【摘要】：背景：彌漫性肺泡出血(DAH)是系統(tǒng)性紅斑狼瘡(SLE)肺部病變中相對罕見,而進展迅猛、死亡率較高的臨床表型,是導致SLE患者死亡的重要原因之一,目前臨床尚無切實有效的診治規(guī)范。目的：分析SLE-DAH患者的臨床特點、危險因素、預后相關因素,為臨床診治提供依據(jù)。方法：回顧北京協(xié)和醫(yī)院自2004年1月至2015年1月間診斷為SLE-DAH的住院患者,同時滿足以下標準即入組：(1)符合1997年ACR或2009年SLICC的SLE分類標準；(2)同時符合以下4條標準中的3條及以上：①肺部癥狀；②新發(fā)的肺部浸潤影；③HGB下降至少15g/L；④支氣管肺泡灌洗液呈血性或可見到含鐵血黃色細胞；并可除外嚴重凝血系統(tǒng)疾病、嚴重的急性肺水腫、嚴重的肺栓塞等。同時以208例同期住院的SLE非DAH的患者作為對照進行病例對照研究。收集全部患者的臨床表現(xiàn)、實驗室檢查、影像學表現(xiàn)的特征,采用SPSS 20.0采集和分析數(shù)據(jù)。連續(xù)變量比較采用獨立樣本t檢驗(其中符合方差齊性者直接用t檢驗,不符合者用近似t檢驗,不符合正態(tài)分布者用秩和檢驗),分類變量資料采用x2檢驗。P值0.05被認為有統(tǒng)計學意義。結果：(1)共納入SLE-DAH患者54例,DAH在SLE患者中患病率為0.73%。其中女性49例(91%),平均年齡為(30.8±12.4)歲,平均病程為(16.9±33.6)月,1/3患者以DAH表現(xiàn)首發(fā)。平均SLEDAI評分為(19±7.9)；(2)SLE-DAH患者最常見的癥狀是呼吸困難(91%),其余依次為低氧血癥(89%)、咳嗽(87%)發(fā)熱(43例,80%),26%患者臨床無咯血；血紅蛋白平均下降(36.1±14.3)g/L,24小時內平均下降(13.4±10.8)g/L。最常見的肺外受累為腎臟受累(91%)；(3)54例SLE-DAH患者中53例接受了糖皮質激素治療,37例(69%)接受了甲基潑尼松龍沖擊治療；(4) SLE-DAH患者院內病死率為20.4%；與院內存活組相比,死亡組患者在發(fā)病年齡、病程上存在統(tǒng)計學差異,同時合并感染、機械通氣的比例更高,或與不良預后相關； (5)與SLE-NDAH患者相比,兩組患者在病程、SLEDAI評分、院內病死率(20% vs 7%)上存在統(tǒng)計學差異,且SLE-DAH患者出現(xiàn)皮膚黏膜病變(70.4% vs 49.0%)、血液系統(tǒng)病變(87% vs 43.8%)、血小板減少(72.2% vs 25.5%)、腎臟病變(90.7% vs 62.9%)更為多見,抗ds-DNA抗體陽性率更高(55.6%vs 42.6%),以上均存在統(tǒng)計學差異(P0.05)；(6)隨著臨床認識的增加,SLE-DAH死亡率在下降(50% vs 10%,P0.05)結論：DAH是SLE的的嚴重并發(fā)癥,臨床表現(xiàn)可無咯血表現(xiàn),應重視支氣管鏡檢查的診斷價值。積極的糖皮質激素、免疫抑制劑可改善預后。發(fā)病年齡、病程合并感染、應用機械通氣與不良預后相關。提高臨床認識,可改善SLE-DAH的預后。
[Abstract]:Background: diffuse alveolar hemorrhage (DAH) is a relatively rare pulmonary lesion in systemic lupus erythematosus (SLE), which is characterized by rapid progression and high mortality, which is one of the important causes of death in patients with SLE. At present, there is no practical and effective diagnosis and treatment standard. Objective: to analyze the clinical features, risk factors and prognostic factors of SLE-DAH patients. Methods: the hospitalized patients diagnosed with SLE-DAH from January 2004 to January 2015 in Peking Union Hospital were reviewed and the following criteria were met: (1) according to the SLE classification criteria of ACR in 1997 or SLICC in 2009; (2) at the same time, 3 or more of the following 4 criteria were conformed to one or more of the following criteria. The newly developed lung infiltrating 3HGB decreased by at least 15 g / L 4 bronchoalveolar lavage fluid (BALF) with blood or iron-containing yellow cells. And may exclude the serious coagulation system disease, the serious acute pulmonary edema, the serious pulmonary embolism and so on. A case-control study was conducted with 208 non-DAH SLE patients hospitalized at the same time. The