儿童反复咯血的病因及临床诊治分析

Etiology, clinical features, and diagnosis and treatment of recurrent hemoptysis in children

摘要:

目的 分析儿童反复咯血的病因、临床特点、治疗方法及预后，以提高儿科医师对小儿反复咯血的病因诊断及治疗水平。方法 收集1996 年1 月至2013 年2 月39 例反复咯血患儿的临床、实验室及影像学资料，对其起病年龄、病因、咯血量、影像学改变、治疗方法及随访转归等进行回顾性分析。结果 39 例反复咯血患儿中，特发性肺含铁血黄素沉着症16 例（41%），肺血管畸形8 例（21%），肺动静脉瘘7 例（18%），支气管扩张症3 例（8%），肺结核和肺囊性纤维化各2 例（5%），肺肿瘤1 例（3%）。肺部增强CT 扫描和肺动脉-支气管动脉造影发现35 例患儿肺部有不同程度的影像学改变。反复咯血患儿以Ⅰ度（51%）和Ⅱ度（28%）咯血为主，Ⅲ度（21%）咯血少见。39 例患儿根据不同病因经相应的治疗后咯血均得到有效控制，随访0.5~5 年，除3 例特发性肺含铁血黄素沉着症患儿失访外，其余患儿均未再次发生咯血。结论 反复咯血患儿的病因以特发性肺含铁血黄素沉着症为主，肺部增强CT 扫描和肺动脉-支气管动脉造影检查是诊断反复咯血患儿病因的重要方法，应根据患儿不同的病因选择不同的治疗方法。

Abstract:

Objective To investigate the causes, clinical features, therapy and treatment outcomes of recurrent hemoptysis in children and to improve the skills of pediatricians in the etiological diagnosis and treatment of recurrent hemoptysis in children. Methods The clinical, laboratory, and imaging data of 39 children with recurrent hemoptysis between January 1996 and February 2013 were collected to retrospectively analyze the age of onset, etiology, amount of hemoptysis, imaging changes, treatment methods, and follow-up outcomes. Results In the 39 children, including idiopathic pulmonary hemosiderosis (16 cases, 41%), pulmonary vascular malformation (8 cases, 21%), pulmonary arteriovenous fistula (7 cases, 18%), bronchiectasis (3 cases, 8%), pulmonary tuberculosis (2 cases, 5%), pulmonary cystic fibrosis (2 cases, 5%), and lung tumor (1 case, 3%). The contrast-enhanced lung CT scans and pulmonary and bronchial arteriography revealed varying degrees of lung imaging changes in 35 cases. Of all cases, 51% were classified as degree I, 28% as degree Ⅱ, and 21% as degree Ⅲ. All children were treated according to the etiology, with the disease controlled. During 0.5-5 years of follow-up, 3 patients with idiopathic pulmonary hemosiderosis were lost to follow-up, and the other cases did not develop hemoptysis again. Conclusions Idiopathic pulmonary hemosiderosis is the main cause of recurrent hemoptysis in children. Contrast-enhanced lung CT scans and pulmonary and bronchial arteriography are important methods for the etiological diagnosis of recurrent hemoptysis in children. Treatment methods should be selected according to the etiology.