本文關鍵詞：彌漫性肺泡出血10例臨床分析　出處：《福建醫(yī)科大學》2015年碩士論文　論文類型：學位論文

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【摘要】：目的:分析總結(jié)DAH的臨床資料,提高臨床醫(yī)生對該病的認識,以便早期診治,改善預后。方法:回顧性分析福建醫(yī)科大學附屬第二醫(yī)院2009年11月至2014年5月期間診斷的10例DAH患者的臨床資料,如臨床表現(xiàn)、輔助檢查結(jié)果、診療經(jīng)過及治療等。結(jié)果:10例DAH患者中SLE占5例,AAV占4例,硬皮病占1例。臨床特點80%(8/10)出現(xiàn)氣喘或呼吸困難,50%(5/10)出現(xiàn)咯血,50%(5/10)出現(xiàn)痰中帶血,90%(9/10)出現(xiàn)貧血,其中70%(7/10)患者血紅蛋白在24-48小時內(nèi)下降≥15g/l,60%(6/10)出現(xiàn)低氧血癥。100%(10/10)患者胸部影像學可見不同程度異常,其中70%(7/10)患者出現(xiàn)雙肺彌漫性病變,80%(8/10)可見大片磨玻璃影,80%(8/10)可見小片實變影,20%(2/10)可見團片狀,20%(2/10)可見小片磨玻璃樣影,20%(2/10)可見網(wǎng)格影。50%(5/10)患者行支氣管鏡檢查和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細胞浸潤、部分吞噬含鐵血黃素。20%患者(2/10)行機械通氣,90%(9/10)予糖皮質(zhì)激素治療,55.6%(5/9)在明確DAH后行大劑量激素沖擊治療,60%(6/10)使用環(huán)磷酰胺抑制免疫,50%(5/10)行血漿置換,50%(5/10)使用免疫球蛋白沖擊治療,20%(2/10)使用嗎替麥考酚脂片,10%(1/10)行免疫吸附治療。90%(9/10)患者無咳嗽、咯血、呼吸困難等不適,好轉(zhuǎn)出院,10%(1/10)放棄進一步治療自動出院后死亡。結(jié)論:1、AAV以及以SLE為代表的自身免疫病是DAH的常見病因。2、當患者出現(xiàn)不明原因的進行性血紅蛋白降低,且胸部影像學出現(xiàn)雙肺磨玻璃樣病變、實變影、團片狀影時,即使無咯血、呼吸困難癥狀,應警惕DAH可能,支氣管肺泡灌洗顯示出血或找到含鐵血黃素肺泡巨噬細胞有助于診斷。3、糖皮質(zhì)激素、免疫抑制劑聯(lián)合血漿置換、免疫球蛋白沖擊治療是治療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.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R563

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相關期刊論文 前1條

1 柯正華;劉翠蓮;洪小平;劉冬舟;;彌漫性結(jié)締組織病并發(fā)彌漫性肺泡出血12例臨床分析[J];山西醫(yī)藥雜志;2014年07期

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本文編號：1359753