Clinical implications of haemoptysis in patients with pulmonary arterial hypertension.
Clinical implications of haemoptysis in patients with pulmonary arterial hypertension.
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DOI：
10.1111/ijcp.12004
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发表时间：
2012-10
期刊：
影响因子：
--
通讯作者：
Safdar Z
中科院分区：
文献类型：
--
作者：
Cantu J;Wang D;Safdar Z
肺动脉高压（PAH）是一种致残疾病，可导致咯血。与以咯血为表现的其他类型PAH患者相比，先天性心脏病相关PAH患者（CHD-APAH）可能具有生存优势。PAH患者咯血的病因和后续治疗选择的影响尚不明确。我们对到卫理公会医院就诊的伴有咯血的冠心病- apah与所有其他亚型PAH患者进行了结果分析。21例患者，冠心病- apah组13例，非冠心病组8例。我们评估了该队列中与治疗相关的结果（支气管动脉栓塞与保守治疗）、住院时间、死亡率和生存率。CHD-APAH组和非chd组具有相似的基线人口统计学、血流动力学和实验室值，只是非chd组的BMI更高，CHD-APAH组的红细胞压积更高。与非冠心病组相比，冠心病- apah患者28天死亡率（0%对31%）和1年死亡率（0%对54%）较低。冠心病- apah组总随访期生存率差异有统计学意义（p = 0.02）。虽然无统计学意义，但BAE患者的住院时间较短（4.0天±4.0比13.7天±22.5;p = 0.26）。在接受BAE治疗的患者中，有43%的患者再次咯血。PAH患者咯血是一种严重的疾病，死亡率很高。冠心病- apah似乎具有生存优势，与所采用的治疗方法无关。除频繁的再出血发作外，BAE咳血终止迅速，并发症相对较少。需要进一步的研究来确定可能使PAH患者因咯血而死亡率过高的危险因素，并确定最佳的治疗方式。
Pulmonary arterial hypertension (PAH) is a disabling disease that may result in haemoptysis. Patients with congenital heart disease associated PAH (CHD-APAH) may have a survival advantage when compared with patients with other types of PAH presenting with haemoptysis. The effects of aetiology and sub-sequent management choice of haemoptysis in PAH patients is not well-defined. We conducted outcome analysis in CHD-APAH vs. all other subtypes of PAH patients presenting with haemoptysis to The Methodist Hospital. Twenty-one patients were identified, thirteen patients in the CHD-APAH group and eight patients in the non-CHD group. We evaluated outcomes related to treatment (bronchial artery embolization vs. conservative management), hospital length of stay, mortality rates and survival in this cohort. The CHD-APAH and non-CHD groups had similar baseline demographic, haemodynamic and laboratory values except BMI was higher in the non-CHD group and haematocrit was higher in the CHD-APAH group. Twenty-eight-day mortality (0% vs. 31%) and 1-year mortality (0% vs. 54%) was lower in the CHD-APAH patients as compared with non-CHD group. A statistically significant difference was found in the survival rate in favour of CHD-APAH group for the total follow-up period (p = 0.02). Although not statistically significant, patients treated with BAE had shorter length of stay (4.0 days ± 4.0 vs. 13.7 days ± 22.5; p = 0.26). There was recurrent haemoptysis in 43% of patients treated with BAE. Haemoptysis in PAH patients is a serious event with a high mortality rate. CHD-APAH seems to confer a survival advantage, independent of therapy utilised. Termination of haemoptysis with BAE is rapid with relatively few complications except for frequent re-bleeding episodes. Further studies are needed to determine the risk factors that may predispose PAH patients to excessive mortality from haemoptysis and to identify an optimal therapeutic modality.
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影响因子：
1.1
作者：
Cantu JA;Safdar Z
通讯作者：
Safdar Z
影响因子：
9.6
作者：
Chin, Kelly M.;Channick, Richard N.;Rubin, Lewis J.
通讯作者：
Rubin, Lewis J.
影响因子：
5
作者：
Hsiao, EI;Kirsch, CM;Baxter, RB
通讯作者：
Baxter, RB
影响因子：
1.3
作者：
KAUCZOR, HU;SCHWICKERT, HC;THELEN, M
通讯作者：
THELEN, M
影响因子：
24.3
作者：
Humbert, M.;Sitbon, O.;Simonneau, G.
通讯作者：
Simonneau, G.