儿童血管相关性咯血影响咯血量及术后复发高危因素分析

doi:10.12372/jcp.2023.22e0415

Abstract

Abstract: Objective To summarize the clinical characteristics of children with vascular-related hemoptysis, in order to find the risk factors of hemoptysis volume and recurrence. Methods The clinical data of children with vascular-related hemoptysis who received interventional therapy from January 2012 to January 2020 were retrospectively analyzed. According to the hemoptysis volume, children were divided into massive hemoptysis group and non-massive hemoptysis group. According to the clinical outcome, they were divided into relapsed group and non-relapsed group. Logistic multivariate regression analysis was used to analyze the factors affecting the hemoptysis volume and the recurrence of postoperative hemoptysis. Results A total of 41 children (19 boys and 22 girls) with vascular-related hemoptysis were included, and the median age was 8.9 (6.9-11.2) years. Chest vascular enhancement CT showed that abnormal blood vessels were located in the right lung in 32 cases, mainly in the lower lobe of the right lung. Abnormal blood vessels were found in both lungs in 3 cases, in the left lung in 1 case, and no abnormal blood vessels were found in 5 cases. Binary logistic regression analysis showed that large abnormal blood vessel diameter and Mycoplasma pneumoniae (MP) infection were independent risk factors for hemoptysis (P<0.05), while increased abnormal blood vessels were independent risk factors for the recurrence of hemoptysis (P<0.05). Conclusions The high risk factors affecting the hemoptysis volume in children with vascular-related hemoptysis are abnormal vascular diameter and MP infection. Interventional occlusion of abnormal blood vessels is a safe and effective treatment method, and the number of abnormal blood vessels is an important predictor of postoperative recurrence.

Key words: hemoptysis, vascular malformation, hemoptysis volume, recurrence, child

XIE Lei, LYU Tiewei. Risk factors of hemoptysis volume and postoperative recurrence in children with vascular-related hemoptysis[J].Journal of Clinical Pediatrics, 2023, 41(1): 42-47.

