系统性红斑狼疮合并肺泡出血10例临床分析

Clinical analysis of 10 cases of systemic lupus erythematosus complicated with alveolar hemorrhage

目的总结SLE合并肺泡出血的临床特点和疗效分析,提高对该病的认识。方法回顾性分析我院2010年2月~2017年4月确诊SLE合并DAH的10例临床资料,并进行统计学分析。结果 (1)10例SLE-DAH患者中,男1例,女9例,平均年龄(27.3±11.6)岁,平均病程(18.2±25.4)个月。(2)3例以DAH表现首发。最常见的症状是气促或呼吸困难、低氧血症,其余依次为咳嗽、发热、咯血、痰中带血;24~48 h内血红蛋白平均下降(20.2±9.5)g/L。最常见的肺外受累为肾脏、浆膜腔;(3)SLEDAI评分平均(24.8±10.1)分,其中90%处于疾病重度活动期;(4)10例患者均接受了糖皮质激素治疗,4例予甲基泼尼松龙冲击治疗;8例予丙种免疫球蛋白冲击,6例使用环磷酰胺抑制免疫,4例予机械通气,1例行血浆置换,病死率为80%。结论 SLE合并DAH的死亡率高,疾病活动度高易发生。积极的糖皮质激素、免疫抑制剂是治疗的主要方法。

Objective To summarize the clinical features and efficacy of SLE complicated with alveolar hemorrhage and to improve the understanding of the disease. Methods A retrospective analysis of 10 cases of clinical data of SLE com- plicated with DAH in our hospital from February 2010 to April 2017 was performed and analyzed statistically. Results （1）Among 10 SLE-DAH patients, 1 was male and 9 were female. The mean age was （27.3±11.6） years old and the aver- age course of disease was（18.2±25.4） months. （2）3 cases showed DAH as the initial symptom. The most commonly seen symptoms were shortness of breath or dyspnea and hypoxemia, followed by cough, fever, hemoptysis, and bloody spu- tum; the average amount of hemoglobin decrease within 24-48 hours was （20.2±9.5） g/1. The most commonly seen extra- pulmonary involvement was kidney and serosal cavity; （3） average SLEDAI score was （24.8±10.1） points, in which 90% of them were in severe disease activity period; （4）10 patients received glucocorticoid therapy. 4 cases were given methyl- prednisolone impact therapy; 8 cases were given immunoglobulin type C impact therapy, 6 cases were given cyelophos- phamide immunosuppression, 4 cases were given mechanical ventilation, and 1 case was given plasmapheresis. The case fatality rate was 80%. Conclusion The mortality rate of SLE complicated with DAH is high, and the disease activity is high, which leads to easy occurrence of the disease. Active glucocorticoids and immunosuppressive agents are the main method of treatment.