弥漫性肺泡出血病人死亡危险因素分析  

RISK FACTORS FOR DEATH IN PATIENTS WITH DIFFUSE ALVEOLAR HEMORRHAGE

作　　者：卢祥云 马柯[1] 温大蔚 梁宏达[1] 李鸣[2] 张怡婧[3] LU Xiangyun;MA Ke;WEN Dawei;LIANG Hongda;LI Ming;ZHANG Yijing(Department of Rheumatology and Immunology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院风湿免疫科,山东青岛266003 [2]山东第一医科大学附属山东省立医院风湿免疫科 [3]山东第一医科大学附属山东省立医院消化内科

出　　处：《青岛大学学报（医学版）》2021年第5期721-724,共4页Journal of Qingdao University(Medical Sciences)

基　　金：山东医药卫生科技发展计划项目(2016WS0434);青岛大学附属医院“临床医学+X”科研项目(3395)。

摘　　要：目的探讨系统性红斑狼疮(SLE)/抗中性粒细胞胞浆抗体相关性血管炎(AAV)合并弥漫性肺泡出血(DAH)病人的死亡危险因素。方法回顾性收集并分析2012年1月—2019年12月就诊于青岛大学附属医院的42例SLE/AAV合并DAH病人的临床资料。将上述病人根据临床转归分为死亡组和存活组,并对两组病人的临床资料进行对比分析。采用Logistic回归分析对DAH病人的死亡危险因素进行分析。结果两组病人在性别、发病年龄、原发病、合并呼吸衰竭、合并肾脏损害、合并心力衰竭等方面差异无显著性(P>0.05),而在原发病确诊至DAH病程时长、合并脑病、大剂量糖皮质激素冲击治疗、应用环磷酰胺和机械通气等方面差异有统计学意义(z=-2.858,χ^(2)=4.747~8.077,P<0.05)。Logistic回归分析结果显示,合并脑病(OR=28.659,95%CI=2.446~335.769,P=0.008)以及机械通气的使用(OR=10.043,95%CI=1.227~82.193,P=0.031)与病人死亡显著相关。结论脑病的发生和机械通气的使用可能是DAH病人死亡的独立危险因素。Objective To investigate risk factors for death in patients with systemic lupus erythematosus(SLE)/ANCA-related vasculitis(AAV) with diffuse alveolar hemorrhage(DAH). Methods A retrospective analysis was performed for the clinical data of 42 patients with SLE/AAV and DAH who attended The Affiliated Hospital of Qingdao University from January 2012 to December 2019, and according to clinical outcome, they were divided into death group and survival group. Related clinical data were compared between the two groups. The Logistic regression analysis was used to investigate the risk factors for death in patients with DAH. Results There were no significant differences between the two groups in sex, age, primary disease, respi-ratory failure, kidney damage, and heart failure(P>0.05), while there were significant differences between the two groups in the course of the disease, encephalopathy, high-dose glucocorticoid impact treatment, and use of cyclophosphamide and mechanical ventilation(z=-2.858,χ^(2)=4.747-8.077,P<0.05). The Logistic regression analysis showed that encephalopathy(OR=28.659,95%CI=2.446-335.769,P=0.008) and use of mechanical ventilation(OR=10.043,95%CI=1.227-82.193,P=0.031) were significantly associated with death. Conclusion Encephalopathy and use of mechanical ventilation may be independent risk factors for death in patients with DAH.

关 键 词：弥漫性肺泡出血 红斑狼疮 系统性 抗中性粒细胞胞浆抗体相关性血管炎 预后 危险因素 

分 类 号：R593.2[医药卫生—内科学]