系统性红斑狼疮合并弥漫性肺泡出血临床分析  

Clinical Analysis to Systemic Lupus Erythematosus Complicated with Diffuse Alveolar Hemorrhage

作　　者：刘桂艳 佟胜全 胖红雯 石哲群 王治国 李雅娟 饶莉 张鸽 燕丽君 

机构地区：[1]河北省唐山市工人医院妇产科,063000 [2]河北省唐山市工人医院风湿科,063000 [3]唐山市康复医疗中心

出　　处：《中国全科医学》2011年第11期1253-1255,共3页Chinese General Practice

基　　金：河北省科学技术研究与发展指导计划项目(072761494)

摘　　要：目的总结系统性红斑狼疮(SLE)并发弥漫性肺泡出血(DAH)的临床特点和治疗效果。方法收集1 247例住院SLE患者的临床资料,其中21例并发DAH(SLE并发DAH组),1 226例SLE(单纯SLE组),回顾性分析患者的临床表现、诊治经过和预后。结果 DAH是SLE少见的并发症,发生率为1.7%,病死率为38.1%,两组患者系统性红斑狼疮疾病活动评分(SLEDAI)、血WBC计数、血小板计数(PLT)、血IgG、血红蛋白、血氧饱和度、24 h尿蛋白、补体C3水平和抗双链DNA(抗dsDNA)阳性率比较,差异均有统计学意义(P<0.05);两组患者呼吸困难发生率、咳嗽咳痰率、咯血痰中带血发生率肺部阴影率、血管炎样皮疹率、肺动脉高压发生率比较,差异均有统计学意义(P<0.05);支气管肺泡灌洗治疗能够提高DHA患者存活率和急性起病率间比较,差异均有统计学意义(P<0.01)。结论 DAH是SLE严重并发症,与疾病活动有关。最常见的表现为急性呼吸困难和新发的肺部浸润,及早行支气管镜检查、支气管肺泡灌洗治疗对及时诊治至关重要。Objective To summarize the clinical features of systemic lupus erythematosus（SLE） complicated with diffuse alveolar hemorrhage（DAH）.Methods Of 1,247 SLE inpatients,21 were confirmed to be complicated with DAH（SLE＋DAH group）,and the remaining 1,226 patients were assigned as SLE alone group.The clinical data were retrospectively analyzed.Results The incidence of DAH was 1.7% and the case-fatality was 38.1%.The Systemic Lupus Erythematosus Activity Index（SLEDAI） score,blood white blood cell,blood platelet,IgG,hemoglobin,oxygen saturation of blood,urine protein,complement-3,and anti-dsDNA positive rate were significantly different between SLE＋DAH group and SLE alone group（all P0.05）.Physical symptoms such as dyspnea,cough,sputum,hemoptysis,blood streaked sputum,newly developed lung opacities on CT,vasculitis rash,and pulmanory artery hypertention also showed significant difference（all P0.05）.The survival in SLE＋DAH group was significantly increased after bronchoalveolar lavage（BAL）,while acute onset of the disease significantly increased the mortality（P0.01）.Conclusion DAH is a serious complications of SLE.The episodes of DAH are relevant with the activity of SLE.The most common clinical manifestation of SLE＋DAH are the newly developed dyspnea and new infiltration of bilateral lungs.Prompt BAL is critical for early diagnosis and treatment.

关 键 词：红斑狼疮 系统性 弥漫性肺泡出血 支气管肺泡灌洗 

分 类 号：R593.24[医药卫生—内科学]