Interventional Treatment for Hemoptysis Associated with Invasive Pulmonary Aspergillosis and Chronic Pulmonary Aspergillosis

doi:10.3877/cma.j.issn.2095-5782.2026.02.007

Abstract

Abstract:

Objective

To study and compare the clinical characteristics and prognosis of patients with hemoptysis associated with chronic pulmonary aspergillosis (CPA) and invasive pulmonary aspergillosis (IPA) after transcatheter arterial embolization (TAE).

Methods

A retrospective analysis was conducted on the clinical data of 109 patients who received TAE for pulmonary aspergillosis-related hemoptysis from January 2014 to January 2025, including 87 patients with CPA and 22 patients with IPA. And the postoperative survival rate without hemoptysis was analyzed using the Kaplan-Meier curve.

Results

The TAE technique and clinical success rate of 109 patients were 91% and 82% respectively. The CPA group had more bronchiectasis, and more pulmonary aspergilloma formation was observed on CT. The IPA group had more diabetes, more multiple pulmonary shadows on CT. Compared with CPA patients, the bleeding arteries of IPA patients were mainly bronchial artery (BA), and the number of non-bronchial systemic artery (NBSA) involved in the bleeding was less, and the recurrence rate was also lower.

Conclusion

TAE can also benefit patients with IPA-related hemoptysis. Compared with CPA patients, the hemoptysis arteries of IPA patients are mainly BA, and the number of involved NBSA is less, with a lower risk of recurrence.

Key words: hemoptysis, transcatheter arterial embolization, invasive pulmonary aspergillosis, chronic pulmonary aspergillosis, recurrence

Wei Luo, Qikun Guo, Menglan Chu, Tongqiang Li, Yongsheng Ye, Bin Xiong. Interventional Treatment for Hemoptysis Associated with Invasive Pulmonary Aspergillosis and Chronic Pulmonary Aspergillosis[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(02): 171-176.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2026.02.007

https://zhjrfsxdzzz.cma-cmc.com.cn/EN/Y2026/V14/I02/171

Figures/Tables 6

指标	CPA患者(n=87)	IPA患者(n=22)	P值
年龄[岁，M(Q₁, Q₃)]	60 (48, 66)	56.5 (42, 65)	0.363
男性[例(%)]	67 (77)	16 (73)	0.674
肺部合并症[例(%)]
支气管扩张	58 (66.7)	9 (40.9)	0.027^*
肺结核	18 (20.7)	3 (13.6)	0.655
慢性阻塞性肺病	7 (8.0)	4 (18.2)	0.311
胸部恶性肿瘤	3 (3.4)	2 (9.1)	0.576
非结核分支杆菌肺病	3 (3.4)	1 (4.5)	>0.999
其他合并症[例(%)]
糖尿病	10 (11.5)	8 (36.4)	0.013^*
高血压	7 (8.0)	3 (13.6)	0.690
慢性肝病	3 (3.4)	2 (9.1)	0.576
冠心病	3 (3.4)	0
胸外恶性肿瘤	2 (2.3)	0
实验室检查
降钙素原[ng/mL，M(Q₁, Q₃)]	0.11 (0.08, 0.18)	0.62 (0.56, 0.68)	<0.001^*
C反应蛋白[mg/mL，M(Q₁, Q₃)]	2.43 (1.51, 5.00)	7.09 (4.34, 12.0)	0.003^*
红细胞沉降率[mm/h，M(Q₁, Q₃)]	47 (22, 87)	51.5 (44.5, 85.8)	0.315
中性粒细胞绝对值[M(Q₁, Q₃)]	5.00 (3.60, 7.00)	6.00 (4.55, 8.23)	0.048^*
白细胞计数[M(Q₁, Q₃)]	7.40 (5.93, 9.51)	8.65 (7.30, 10.1)	0.046^*
白蛋白（g/L， $x ¯$ ±s）	36.2±4.42	35.3±3.70	0.360
病原学检测[例(%)]
GM试验阳性	37 (42.5)	6 (27.3)	0.191
G试验阳性	24 (27.6)	5 (22.7)	0.645
曲霉菌培养/镜检阳性	19 (21.8)	9 (40.9)	0.067
呼吸道样本NGS阳性	43 (49.4)	20 (90.9)	<0.001^*

