavian artery found in 22 patients（23.9%）. Of all 64 patients，17（26.6%） had proliferation of pulmonary lesions，15（23.4%） had exudation of pulmonary lesions，and 32（50%） had fibrosis of pulmonary lesions；26（40.6%） had no or mild pleural thickening，and 38（59.4%） had marked pleural thickening；25 （39.1%） had no or mild adhesion between lesions and the pleura，and 39（60.9%） had severe adhesion. The numbers of patients with pathological NBSA in each group were 6（35.3%），6（40.0%），29 （90.6%）；4（15.4%），37（97.4%），2（8.0%），and 39（100%），respectively，and there was a significant difference between groups（P<0.01）. The extent of lesions and the presence or absence of bronchiectasis in lesions were not significantly associated with the offending vessels of hemoptysis. Conclusion：In patients with pulmonary tuberculosis，chest CT findings of pulmonary tuberculosis lesions are closely associated with the source of offending vessels of hemoptysis. For patients with marked fibrosis of pulmonary lesions，marked thickening of the adjacent pleura，and severe adhesion between lesions and the pleura，CTA should be performed to evaluate BA，and it is also necessary to determine whether NBSAs are responsible for hemoptysis.