Figures/Tables 4

References 23

[1]	Barut K, Sahin S, Adrovic A, et al. Idiopathic pulmonary hemosiderosis in a child with recurrent macrophage activation syndrome secondary to systemic juvenile idiopathic arthritis[J]. Case Rep Pediatr, 2017: 5693501.
[2]	Springer DM, Cofta S, Juszkat R, et al. The effectiveness of bronchial artery embolisation in patients with haemoptysis[J]. Adv Respir Med, 2018, 86(5): 220-226. doi: 10.5603/ARM.2018.0035 pmid: 30378649
[3]	Rémy J, Voisin C, Dupuis C, et al. Treatment of hemoptysis by embolization of the systemic circulation[J]. Ann Radiol (Paris), 1974, 17(1): 5-16. pmid: 4820232
[4]	Springer DM, Cofta S, Juszkat R, et al. The effectiveness of bronchial artery embolisation in patients with haemoptysis[J]. Adv Respir Med, 2018, 86(5): 220-226. doi: 10.5603/ARM.2018.0035 pmid: 30378649
[5]	Zheng Z, Zhuang Z, Yang M, et al. Bronchial artery embolization for hemoptysis: a systematic review and meta-analysis[J]. J Interv Med, 2021, 4(4): 172-180. doi: 10.1016/j.jimed.2021.08.003 pmid: 35586385
[6]	Dorji K, Hongsakul K, Jutidamrongphan W, et al. Bronchial artery embolization in life-threatening hemoptysis: outcome and predictive factors[J]. J Belg Soc Radiol, 2021, 105(1): 5. doi: 10.5334/jbsr.2310 pmid: 33598631
[7]	Fu Z, Li X, Cai F, et al. Microspheres present comparable efficacy and safety profiles compared with polyvinyl alcohol for bronchial artery embolization treatment in hemoptysis patients[J]. J Transl Med, 2021, 19(1): 422. doi: 10.1186/s12967-021-02947-7 pmid: 34635108
[8]	Kuang HY, Li Q, Xiang P, et al. Potential factors affected safety and efficacy of transcatheter plug closure for pediatric hemoptysis with anomalous bronchial arteries[J]. J Interv Cardiol, 2019: 5408618.
[9]	吕铁伟, 况虹宇, 易岂建, 等. 儿童血管相关性咯血的规范诊断与治疗[J]. 中华实用儿科临床杂志, 2018, 33(13): 979-982.
[10]	Chiel L, Welsh S, Andren K, et al. Pediatric hemoptysis without bronchiectasis or cardiac disease: etiology, recurrence, and mortality[J]. J Pediatr, 2019, 214: 66-70. doi: 10.1016/j.jpeds.2019.07.049
[11]	Dabó H, Gomes R, Marinho A, et al. Bronchial artery embolisation in management of hemoptysis--a retrospective analysis in a tertiary university hospital[J]. Rev Port Pneumol (2006), 2016, 22(1): 34-38.
[12]	Abid N, Loukil M, Mokni A, et al. Outcomes of bronchial artery embolization for the management of hemoptysis[J]. Tunis Med, 2021, 99(2): 264-268. pmid: 33899197
[13]	Yang J, Liu F, Liang Y, et al. Massive hemoptysis in children[J]. Can Respir J, 2020: 6414719.
[14]	朱紫阳, 覃伟, 余伟, 等. 支气管扩张症伴咯血的血管介入治疗疗效及其复发相关危险因素分析[J]. 中国介入心脏病学杂志, 2021, 29(5): 266-270.
[15]	Bi Y, Zhu Y, Ma X, et al. Development of a scale for early prediction of refractory Mycoplasma pneumoniae pneumonia in hospitalized children[J]. Sci Rep, 2021, 11(1): 6595. doi: 10.1038/s41598-021-86086-5
[16]	Xiao Z, Jiang Y, Gao X, et al. Comparison of the ameliorative effects of Qingfei Tongluo formula and azithromycin on Mycoplasma pneumoniae pneumonia[J]. J Nat Med, 2017, 71(4): 685-692. doi: 10.1007/s11418-017-1098-1
[17]	Fruchter O, Schneer S, Rusanov V, et al. Bronchial artery embolization for massive hemoptysis: long-term follow-up[J]. Asian Cardiovasc Thorac Ann, 2015, 23(1): 55-60. doi: 10.1177/0218492314544310
[18]	Yan HT, Lu GD, Huang XZ, et al. Development of a model to predict recurrence after bronchial artery embolization for non-cancer related hemoptysis[J]. BMC Pulm Med, 2021, 21(1): 419. doi: 10.1186/s12890-021-01790-2
[19]	Tom LM, Palevsky HI, Holsclaw DS, et al. Recurrent bleeding, survival, and longitudinal pulmonary function following bronchial artery embolization for hemoptysis in a U.S. adult population[J]. J Vasc Interv Radiol, 2015, 26(12): 1806-1813. doi: 10.1016/j.jvir.2015.08.019 pmid: 26481824
[20]	Merida-Vieyra J, Aquino-Andrade A, Palacios-Reyes D, et al. Detection of Mycoplasma pneumoniae in Mexican children with community-acquired pneumonia: experience in a tertiary care hospital[J]. Infect Drug Resist, 2019, 12: 925-935. doi: 10.2147/IDR.S193076 pmid: 31118700
[21]	Krafft C, Christy C. Mycoplasma pneumonia in children and adolescents[J]. Pediatr Rev, 2020, 41(1): 12-19. doi: 10.1542/pir.2018-0016
[22]	He J, Liu M, Ye Z, et al. Insights into the pathogenesis of Mycoplasma pneumoniae (Review)[J]. Mol Med Rep, 2016, 14(5): 4030-4036. doi: 10.3892/mmr.2016.5765
[23]	Miyata M, Hamaguchi T. Integrated information and prospects for gliding mechanism of the pathogenic bacterium Mycoplasma pneumoniae[J]. Front Microbiol, 2016, 7: 960.

项目	大咯血组(n=18)	非大咯血组(n=23)	统计量	P
男性[n(%)]	10(55.6)	9(39.1)	χ²=1.10	0.295
年龄[M(P₂₅~P₇₅)]/岁	8.8(7.3~10.8)	9.6(6.0~11.8)	Z=0.36	0.723
体重[M(P₂₅~P₇₅)]/kg	24.5(21.5~31.5)	30.0(19.0~38.0)	Z=0.67	0.503
白细胞计数[M(P₂₅~P₇₅)]×10⁹·L^-1	7.1(5.4~8.5)	6.9(5.6~9.7)	Z=0.32	0.753
血红蛋白[M(P₂₅~P₇₅)]/g·L^-1	107.5(102.0~114.8)	117.0(114.0~122.0)	Z=3.56	0.001
中性粒细胞绝对值[M(P₂₅~P₇₅)]×10⁹·L^-1	4.3(2.7~6.3)	4.6(3.4~7.2)	Z=0.97	0.331
MP-PA≥1:320[n(%)]	12(66.7)	8(34.8)	χ²=4.11	0.043
胸部CTA异常血管走向[n(%)]			-	0.423¹⁾
右肺	14(77.7)	18(78.3)
左肺	1(5.6)	0(0.0)
双肺	2(11.1)	1(4.3)
无异常	1(5.6)	4(17.4)
异常血管数量[M(P₂₅~P₇₅)]/支	2.0(1.0~3.0)	2.0(1.0~2.0)	Z=1.73	0.083
异常血管内径[M(P₂₅~P₇₅)]/cm	2.7(1.9~4.7)	1.9(1.5~2.8)	Z=2.00	0.046
手术时间[M(P₂₅~P₇₅)]/h	1.3(1.0~1.9)	0.8(0.6~1.2)	Z=3.23	0.001
住院时间[M(P₂₅~P₇₅)]/d	9.0(5.0~12.0)	12.0(10.0~14.0)	Z=2.16	0.031