指标	CPA患者(n=87)	IPA患者(n=22)	P值
年龄[岁，M(Q₁, Q₃)]	60 (48, 66)	56.5 (42, 65)	0.363
男性[例(%)]	67 (77)	16 (73)	0.674
肺部合并症[例(%)]
支气管扩张	58 (66.7)	9 (40.9)	0.027^*
肺结核	18 (20.7)	3 (13.6)	0.655
慢性阻塞性肺病	7 (8.0)	4 (18.2)	0.311
胸部恶性肿瘤	3 (3.4)	2 (9.1)	0.576
非结核分支杆菌肺病	3 (3.4)	1 (4.5)	>0.999
其他合并症[例(%)]
糖尿病	10 (11.5)	8 (36.4)	0.013^*
高血压	7 (8.0)	3 (13.6)	0.690
慢性肝病	3 (3.4)	2 (9.1)	0.576
冠心病	3 (3.4)	0
胸外恶性肿瘤	2 (2.3)	0
实验室检查
降钙素原[ng/mL，M(Q₁, Q₃)]	0.11 (0.08, 0.18)	0.62 (0.56, 0.68)	<0.001^*
C反应蛋白[mg/mL，M(Q₁, Q₃)]	2.43 (1.51, 5.00)	7.09 (4.34, 12.0)	0.003^*
红细胞沉降率[mm/h，M(Q₁, Q₃)]	47 (22, 87)	51.5 (44.5, 85.8)	0.315
中性粒细胞绝对值[M(Q₁, Q₃)]	5.00 (3.60, 7.00)	6.00 (4.55, 8.23)	0.048^*
白细胞计数[M(Q₁, Q₃)]	7.40 (5.93, 9.51)	8.65 (7.30, 10.1)	0.046^*
白蛋白（g/L， $x ¯$ ±s）	36.2±4.42	35.3±3.70	0.360
病原学检测[例(%)]
GM试验阳性	37 (42.5)	6 (27.3)	0.191
G试验阳性	24 (27.6)	5 (22.7)	0.645
曲霉菌培养/镜检阳性	19 (21.8)	9 (40.9)	0.067
呼吸道样本NGS阳性	43 (49.4)	20 (90.9)	<0.001^*

指标	CPA患者(n=87)	IPA患者(n=22)	P值
CT影像[例(%)]
肺部空洞	60 (69.0)	11 (50.0)	0.095
肺部阴影	15 (17.2)	21 (95.5)	<0.001^*
曲霉球/空洞结节	67 (77.0)	8 (36.4)	<0.001^*
DSA影像[例(%)]
动脉肥大	85 (97.7)	22 (100)	>0.999
新血管形成	83 (95.4)	22 (100)	0.581
血管异常染色	12 (13.8)	4 (18.2)	0.855
假性动脉瘤	9 (10.3)	1 (4.5)	0.668
SPS	81 (93.1)	19 (86.4)	0.553
异位BA	18 (20.7)	2 (9.1)	0.343
栓塞材料[例(%)]
PVA	87 (100)	22 (100)
弹簧圈	15 (17.2)	2 (9.1)	0.540
明胶海绵	10 (11.5)	3 (13.6)	>0.999
栓塞靶动脉[例(%)]
BA	86 (98.9)	22 (100)	>0.999
NBSA	74 (85.1)	15 (68.2)	0.129
栓塞靶动脉数量[条，M(Q₁, Q₃)]
BA	2 (1, 2)	2 (1, 2)	0.077
NBSA	4 (1, 6)	1 (0, 2)	<0.001^*
BA+NBSA	6 (3, 9)	3 (1.75, 4)	<0.001^*

指标	CPA患者(n=87)	IPA患者(n=22)	P值
TAE结果[例(%)]
技术成功	78 (89,7)	21 (95.5)	0.668
临床成功	69 (79.3)	20 (90.9)	0.343
不良事件[例(%)]
短暂胸痛	19 (21.8)	6 (27.3)	0.588
发热	16 (18.4)	4 (18.2)	>0.999
对比剂诱导荨麻疹	12 (13.8)	2 (9.1)	0.816
肺栓塞	1 (1.1)	0
随访结果
咯血复发[例(%)]	50 (57.5)	7 (31.8)	0.031^*
咯血复发时间[月，例(%)]
<3个月	22 (25.3)	2 (9.1)	0.177
3~12个月	18 (20.7)	3 (13.6)	0.655
>12个月	10 (11.5)	2 (9.1)	>0.999
无咯血生存时间[月，M(Q₁, Q₃)]	11 (2, 30)	19.5 (8.25, 36)	0.096