clinical, laboratory and imaging features of all patients were collected and analyzed by SPSS 20.0. The independent sample t test was used to compare the continuous variables (where the homogeneity of variance was used directly by t test, and the non-conformance was tested by approximate t test). Rank sum test was used for those who did not conform to normal distribution). The data of classified variables were analyzed by x2 test. P value 0.05 was considered to be statistically significant. Results: (1) the prevalence of SLE-DAH in 54 patients with SLE was 0.73. The mean age was (30.8 鹵12.4) years old and the mean course of disease was (16.9 鹵33.6) months / 1 / 3 of DAH in 49 women (91%). The most common symptoms in patients with SLE-DAH were dyspnea (91%), hypoxiaemia (89%), cough (87%), fever (43 cases, 80%) and hemoglobin (36.1 鹵14.3) g / L in 24 hours (13.4 鹵10.8) g / L, respectively. The average SLEDAI score was (19 鹵7.9); (2. The most common symptoms were dyspnea (91%), followed by hypoxiaemia (89%), cough (87%), fever (43 cases 80%) and no hemoptysis (26%). The most common extrapulmonary involvement was kidney involvement (91%); (3), 53 of 54 SLE-DAH patients received glucocorticoid therapy, 37 (69%) received methylprednisolone shock therapy, (4) the nosocomial mortality of SLE-DAH patients was 20. 4%. In the death group, there were statistical differences in age and course of disease, and the incidence of infection and mechanical ventilation were higher, or associated with poor prognosis. (5) compared with SLE-NDAH patients, the two groups had a SLEDAI score in the course of the disease. There were significant differences in hospital mortality (20% vs 7%), and there were skin and mucosal lesions (70.4% vs 49.0%), hematological diseases (87% vs 43.8%), thrombocytopenia (72.2% vs 25.5%) and renal lesions (90.7% vs 62.9%) in patients with SLE-DAH. The positive rate of anti ds-DNA antibody was higher (55.6%vs 42.6%), and there was statistical difference (P0.05); (6). With the increase of clinical knowledge, the mortality of SLE-DAH decreased (50% vs 10%, P0.05). Conclusion the positive rate of ds-DNA is a serious complication of SLE, and no hemoptysis is found in the clinical manifestation. Attention should be paid to the diagnostic value of bronchoscopy. Active glucocorticoids, immunosuppressants can improve prognosis. Age of onset, course of disease with infection, mechanical ventilation and poor prognosis were related. Improving clinical knowledge can improve the prognosis of SLE-DAH.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R593.241

