弥漫性肺泡出血10例临床分析

发布时间：2017-12-31 12:20

本文关键词：弥漫性肺泡出血10例临床分析　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:分析总结DAH的临床资料,提高临床医生对该病的认识,以便早期诊治,改善预后。方法:回顾性分析福建医科大学附属第二医院2009年11月至2014年5月期间诊断的10例DAH患者的临床资料,如临床表现、辅助检查结果、诊疗经过及治疗等。结果:10例DAH患者中SLE占5例,AAV占4例,硬皮病占1例。临床特点80%(8/10)出现气喘或呼吸困难,50%(5/10)出现咯血,50%(5/10)出现痰中带血,90%(9/10)出现贫血,其中70%(7/10)患者血红蛋白在24-48小时内下降≥15g/l,60%(6/10)出现低氧血症。100%(10/10)患者胸部影像学可见不同程度异常,其中70%(7/10)患者出现双肺弥漫性病变,80%(8/10)可见大片磨玻璃影,80%(8/10)可见小片实变影,20%(2/10)可见团片状,20%(2/10)可见小片磨玻璃样影,20%(2/10)可见网格影。50%(5/10)患者行支气管镜检查和BAL,80%(4/5)肺泡灌洗液呈血性,20%(1/5)患者行TBLB病理提示肺泡腔出血并吞噬细胞浸润、部分吞噬含铁血黄素。20%患者(2/10)行机械通气,90%(9/10)予糖皮质激素治疗,55.6%(5/9)在明确DAH后行大剂量激素冲击治疗,60%(6/10)使用环磷酰胺抑制免疫,50%(5/10)行血浆置换,50%(5/10)使用免疫球蛋白冲击治疗,20%(2/10)使用吗替麦考酚脂片,10%(1/10)行免疫吸附治疗。90%(9/10)患者无咳嗽、咯血、呼吸困难等不适,好转出院,10%(1/10)放弃进一步治疗自动出院后死亡。结论:1、AAV以及以SLE为代表的自身免疫病是DAH的常见病因。2、当患者出现不明原因的进行性血红蛋白降低,且胸部影像学出现双肺磨玻璃样病变、实变影、团片状影时,即使无咯血、呼吸困难症状,应警惕DAH可能,支气管肺泡灌洗显示出血或找到含铁血黄素肺泡巨噬细胞有助于诊断。3、糖皮质激素、免疫抑制剂联合血浆置换、免疫球蛋白冲击治疗是治疗DAH有效方法。
[Abstract]:Objective: to analyze and summarize the clinical data of DAH so as to improve the understanding of the disease by clinicians so as to make early diagnosis and treatment. Methods: the clinical data of 10 patients with DAH diagnosed from November 2009 to May 2014 in the second affiliated Hospital of Fujian Medical University were analyzed retrospectively. Results among the 10 cases of DAH, 5 cases had SLE and 4 cases had SLE. Scleroderma accounted for 1 case. Clinical features 80 / 10) asthma or dyspnea 50% 10) hemoptysis 50% 5 / 10) sputum with blood. 90 / 9 / 10) anemia, 70 / 7 / 10) the hemoglobin of the patient dropped more than 15g / l within 24-48 hours. The chest imaging of patients with hypoxemia. 100% 10 / 10) was abnormal to varying degrees, and 70% of 10% of the patients had diffuse lesions of the lungs. 80 / 8 / 10) A large glass shadow can be seen 80 / 8 / 10) A small piece of solid shadow can be seen 20 / 2 / 10) and a patch 20 / 10) can be seen as a small glass grinding shadow. (20 / 2 / 10) you can see the mesh shadow. 50 / 10) the patients underwent bronchoscopy and BALA 80% 4 / 5) alveolar lavage fluid presented with blood. The TBLB pathology showed that alveolar hemorrhage combined with infiltration of macrophages and partial phagocytosis of hemosiderin. 20% of the patients were given mechanical ventilation. 90 / 9 / 10) Glucocorticoid therapy 55.6% 5 / 9) High dose hormone shock therapy 60 / 6 / 10 after DAH was defined) Cyclophosphamide was used to suppress immunity. 50 / 10) take plasma exchange 50 / 10) use immunoglobulin shock therapy 20 / 10) and use metocophenolate tablets. 10 / 1 / 10) Immunosorbent therapy. 90 / 10) patients without cough, hemoptysis, dyspnea, etc., were discharged from the hospital. 10 / 10) giving up further treatment for death after automatic discharge. Conclusion: 1 / 1 AAV and autoimmune disease, represented by SLE, are the common etiology of DAH. When the patient had unexplained progressive hemoglobin lowering, and chest imaging appeared double lung ground-glass lesions, solid shadow, flake shadow, even if there is no hemoptysis, dyspnea symptoms, we should be aware of DAH may. Bronchoalveolar lavage shows bleeding or finding the hemosiderin alveolar macrophages to help diagnose. 3 glucocorticoid immunosuppressant combined with plasma exchange. Immunoglobulin shock therapy is an effective method in the treatment of DAH.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R563

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