项目	偏回归系数	标准误	χ²值	P	OR(95%CI)
MP-PA≥1:320	1.63	0.76	4.65	0.031	5.10(1.16~22.44)
异常血管内径	0.58	0.28	4.45	0.035	1.79(1.04~3.08)
常量	-2.69	1.01	7.11	0.008	0.068

项目	复发组(n=13)	非复发组(n=28)	统计量	P
男性[n(%)]	7(53.8)	12(42.9)	χ²=0.43	0.737
年龄[M(P₂₅~P₇₅)]/岁	9.0(8.1~12.9)	8.9(6.0~10.5)	Z=1.15	0.260
体重[M(P₂₅~P₇₅)]/kg	30.0(24.3~39.5)	24.0(17.5~35.4)	Z=1.64	0.102
白细胞计数[M(P₂₅~P₇₅)]×10⁹·L^-1	7.0(5.3~8.9)	7.1(5.8~9.5)	Z=0.48	0.648
血红蛋白[M(P₂₅~P₇₅)]/g·L^-1	111.0(93.5~117.0)	115.0(109.0~121.5)	Z=2.19	0.029
中性粒细胞绝对值×10⁹·L^-1	4.4(2.9~6.5)	4.6(2.9~6.7)	Z=0.35	0.730
MP-PA≥1:320[n(%)]	10(76.9)	10(35.7)	χ²=6.03	0.020
胸部CTA异常血管走向[n(%)]			-	1.000¹⁾
右肺	11(84.6)	21(75.0)
左肺	0(0.0)	1(3.6)
双肺	1(7.7)	2(7.1)
无异常	1(7.7)	4(14.3)
异常血管数量[M(P₂₅~P₇₅)]/支	2.0(2.0~2.5)	1.0(1.0~2.0)	Z=2.40	0.029
异常血管内径[M(P₂₅~P₇₅))]/cm	2.8(2.1~4.5)	2.0(1.6~3.0)	Z=1.71	0.090
咯血量[M(P₂₅~P₇₅)]/mL·kg^-1·24h^-1	3.7(2.7~3.8)	2.5(1.4~3.7)	Z=1.43	0.159
手术时间[M(P₂₅~P₇₅)]/h	1.0(0.7~1.8)	1.1(0.6~1.4)	Z=0.34	0.750
住院时间[M(P₂₅~P₇₅)]/d	9.0(6.0~12.5)	11.5(9.0~14.0)	Z=1.35	0.186

项目	偏回归系数	标准误	χ²值	P	OR(95%CI)
血红蛋白	-0.08	0.05	2.33	0.127	0.93(0.84~1.02)
MP-PA≥1:320	1.42	0.95	2.27	0.132	4.15(0.65~26.47)
异常血管数量	1.34	0.65	4.27	0.039	3.81(1.07~13.56)
常量	4.32	5.83	0.55	0.458	75.45

Risk factors of hemoptysis volume and postoperative recurrence in children with vascular-related hemoptysis

RichHTML

PDF (PC)

