肺肿瘤性血栓性微血管病的早期识别与处理  

Early identification and management of pulmonary tumor thrombotic microangiopathy

作　　者：张甲燚 陈玲 周宏 何梦钰 孔辉 解卫平 Zhang Jiayi;Chen Ling;Zhou Hong;He Mengyu;Kong Hui;Xie Weiping(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院呼吸与危重症医学科,南京210029

出　　处：《国际呼吸杂志》2023年第7期745-751,共7页International Journal of Respiration

基　　金：国家自然科学基金(81870054、82000061)。

摘　　要：肺肿瘤性血栓性微血管病(PTTM)是肿瘤患者易发生的致命性并发症之一。恶性肿瘤细胞栓塞肺小血管,特别是肺小动脉,并激活凝血功能,释放多种细胞因子如血小板源性生长因子、血管内皮生长因子、骨桥蛋白、组织因子和胎盘生长因子等,可短时间内导致肺动脉高压、右心衰竭。PTTM发病机制复杂且预后极差,中位生存期仅9 d,早期识别、早期诊断、综合治疗是改善预后的关键。但由于目前PTTM尚无明确的诊断指南,以PTTM症状为主诉就诊的患者易被漏诊、误诊。本文梳理了PTTM早期识别、诊断线索,为PTTM的早期识别和处理提供依据,改善预后。Pulmonary tumor thrombotic microangiopathy(PTTM)is one of the fatal complications of tumor patients.PTTM is caused by tumor embolism in small pulmonary vessels,especially in pulmonary arterioles.Tumor cells activate coagulation function,leading to the release of various cytokines like platelet-derived growth factors,vascular endothelial growth factors,osteopontins,tissue factors and placental growth factors,which eventually cause pulmonary hypertension,right heart failure in a short period of time.The pathogenesis of PTTM is complex and its prognosis is very poor,with the median survival time of only 9 days.Early identification and diagnosis,and comprehensive treatment are key factors for favoring the outcome.Currently,there are no standard diagnostic guidelines for PTTM,and patients with the main PTTM symptoms as the main complaint are easily misdiagnosed.This review explores the early recognition and diagnosis clues of PTTM,aiming to provide evidences for the early recognition and treatment of PTTM,as well as to improve the prognosis.

关 键 词：血栓性微血管病 肿瘤 高血压 肺性 肺小动脉 微血栓 

分 类 号：R734.2[医药卫生—肿瘤]