三例肺腫瘤血栓性微血管病的臨床、影像及病理分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

張娟娟 ¹ , 桂賢華 ² , 蔡后榮 ² , 肖永龍 ² ,  邱玉英 ² , 孟凡青 ³ , 付堯 ³

1. ;
2. ;
3. ;

Corresponding?author：

邱玉英, Email: qiuyuying1402@sina.com

Keywords：

肺腫瘤血栓性微血管病; 肺栓塞; 肺動脈高壓; 胸部高分辨率 CT

DOI：

10.7507/1671-6205.201707049

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目的觀察肺腫瘤血栓性微血管病（PTTM）的臨床、影像學及病理特點，提高臨床醫生對該病的認識。方法回顧性分析南京大學醫學院附屬鼓樓醫院 2013 年 10 月至 2016 年 8 月根據臨床、影像學及病理特點確診的 3 例 PTTM 的臨床資料，總結其臨床、影像學以及病理特征。結果3 例 PTTM 中男 2 例，女 1 例，年齡 29～51 歲，均為亞急性起病，主要臨床表現為干咳、進行性呼吸困難。實驗室檢查示 D-二聚體明顯增高，血氣分析提示低氧血癥。超聲心動圖肺動脈收縮壓中重度增高。高分辨率 CT 均表現為雙肺彌漫性小結節影、小葉間隔增厚。正電子發射計算機斷層顯像均證實原發腫瘤部位。3 例患者原發病均為胃癌，其中 2 例經支氣管鏡肺活檢證實胃癌肺轉移，另一例骨活檢證實胃癌伴骨轉移。患者入院時均未明確診斷為腫瘤，病情進展迅速，于入院后 2 周內死亡。結論PTTM 臨床癥狀無特異性，一旦腫瘤患者出現進行性的呼吸困難及血液高凝狀態，出現不明原因的肺動脈高壓，而 CT 下肺動脈造影未顯示肺栓塞時，應警惕 PTTM 的可能。PTTM 診斷困難，容易漏診、誤診，缺乏有效的治療手段，預后極差。

Citation： 張娟娟, 桂賢華, 蔡后榮, 肖永龍, 邱玉英, 孟凡青, 付堯. 三例肺腫瘤血栓性微血管病的臨床、影像及病理分析. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(5): 509-513. doi: 10.7507/1671-6205.201707049 Copy

1.	von Herbay A, Illes A, Waldherr R, et al. Pulmonary tumor thrombotic microangiopathy with pulmonary hypertension. Cancer, 1990, 66(3): 587-592.
2.	Uruga H, Fujii T, Kurosaki A. Pulmonary tumor thrombotic microangiopathy: a clinical analysis of 30 autopsy cases. Intern Med, 2013, 52(12): 1317-1323.
3.	Chinen K, Tokuda Y, Fujiwara M. Pulmonary tumor thrombotic microangiopathy in patients with gastric carcinoma: an analysis of 6 autopsy cases and review of the literature. Pathol Res Pract, 2010, 206(10): 682-689.
4.	Higo K, Kubota K, Takeda A. Successful antemortem diagnosis and treatment of pulmonary tumor thrombotic microangiopathy. Intern Med, 2014, 53(22): 2595-2599.
5.	桂賢華, 蔡后榮. 肺腫瘤血栓性微血管病. 中華結核和呼吸雜志, 2016, 39(7): 546-547.
6.	Higashi A, Dohi Y, Uraoka N. The potential role of inflammation associated with interaction between osteopontin and CD44 in a case of pulmonary tumor thrombotic microangiopathy caused by breast cancer. Intern Med, 2015, 54(22): 2877-2880.
7.	Takahashi F, Kumasaka T, Nagaoka T. Osteopontin expression in pulmonary tumor thrombotic microangiopathy caused by gastric carcinoma. Pathol Int, 2009, 59(10): 752-756.
8.	陳久玲, 劉越, 尹新華. 肺腫瘤血栓性微血管病研究新進展. 醫學研究雜志, 2016, 45(8): 8-10.
9.	李羲, 張劭夫, 錢桂生. 關注肺腫瘤血栓性微血管病. 中華肺部疾病雜志(電子版), 2013, 6(6): 1-3.
10.	Fukada I, Araki K, Kobayashi K, et al. Imatinib could be a new strategy for pulmonary hypertension caused by pulmonary tumor thrombotic microangiopathy in metastatic breast cancer. Springerplus, 2016, 5(1): 1582.

1. von Herbay A, Illes A, Waldherr R, et al. Pulmonary tumor thrombotic microangiopathy with pulmonary hypertension. Cancer, 1990, 66(3): 587-592.
2. Uruga H, Fujii T, Kurosaki A. Pulmonary tumor thrombotic microangiopathy: a clinical analysis of 30 autopsy cases. Intern Med, 2013, 52(12): 1317-1323.
3. Chinen K, Tokuda Y, Fujiwara M. Pulmonary tumor thrombotic microangiopathy in patients with gastric carcinoma: an analysis of 6 autopsy cases and review of the literature. Pathol Res Pract, 2010, 206(10): 682-689.
4. Higo K, Kubota K, Takeda A. Successful antemortem diagnosis and treatment of pulmonary tumor thrombotic microangiopathy. Intern Med, 2014, 53(22): 2595-2599.
5. 桂賢華, 蔡后榮. 肺腫瘤血栓性微血管病. 中華結核和呼吸雜志, 2016, 39(7): 546-547.
6. Higashi A, Dohi Y, Uraoka N. The potential role of inflammation associated with interaction between osteopontin and CD44 in a case of pulmonary tumor thrombotic microangiopathy caused by breast cancer. Intern Med, 2015, 54(22): 2877-2880.
7. Takahashi F, Kumasaka T, Nagaoka T. Osteopontin expression in pulmonary tumor thrombotic microangiopathy caused by gastric carcinoma. Pathol Int, 2009, 59(10): 752-756.
8. 陳久玲, 劉越, 尹新華. 肺腫瘤血栓性微血管病研究新進展. 醫學研究雜志, 2016, 45(8): 8-10.
9. 李羲, 張劭夫, 錢桂生. 關注肺腫瘤血栓性微血管病. 中華肺部疾病雜志(電子版), 2013, 6(6): 1-3.
10. Fukada I, Araki K, Kobayashi K, et al. Imatinib could be a new strategy for pulmonary hypertension caused by pulmonary tumor thrombotic microangiopathy in metastatic breast cancer. Springerplus, 2016, 5(1): 1582.

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三例肺腫瘤血栓性微血管病的臨床、影像及病理分析

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