Like

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 4

References 23

Related Articles 15

Metrics

Comments

Recommended 0

[1]	LIN Jinfeng, CHEN Yi, DENG Yan, FENG Ai, HUANG Juan, CHEN Lizhu, XIE Jingqi, NIE Xiaojing. A comparative study on the detection of anti-Nephrin antibodies in children's nephrotic syndrome by chemiluminescence method and cell-based assay [J]. Journal of Clinical Pediatrics, 2026, 44(8): 682-689.
[2]	ZHENG Fangyuan, WANG Miao, DING Mingming, LU Aidong, JIA Yueping, ZENG Huimin, ZHANG Leping. Next-generation sequencing identified gene variants and their prognostic impact in pediatric Philadelphia chromosome positive acute lymphoblastic leukemia [J]. Journal of Clinical Pediatrics, 2026, 44(8): 690-697.
[3]	ZHANG Xiao, FANG Hongjun, KUANG Xiaojun, WANG Lijuan, WU Zhao, JIANG Sha, LI Pei, WU Liwen. Analysis of the clinical and electrophysiological characteristics of atonic seizures in children [J]. Journal of Clinical Pediatrics, 2026, 44(8): 698-704.
[4]	WANG Mengqian, YANG Hui. Case series analysis of 13 intestinal Behcet’s syndrome in children [J]. Journal of Clinical Pediatrics, 2026, 44(8): 705-711.
[5]	WU Xirong, GAO Qi, GUO Siyuan, YIN Qingqin, QIN Qiang, YIN Ju, JIAO Anxia, CHEN Chenghao, WU Di, WANG Bei, DUAN Xiaomin, PENG Yun, XU Baoping, GAO Liwei. Clinical characteristics and prognosis of pulmonary mucormycosis in children with diabetes mellitus [J]. Journal of Clinical Pediatrics, 2026, 44(8): 712-720.
[6]	HAN Yanan, GE Lanlan, CUI Jieyuan. A case report of branchio-oto-renal syndrome caused by EYA1 gene variant with a 6-year follow-up [J]. Journal of Clinical Pediatrics, 2026, 44(8): 721-726.
[7]	SHI Jiayi, GAO Chunlin, JIA Lili, LU Yunyun, SUN Tao, ZHU Xiaodong, XIA Zhengkun, ZHANG Pei. Phenotypic characteristics and prognostic analysis of a pedigree with childhood isolated nephrotic syndrome caused by compound heterozygous mutations in the COQ2 gene [J]. Journal of Clinical Pediatrics, 2026, 44(8): 727-732.
[8]	Rachel Rosen, Osvaldo Borrelli, Christophe Faure, Katja Karrento, Usha Krishnan, Samuel Nurko, Nathalie Rommel, Alan Silverman, Michiel van Wijk, Marc Benninga (Author), Chinese Medical Association Parenteral and Enteral Nutrition Branch Pediatrics Group, The Subspecialty Group of Gastroenterology, The Society of Pediatric, Chinese Medical Association, Gastroenterology Group, Pediatrician Branch, Chinese Medical Doctor Association (Translator). Core interpretation and explanation of Rome Ⅴ diagnostic criteria: upper gastrointestinal disorders of gut-brain interaction in children and adolescents [J]. Journal of Clinical Pediatrics, 2026, 44(7): 595-608.
[9]	Carlo Di Lorenzo, Miguel Saps, Bruno P. Chumpitazi, Shaman Rajindrajith, Annamaria Staiano, Nikhil Thapar, Miranda van Tilburg, Carlos Velasco-Benítez, Arine Vlieger (Author), Chinese Medical Association Parenteral and Enteral Nutrition Branch Pediatrics Group, The Subspecialty Group of Gastroenterology, The Society of Pediatric, Chinese Medical Association, Gastroenterology Group, Pediatrician Branch, Chinese Medical Doctor Association (Translator). Core interpretation and explanation of Rome Ⅴ diagnostic criteria: lower and biliary disorders of gut-brain interaction in children and adolescents [J]. Journal of Clinical Pediatrics, 2026, 44(7): 609-621.
[10]	LI Xufeng, TANG Haoxun, LI Xingjun, ZHANG Lize, GAO Chenqing, ZHAO Shunying, LIU Jianhua. Clinical characteristics, chest CT imaging phenotypes, and their correlation with prognosis in 76 children with Chlamydia pneumoniae pneumonia [J]. Journal of Clinical Pediatrics, 2026, 44(7): 622-627.
[11]	WANG Zhen, SHAO Jingbo, ZHANG Na, XIA Min, ZHU Jiashi, DU Chengkan, LI Hong. Factors influencing long-term recurrence in pediatric acute lymphoblastic leukemia patients with low-risk disease at initial diagnosis: a five-year follow-up analysis of 254 cases from a single center [J]. Journal of Clinical Pediatrics, 2026, 44(7): 628-635.
[12]	GUO Xuemei, XUE Yao, WANG Yongren, RONG Liucheng, FANG Yongjun, LIN Rufeng. Clinical features and prognosis of childhood acute myeloid leukemia with CBFA2T3::GLIS2 fusion [J]. Journal of Clinical Pediatrics, 2026, 44(7): 636-643.
[13]	YANG Lijun, FU Dongxia, CUI Yan, YANG Junmei, ZHANG Liming. Clinical manifestation and genetic analysis of CHARGE syndrome caused by CHD7 gene variation [J]. Journal of Clinical Pediatrics, 2026, 44(7): 644-650.
[14]	HU Yan, YANG Fan, LIANG Aimin, MAO Meng. Identification and management of faltering growth in children: insights from the 13th International Conference on Nutrition and Growth [J]. Journal of Clinical Pediatrics, 2026, 44(6): 485-488.
[15]	LIU Ziyao, WANG Congying, WANG Hongmao, ZHANG Mingming, XU Yingjie, LAI Jianming, NIU Wenquan, LI Xiaohui. Early differentiation of Kawasaki disease with joint symptoms and systemic juvenile idiopathic arthritis with Kawasaki disease-like symptoms: a single-center retrospective study [J]. Journal of Clinical Pediatrics, 2026, 44(6): 489-498.