138例儿童弥漫性肺泡出血临床特点及病因分析  

The clinical characteristics and etiological analysis of diffuse alveolar hemorrhage in 138 children

作　　者：王维[1] 张慧[1] 田小银 张光莉[1] 陈明[1] 孟庆清[1] 罗征秀[1] 

机构地区：[1]重庆医科大学附属儿童医院呼吸科儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室,重庆400014

出　　处：《临床儿科杂志》2016年第9期670-673,共4页Journal of Clinical Pediatrics

基　　金：国家临床重点专科建设项目(No.2011-873)

摘　　要：目的分析儿童弥漫性肺泡出血(DAH)的临床特点及其常见病因。方法回顾性分析138例首次诊断DAH患儿的临床资料,总结病因、诊治经过及预后。结果 138例患儿中男76例、女62例;临床表现为面色苍白130例(94.2%),咳嗽86例(62.3%),发热74例(53.6%),气促67例(48.6%),咯血59例(42.8%),呼吸困难43例(31.2%);胸部影像学改变以斑片影及磨玻璃样影为主;痰液、胃液及支气管肺泡灌洗液含铁血黄素巨噬细胞检出率90.8%(79/87)。引起DAH常见基础疾病分别为特发性肺含铁血黄素沉着症65例,血液系统疾病22例,血管炎性疾病15例,感染性疾病14例,心血管疾病5例。DHA患儿急性期病死率23.2%(32/138)。结论 DAH是危及生命的临床急重症,病因复杂多样,急性期病死率高,糖皮质激素是多数患者的首选治疗方法。Objective To analyze the clinical feature and common etiology of diffuse alveolar hemorrhage（DAH） in children. Methods Clinical data from 138 children with initially diagnosed DAH were retrospectively analyzed. The etiology, diagnosis, treatment, and prognosis had been summarized. Results Among 138 children, 76 were male and 62 were female. The clinical features are pallor（ 130 cases, 94. 2 %）, cough（ 86 cases, 62. 3 %）, fever（ 74 cases, 53. 6 %）, anhelation（ 67 cases, 48. 6 %）, hemoptysis（ 59 cases, 42. 8 %） and dyspnea（ 43 cases, 31. 2 %）. Chest imaging changes were mainly patch shadow and ground glass shadow. Moreover, the detection rate of hemosiderin cells in sputum, gastric juice and bronchoalveolar lavage fluid was 90.8%（79/87）. The common underlying diseases that caused DAH were idiopathic pulmonary hemosiderosis（ 65 cases）, hematological system disease（ 22 cases）, vascular inflammatory diseases（15 cases）, infectious diseases（14 cases） and cardiovascular disease（5 cases）. The mortality rate in acute phase of DHA was 23. 2 %（ 32 / 138）. Conclusions DHA is a life-threatening clinical emergency disease, its cause was complex and diverse, and the acute mortality rate is high. Glucocorticoid is the first choice of treatment for majority of patients.

关 键 词：弥漫性肺泡出血 病因 治疗 儿童 

分 类 号：R725.6[医药卫生—儿科]