急性白血病诱导治疗合并肺泡出血的临床分析并文献复习  

Clinical analysis of alveolar hemorrhage in acute leukemia induction therapy and literatures review

作　　者：高然[1] 蔡大利[1] 侯刚[2] 高峰[1] 王柏勋[1] 于锦香[1] 李艳[1] 

机构地区：[1]中国医科大学附属第一医院血液科,沈阳110001 [2]中国医科大学附属第一医院呼吸科,沈阳110001

出　　处：《白血病．淋巴瘤》2012年第12期742-745,共4页Journal of Leukemia & Lymphoma

摘　　要：目的探讨急性白血病诱导治疗合并肺泡出血的临床特征。方法分析确诊的2例和检索Medline数据库文献中资料完整的8例白血病合并肺泡m血患者临床资料，总结其临床特征、诊断及鉴别诊断策略和治疗方法。结果肺泡出血为急性白血病化疗后极少出现的严重并发症，多表现为咯血以及进行性呼吸困难加重，血红蛋白进行性下降。血气分析多提示为I型呼吸衰竭，CT表现为双肺弥漫性肺泡浸润影。支气管肺泡灌洗液为血性，肺活检多表现为肺泡充血，肺毛细血管炎。而病原学检测包括痰细菌及真菌培养、病毒抗体检测、1-3—β-D葡聚糖定量检测、血管炎相关抗体、降钙素原、脑钠肽等均为阴性，经验性给予广谱抗生素、抗病毒及抗心衰等治疗无效。死亡率高达40％（4／10），糖皮质激素治疗具有一定疗效，8例接受糖皮质激素治疗者死亡率为25％（2／8）。结论急性白血病合并肺泡出血少见，但病情危重，死亡率高，治疗的关键在于早期诊断和及时使用糖皮质激素治疗。Objective To analyze the clinical manifestation of diffusive alveolar hemorrhage in acute leukemia induction therapy. Methods Clinieal data of two diagnosed cases of diffusive alveolar hemorrhage secondary to acute leukemia were collected. Clinical data of eight cases of diffusive alveolar hemorrhage secondary to acute leukemia which were published were also collected by searching in Medline database. The clinical manifestation, diagnosis, strategy of differential diagnosis and treatment of diffusive alveolar hemorrhage secondary to acute leukemia were analyzed. Results Diffusive alveolar hemorrhage was a rare but fatal complication of acute leukemia. The common clinical manifestations included hemoptysis, progressive dyspnea and progressive deerease in eoneentration of hemoglobin. The analysis of blood gas showed type I respiratory failure. The manifestations of chest computed tomography included diffusive ground glass opacity and infiltration of parenchyma. The bronehoalveolar lavage fluid was bloody. And lung biopsy showed congestion of alveoli and capillaritis. The detection for pathogens, vasculitis related antibodies, brain natrium peptide were negative. The mortality of those eases was 40 % （4/10）. Cortieosteroids therapy was effective. The mortality of patients received cortieosteroids therapy was 25 % （2/8）. Conclusion Diffusive alveolar hemorrhage is a rare but fatal complication of acute leukemia. The mortality is high. The key points of therapy are early diagnosis and corticosteroids therapy.

关 键 词：白血病 急性 肺泡出血 诱导治疗 

分 类 号：R733.71[医药卫生—肿瘤]