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系统性红斑狼疮合并弥漫肺泡出血17例临床分析
引用本文:沈敏,曾学军,范洪伟,许文兵,张奉春.系统性红斑狼疮合并弥漫肺泡出血17例临床分析[J].中华医学杂志,2009,89(3).
作者姓名:沈敏  曾学军  范洪伟  许文兵  张奉春
作者单位:1. 中国医学科学院中国协和医科大学北京协和医院风湿免疫科,100730
2. 中国医学科学院中国协和医科大学北京协和医院普通内科,100730
3. 中国医学科学院中国协和医科大学北京协和医院感染科,100730
4. 中国医学科学院中国协和医科大学北京协和医院呼吸科,100730
摘    要:目的 结系统性红斑狼疮(SEE)合并弥漫肺泡出血(DAH)的临床特点.方法 回顾性分析17例SLE合并DAH患者的临床表现、实验室检查、诊治和转归.结果 SLE合并DAH主要表现为低氧血症(100%)、呼吸困难(88%)、咳嗽(88%)、发热(82%)和咯血(71%).大部分(94%)患者同时合并肾脏受累.近60%合并肺部感染.血红蛋白平均下降(32±11.3)g/L.SLE疾病活动指数平均(17 ±10)分.17例患者全部接受激素治疗,13例并用免疫抑制剂.死亡组机械通气率高于存活组(P<0.05).结论 DAH是SEE少见而危重的并发症,与SLE疾病活动有关.常合并狼疮性肾炎.并非所有患者均有咯血表现.

关 键 词:红斑狼疮  系统性  肺泡  出血

Diffuse alveolar hemorrhage in systemic lupus erythematosus
SHEN Min,ZENG Xue-jun,FAN Hong-wei,XU Wen-bing,ZHANG Feng-chun.Diffuse alveolar hemorrhage in systemic lupus erythematosus[J].National Medical Journal of China,2009,89(3).
Authors:SHEN Min  ZENG Xue-jun  FAN Hong-wei  XU Wen-bing  ZHANG Feng-chun
Abstract:Objective To determine the clinical features of systemic lupus erythematosus (SLE) patients with diffuse alveolar hemorrhage (DAH).Methods The medical records of seventeen SLE patients with DAH were reviewed.Results Hypoxemia ( 100% ),dyspnea ( 88% ),cough ( 88% ) and fever (82%) wore the most common symptoms instead of hemoptysis (71%).The most common extrapulmonary presentation was renal involvement (94%).About 60% patients were complicated with lung infection.The mean drop in hemoglobin was ( 32 ± 11.3 ) g/L Mean SLEDAI was ( 17~10 ).All received high-dose steroids and most also were given cyclophosphamlde.Ratio of mechanical ventilation in non-survivors was higher than that of survivors ( P < 0.05 ).Conclusions DAH is a rare and catastrophic event in SLE.DAH can occur in any course,which suggests active SLE,and frequently complicated with lupus nephritis.Some patients may have no hemoptysis.
Keywords:Lupus erythematosus  systemic  Pulmonary alvcoli  Hemorrhage
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