【相似文獻】

相關期刊論文 前10條

1 周新;李志仁;汪均陶;;彌漫性肺泡出血[J];國外醫(yī)學.呼吸系統(tǒng)分冊;1987年03期

2 侯顯明;彌漫性肺泡出血[J];臨床內科雜志;2003年06期

3 張素;許麗杰;;1例彌漫性肺泡出血病人的護理[J];護理研究;2007年33期

4 吳明;張建國;聶成;曾振國;錢克儉;;彌漫性肺泡出血5例臨床分析[J];江西醫(yī)藥;2008年10期

5 陳英;;1例成人特發(fā)性肺含鐵血黃素沉著癥合并彌漫性肺泡出血的護理[J];護理研究;2009年34期

6 張華;高俊珍;;淺析彌漫性肺泡出血[J];臨床肺科雜志;2010年08期

7 鮑雋君;韓一平;蕭毅;王騰;;彌漫性肺泡出血[J];中國呼吸與危重監(jiān)護雜志;2010年06期

8 薛青;焦維克;吳建輝;張文;方桂桔;鄧新宇;成英;;藥物相關性彌漫性肺泡出血綜合征2例報道及文獻復習[J];臨床肺科雜志;2011年12期

9 李志仁,周新;彌漫性肺泡出血[J];實用內科雜志;1987年09期

10 柯正華;劉翠蓮;洪小平;劉冬舟;;彌漫性結締組織病并發(fā)彌漫性肺泡出血12例臨床分析[J];山西醫(yī)藥雜志;2014年07期

相關會議論文 前9條

1 毋靜;于清宏;賴蓉;梁婉怡;曲源;鄧家鑫;;以彌漫性肺泡出血為主要首發(fā)表現(xiàn)的兒童系統(tǒng)性紅斑狼瘡1例報告并文獻復習[A];全國第八屆中西醫(yī)結合風濕病學術會議論文匯編[C];2010年

2 朱衛(wèi)國;曹彬;鄭文潔;;變應性肉芽腫血管炎并彌漫性肺泡出血一例[A];全國自身免疫性疾病專題研討會暨第十一次全國風濕病學學術年會論文匯編[C];2006年

3 查艷;;免疫力低下患者合并藥物性肺損傷及彌漫性肺泡出血[A];中華醫(yī)學會呼吸病學年會——2011（第十二次全國呼吸病學學術會議）論文匯編[C];2011年

4 查艷;楊霞;張湘燕;;免疫力低下患者合并藥物性肺損傷及彌漫性肺泡出血(病例剖析)[A];中華醫(yī)學會第七屆全國呼吸道感染學術大會暨第一屆多學科抗感染治療學術研討會論文匯編[C];2011年

5 楊霞;趙盈葶;龍艷君;查艷;;免疫力低下患者合并藥物性肺損傷及彌漫性肺泡出血(病例剖析)[A];貴州省中西醫(yī)結合學會腎病專業(yè)委員會成立暨中西醫(yī)結合診治腎臟病學習班論文匯編[C];2011年

6 陳茜圓;;成人特發(fā)性肺含鐵血黃素沉著癥[A];2011年第三十三屆浙江省呼吸系病學術年會暨呼吸疾病診治新進展學習班論文匯編[C];2011年

7 林玲;施宏瑩;;SLE并彌漫性肺泡出血診療進展[A];2011年華東六省一市風濕病學學術年會暨2011年浙江省風濕病學學術年會論文匯編[C];2011年

8 王梅芳;劉玉全;湯顯斌;杜春玲;唐以軍;劉為舜;熊暢;劉先軍;盧進昌;王云;段敬柱;;彌漫性肺泡出血診斷為IgA腎病一例并文獻復習[A];中華醫(yī)學會呼吸病學年會——2011（第十二次全國呼吸病學學術會議）論文匯編[C];2011年

9 鄒紅;;特重型燒傷并發(fā)不明原因彌漫性肺泡出血的救治護理[A];浙江省第十八屆燒傷外科學術會議論文匯編[C];2008年

相關碩士學位論文 前3條

1 陳彬瓊;彌漫性肺泡出血10例臨床分析[D];福建醫(yī)科大學;2015年

2 周聰;系統(tǒng)性紅斑狼瘡合并彌漫性肺泡出血：單中心54例臨床回顧性分析[D];北京協(xié)和醫(yī)學院;2015年

3 王荷s，

本文編號：2192360