并发乙酰水杨酸对经皮图像引导肺活检出血并发症的影响

IF 1.8 4区医学 Q3 RESPIRATORY SYSTEM

Respiratory Medicine and Research Pub Date : 2024-12-12 DOI:10.1016/j.resmer.2024.101150

Julie Tronchetti , Paul Habert , Thibault Agripnidis , Katia Chaumoitre , Noémie Resseguier , Anh Thu Nguyen , Jean-Yves Gaubert , Hervé Dutau , Philippe Astoul , Julien Guinde

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引用次数: 0

摘要

背景ct引导下经胸肺活检（CT-TTLB）是诊断肺结节的有效且广泛的方法。排在气胸之后，第二常见的并发症是咯血，这可能危及生命。这些患者通常有合并症，并接受乙酰水杨酸（ASA）治疗。本研究的目的是评估ASA作为CT-TTLB后咯血或严重咯血的危险因素。方法回顾性分析2018年1月至2021年1月2个中心连续接受CT-TTLB的患者。排除标准为胸膜接触结节或肺穿刺禁忌症。记录年龄、性别、合并症、咯血（每次吐血）、重度咯血（需氧量200 mL /min /次干预或复苏/死亡）、结节大小、穿刺深度、肺气肿、结节位置、患者体位、组织学等临床及影像学资料。活检后CT定量肺实质出血（LPH），以cm³为单位。单因素和多因素分析采用逻辑回归模型，无倾向匹配评分和有倾向匹配评分，以确定与咯血和严重咯血相关的变量。结果共分析401例患者，ASA组106例，对照组295例。在多因素分析中，ASA的使用是严重咯血的危险因素(OR=4.5；95% CI[1.3-15.9])，但咯血无统计学意义(OR=1.7；95% CI[0.5-3.1])，匹配后持续。ASA组和对照组之间LPH无差异（中位数（IQR）） 5.2cm³（15.3）vs 3.1cm³（11.5）p = 0.2)。结论ASA治疗并没有增加CT-TTLB术后所有咯血的发生风险，但却是严重咯血的危险因素。

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The effect of concurrent acetylsalicylic acid on hemorrhagic complications during percutaneous image-guided lung biopsy

Background

CT-guided trans-thoracic lung biopsy (CT-TTLB) is efficient and widely used to diagnose pulmonary nodules. After pneumothorax, the second most frequent complication is hemoptysis, which can be life-threatening. These patients often have comorbidities and are on acetylsalicylic-acid (ASA) therapy. The aim of this study was to assess ASA as a risk factor for hemoptysis or severe hemoptysis following CT-TTLB.

Methods

We retrospectively reviewed consecutive patients undergoing CT-TTLB from 2 centers between 01/2018 and 01/2021. Exclusion criteria were nodules with a pleural contact or a contraindication to lung puncture. Clinical and imaging data were recorded such as age, gender, comorbidities, hemoptysis (every blood spit), severe hemoptysis (>200 mL / oxygen need>10L/min / intervention or resuscitation / death), nodule size, puncture depth, emphysema, nodule location, patient position and histology. Lung parenchymal hemorrhage (LPH) was quantified in cm³ on CT after biopsy. Univariate and multivariate analysis were performed with a logistic regression model, without and with propensity match score, to identify variables associated with hemoptysis and severe hemoptysis.

Results

Four-hundred-and-one patients were analyzed, 106 and 295 in the ASA or the control group respectively. In multivariate analysis, ASA use was a risk factor for severe hemoptysis (OR=4.5; 95 %CI[1.3–15.9]) but not for hemoptysis (OR=1.7; 95 %CI[0.5–3.1]), persisting after matching. There was no difference for LPH between the ASA and the control sub-groups (median (IQR)) 5.2cm³ (15.3) vs 3.1cm³ (11.5) p = 0.2).