Efficacy and Safety of Bronchial Artery Embolization on Hemoptysis in Chronic Thromboembolic Pulmonary Hypertension: A Pilot Prospective Cohort Study
Efficacy and Safety of Bronchial Artery Embolization on Hemoptysis in Chronic Thromboembolic Pulmonary Hypertension: A Pilot Prospective Cohort Study
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支气管动脉栓塞治疗慢性血栓栓塞性肺动脉高压咯血的疗效和安全性：一项试点前瞻性队列研究
DOI：
10.1097/ccm.0000000000003578
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发表时间：
2019-03-01
影响因子：
8.8
通讯作者：
Huang, Kewu
中科院分区：
文献类型：
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作者：
Yang, Suqiao;Wang, Jianfeng;Huang, Kewu
目的：由于难以维持受影响患者的凝血稳态，因此管理慢性血栓栓塞性肺动脉高压的咯血可能具有挑战性。在本研究中，我们评估支气管动脉栓塞治疗慢性血栓栓塞性肺动脉高压患者咯血的有效性和安全性。设计：前瞻性队列研究。单位：一家大型呼吸医学研究所。患者：从2012年1月1日至2017年12月31日，住院的慢性血栓栓塞性肺动脉高压患者有资格入选。排除因其他疾病引起的肺动脉高压患者或未能参加随访的患者。干预措施：慢性血栓栓塞性肺动脉高压患者的咯血根据是否可以单独使用药物止血以及患者是否愿意进行支气管动脉栓塞治疗而进行支气管动脉栓塞治疗。测量和主要结果：连续收集328例确诊为慢性血栓栓塞性肺动脉高压的患者，317例患者完成随访。慢性血栓栓塞性肺动脉高压合并咯血患者共15例，咯血发生率为4.7%。在咯血的慢性血栓栓塞性肺动脉高压患者中，10例（67%）接受了支气管动脉栓塞治疗，5例（33%）仅接受药物治疗。咯血患者的中位随访期为7.6个月。在接受支气管动脉栓塞治疗的患者中，氧合指数和右心功能在支气管动脉栓塞前后无显著差异。与未接受支气管动脉栓塞治疗的患者相比，接受支气管动脉栓塞治疗的患者的咯血复发率（20% vs 80%; p = 0.025）和咯血相关死亡率（0% vs 40%; p = 0.032）显著较低，而总生存率（90% vs 40%; p = 0.040）较高。结论：支气管动脉栓塞术在我们中心治疗慢性血栓栓塞性肺动脉高压患者咳血方面表现出有效性和安全性，但在被认为是这些患者的有效治疗方法之前还需要进一步的对照研究。
Objectives: Managing hemoptysis in chronic thromboembolic pulmonary hypertension can be challenging due to the difficulties in maintaining coagulation homeostasis in affected patients. In this study, we evaluated the efficacy and safety of bronchial artery embolization in treating hemoptysis in chronic thromboembolic pulmonary hypertension patients. Design: Pilot, prospective cohort study. Setting: A large respiratory medical institute. Patients: From January 1, 2012, to December 31, 2017, hospitalized chronic thromboembolic pulmonary hypertension patients were eligible for inclusion. Patients with pulmonary hypertension caused by other conditions, or who failed to participate in the follow-up were excluded. Interventions: Hemoptysis in chronic thromboembolic pulmonary hypertension patients was treated with or without bronchial artery embolization based on whether the bleeding could be stopped with medication alone and patient willingness for bronchial artery embolization treatment. Measurements and Main Results: A total of 328 patients diagnosed with chronic thromboembolic pulmonary hypertension were consecutively collected, 317 patients were completed the follow-up. There were 15 chronic thromboembolic pulmonary hypertension patients with hemoptysis in total, and the occurrence rate of hemoptysis in chronic thromboembolic pulmonary hypertension patients was 4.7%. Among the hemoptysis chronic thromboembolic pulmonary hypertension patients, 10 (67%) underwent bronchial artery embolization, and five (33%) were treated with medication only. The median follow-up period for hemoptysis patients was 7.6 months. In patients underwent bronchial artery embolization treatment, oxygenation index and right heart function showed no significant difference between pre bronchial artery embolization and post bronchial artery embolization. Hemoptysis relapse (20% vs 80%; p = 0.025) and hemoptysis-related mortality (0% vs 40%; p = 0.032) were significantly lower, whereas the overall survival (90% vs 40%; p = 0.040) was higher in patients treated with bronchial artery embolization than in patients treated without bronchial artery embolization. Conclusions: Bronchial artery embolization procedure demonstrated effectiveness and safety to treat hemoptysis in chronic thromboembolic pulmonary hypertension patients at our center, but further controlled studies are needed before it can be considered as an effective therapy for these patients.