References 21

[1]	Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America[J]. Clin Infect Dis, 2016, 63(4): e1-e60.
[2]	Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management[J]. Eur Respir J, 2016, 47(1): 45-68.
[3]	Shin B, Koh WJ, Shin SW, et al. Outcomes of bronchial artery embolization for life-threatening hemoptysis in patients with chronic pulmonary aspergillosis[J]. PloS One, 2016, 11(12): e0168373.
[4]	Piracha S, Mahmood A, Qayyum N, et al. Massive haemoptysis secondary to mycotic pulmonary artery aneurysm in subacute invasive aspergillosis[J]. BMJ Case Rep, 2018, 2018: bcr2017223088.
[5]	Bölükbas S, Eberlein M. Pulmonary aspergilloma: indications for surgery and surgical techniques[J]. Zentralbl Chir, 2015, 140 Suppl 1: S43-S46.
[6]	Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review[J]. Diagn Interv Radiol, 2017, 23(4): 307-317.
[7]	Dixit D, Kuete NT, Bene P, et al. Invasive Pulmonary Aspergillosis with Hydropneumothorax in a Patient Taking High-Dose Glucocorticoids[J]. Am J Case Rep, 2020, 21: e928499.
[8]	中华医学会呼吸病学分会. 慢性阻塞性肺疾病伴肺曲霉病诊治和管理专家共识[J]. 中华结核和呼吸杂志, 2024, 47(7): 604-622.
[9]	中华内科杂志编辑委员会. 侵袭性肺部真菌感染的诊断标准与治疗原则(草案)[J]. 中华内科杂志, 2006, 45(8): 697-700.
[10]	Ravetta P, Bruyneel M, Vouche M. New insights on Bronchial Artery Embolization (BAE) for hemoptysis: a systematic review[J]. BMC Pulm Med, 2025, 25(1): 541.
[11]	Marquis KM, Raptis CA, Rajput MZ, et al. CT for Evaluation of Hemoptysis[J]. Radiographics, 2021, 41(3): 742-761.
[12]	Long Z, Li X, Li Z, et al. Improved diagnostic markers for invasive pulmonary aspergillosis in COPD patients[J]. Front Cell Infect Microbiol, 2024, 14: 1294971.
[13]	王卓萍, 胡小燕, 胡慧佳, 等. mNGS技术联合GM试验、血清烟曲霉特异性抗体检测对COPD合并侵袭性肺曲霉菌病的诊断价值[J]. 现代实用医学, 2024, 36(2): 186-188.
[14]	Garg M, Bhatia H, Chandra T, et al. Imaging Spectrum in Chronic Pulmonary Aspergillosis[J]. Am J Trop Med Hyg, 2022, 108(1): 15-21.
[15]	杨仁恒. 慢性阻塞性肺疾病并侵袭性肺曲霉菌病患者的临床表现及胸部Ct表现分析[J]. 实用心脑肺血管病杂志, 2016(1): 105-107.
[16]	高金燕. 伏立康唑序贯治疗对24例糖尿病合并侵袭性肺曲霉菌病的临床作用研究[J]. 糖尿病新世界, 2021, 24(5): 99-101.
[17]	Vanderbeke L, Jacobs C, Feys S, et al. A Pathology-based Case Series of Influenza-and COVID-19-associated Pulmonary Aspergillosis: The Proof Is in the Tissue[J]. Am J Respir Crit Care Med, 2023, 208(3): 301-311.
[18]	Chun JY, Belli AM. Immediate and long-term outcomes of bronchial and non-bronchial systemic artery embolisation for the management of haemoptysis[J]. Eur Radiol, 2009, 20(3): 558-565.
[19]	Khalilzadeh O, Baerlocher MO, Shyn PB, et al. Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee[J]. J Vasc Interv Radiol, 2017, 28(10): 1432-1437. e3.
[20]	张文浩, 叶丽芳, 任医民, 等. 选择性动脉栓塞术治疗咯血效果及复发相关因素分析[J]. 介入放射学杂志, 2020, 29(1): 35-38.
[21]	温宇, 伍筱梅, 朱巧洪. 支气管动脉128层螺旋CT造影分析[J]. 中华介入放射学电子杂志, 2013(2): 135-139.

Please choose a citation manager

Content to export