CAJ | 학술논문

目的探讨急性白血病诱导治疗合并肺泡出血的临床特征.方法分析确诊的2例和检索Medline数据库文献中资料完整的8例白血病合并肺泡出血患者临床资料,总结其临床特征、诊断及鉴别诊断策略和治疗方法.结果肺泡出血为急性白血病化疗后极少出现的严重并发症,多表现为咯血以及进行性呼吸困难加重,血红蛋白进行性下降.血气分析多提示为Ⅰ型呼吸衰竭,CT表现为双肺弥漫性肺泡浸润影.支气管肺泡灌洗液为血性,肺活检多表现为肺泡充血,肺毛细血管炎.而病原学检测包括痰细菌及真菌培养、病毒抗体检测、1-3-β-D葡聚糖定量检测、血管炎相关抗体、降钙素原、脑钠肽等均为阴性,经验性给予广谱抗生素、抗病毒及抗心衰等治疗无效.死亡率高达40％(4/10),糖皮质激素治疗具有一定疗效,8例接受糖皮质激素治疗者死亡率为25％(2/8).结论急性白血病合并肺泡出血少见,但病情危重,死亡率高,治疗的关键在于早期诊断和及时使用糖皮质激素治疗.
목적 탐토급성백혈병유도치료합병폐포출혈적림상특정.방법 분석학진적2례화검색Medline수거고문헌중자료완정적8례백혈병합병폐포출혈환자림상자료,총결기림상특정、진단급감별진단책략화치료방법.결과 폐포출혈위급성백혈병화료후겁소출현적엄중병발증,다표현위각혈이급진행성호흡곤난가중,혈홍단백진행성하강.혈기분석다제시위Ⅰ형호흡쇠갈,CT표현위쌍폐미만성폐포침윤영.지기관폐포관세액위혈성,폐활검다표현위폐포충혈,폐모세혈관염.이병원학검측포괄담세균급진균배양、병독항체검측、1-3-β-D포취당정량검측、혈관염상관항체、강개소원、뇌납태등균위음성,경험성급여엄보항생소、항병독급항심쇠등치료무효.사망솔고체40％(4/10),당피질격소치료구유일정료효,8례접수당피질격소치료자사망솔위25％(2/8).결론 급성백혈병합병폐포출혈소견,단병정위중,사망솔고,치료적관건재우조기진단화급시사용당피질격소치료.
Objective To analyze the clinical manifestation of diffusive alveolar hemorrhage in acute leukemia induction therapy.Methods Clinical data of two diagnosed cases of diffusive alveolar hemorrhage secondary to acute leukemia were collected.Clinical data of eight cases of diffusive alveolar hemorrhage secondary to acute leukemia which were published were also collected by searching in Medline database.The clinical manifestation,diagnosis,strategy of differential diagnosis and treatment of diffusive alveolar hemorrhage secondary to acute leukemia were analyzed.Results Diffusive alveolar hemorrhage was a rare but fatal complication of acute leukemia.The common clinical manifestations included hemoptysis,progressive dyspnea and progressive decrease in concentration of hemoglobin.The analysis of blood gas showed type Ⅰ respiratory failure.The manifestations of chest computed tomography included diffusive ground glass opacity and infiltration of parenchyma.The bronchoalveolar lavage fluid was bloody.And lung biopsy showed congestion of alveoli and capillaritis.The detection for pathogens,vasculitis related antibodies,brain natrium peptide were negative.The mortality of those cases was 40 ％ (4/10).Corticosteroids therapy was effective.The mortality of patients received corticosteroids therapy was 25 ％ (2/8).Conclusion Diffusive alveolar hemorrhage is a rare but fatal complication of acute leukemia.The mortality is high.The key points of therapy are early diagnosis and corticosteroids therapy.