临床病例评析——咳嗽 咯血3个月余  

Clinical case analysis——cough and hemoptysis for more than 3 months

作　　者：宫宁宁 赵久良[1] 周央中 李梦涛[1] Gong Ningning;Zhao Jiuliang;Zhou Yangzhong;Li Mengtao(Department of Rheumatology and Immunology,Peking Union Medical College,Chinese Academy of Medical Sciences,Peking Union Medical College Hospital,Beijing 100730,China;Department of Rheumatology and Immunology,Gansu Provincal People′s Hospital,Lanzhou 730000,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院风湿免疫科,北京100730 [2]甘肃省人民医院风湿免疫科,兰州730000

出　　处：《中华风湿病学杂志》2025年第2期128-132,共5页Chinese Journal of Rheumatology

基　　金：中国医学科学院医学与健康科技创新工程项目(2023-I2M-C&T-B-051)。

摘　　要：目的提高临床对抗磷脂综合征(APS)继发弥漫性肺泡出血(DAH)的认识。方法报道1例以DAH为首发症状、抗磷脂抗体(aPLs)阳性的患者,2024年3月20日就诊于北京协和医院风湿免疫科。分析其临床特点和诊治经过。结果43岁男性患者,以"咳嗽、咯血3个月余"就诊,影像学及肺泡灌洗液明确为DAH。病程中伴随血小板减少及炎症指标升高,多种抗磷脂抗体高滴度阳性。在排除其他潜在病因后,最终诊断为APS继发DAH。患者接受大剂量糖皮质激素和免疫抑制剂的规范治疗后,病情缓解,肺部病变吸收,血小板恢复,aPLs滴度较前下降。结论对于不明原因的DAH,需进一步排除感染等因素后筛查自身免疫病,该患者积极筛查病因后明确诊断为APS继发DAH,给予激素及环磷酰胺治疗后病变吸收。早期识别微血管事件对于改善患者预后至关重要。ObjectiveTo improve clinical understanding of diffuse alveolar hemorrhage(DAH)secondary to antiphospholipid syndrome(APS).MethodsA patient with DAH as the initial symptom and positive for antiphospholipid antibodies(aPLs)was reported,and their clinical characteristics and diagnosis and treatment process were analyzed.ResultsA 43 year old male patient presented with"cough and hemoptysis for more than 3 months",and the imaging and bronchoalveolar lavage fluid confirmed DAH.During the course of the disease,there was a decrease in platelets and an increase in inflammatory markers,as well as high titers of various antiphospholipid antibodies.After excluding other potential causes,the final diagnosis was APS secondary DAH.After receiving high-dose glucocorticoid and immunosuppressant,the patient′s condition was relieved,pulmonary lesions were absorbed,platelets recovered,and aPLs titer decreased.ConclusionFor unexplained DAH,it is necessary to further exclude infection and other factors before screening autoimmune diseases.The patient was diagnosed as APS-DAH after actively screening the cause,and the lesion was absorbed after hormone and cyclophosphamide treatment.Early identification of microvascular events is crucial for improving patient prognosis.

关 键 词：抗磷脂综合征 弥漫性肺泡出血 抗磷脂抗体 微血管事件 

分 类 号：R563[医药卫生—呼吸系统]