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目的总结系统性红斑狼疮(SLE)并发弥漫性肺泡出血(DAH)的临床特点和治疗效果。方法收集1 247例住院SLE患者的临床资料,其中21例并发DAH(SLE并发DAH组),1 226例SLE(单纯SLE组),回顾性分析患者的临床表现、诊治经过和预后。结果 DAH是SLE少见的并发症,发生率为1.7%,病死率为38.1%,两组患者系统性红斑狼疮疾病活动评分(SLEDAI)、血WBC计数、血小板计数(PLT)、血IgG、血红蛋白、血氧饱和度、24 h尿蛋白、补体C3水平和抗双链DNA(抗dsDNA)阳性率比较,差异均有统计学意义(P<0.05);两组患者呼吸困难发生率、咳嗽咳痰率、咯血痰中带血发生率肺部阴影率、血管炎样皮疹率、肺动脉高压发生率比较,差异均有统计学意义(P<0.05);支气管肺泡灌洗治疗能够提高DHA患者存活率和急性起病率间比较,差异均有统计学意义(P<0.01)。结论 DAH是SLE严重并发症,与疾病活动有关。最常见的表现为急性呼吸困难和新发的肺部浸润,及早行支气管镜检查、支气管肺泡灌洗治疗对及时诊治至关重要。
Objective To summarize the clinical features and therapeutic effects of systemic lupus erythematosus (SLE) complicated with diffuse alveolar hemorrhage (DAH). Methods The clinical data of 1 247 hospitalized patients with SLE were collected. Among them, 21 cases were complicated with DAH (SLE with DAH) and 1 226 with SLE (SLE alone). The clinical manifestations, diagnosis and treatment of patients with SLE were retrospectively analyzed. Results DAH was a rare complication of SLE with a prevalence of 1.7% and a case fatality rate of 38.1%. SLEDAI, blood WBC count, platelet count (PLT), blood IgG, hemoglobin, Oxygen saturation, 24h urinary protein, complement C3 level and anti-dsDNA positive rate were significantly different (P <0.05). The incidence of dyspnea, cough and expectoration rate (P <0.05). The treatment of bronchoalveolar lavage could improve the survival rate and acuteness of DHA patients, and the difference was statistically significant Prevalence rate between the differences were statistically significant (P <0.01). Conclusion DAH is a serious complication of SLE, which is related to disease activity. The most common manifestations of acute respiratory distress and the new pulmonary infiltrates, early bronchoscopy, bronchoalveolar lavage treatment of timely diagnosis and treatment is essential.