解放军医学院学报
解放軍醫學院學報
해방군의학원학보
Academic Journal of Chinese Pla Medical School
2015年
5期
447-450
,共4页
刘毅%郑培浩%岑坚%李莉%赵德峰%尹文杰%钱李仁%马媛媛%王立新%沈建良
劉毅%鄭培浩%岑堅%李莉%趙德峰%尹文傑%錢李仁%馬媛媛%王立新%瀋建良
류의%정배호%잠견%리리%조덕봉%윤문걸%전리인%마원원%왕립신%침건량
弥漫性肺泡出血%白血病化疗%造血干细胞移植%再生障碍性贫血%诊断%治疗
瀰漫性肺泡齣血%白血病化療%造血榦細胞移植%再生障礙性貧血%診斷%治療
미만성폐포출혈%백혈병화료%조혈간세포이식%재생장애성빈혈%진단%치료
diffuse alveolar hemorrhage%leukemia chemotherapy%hematopoietic stem cell transplantation%aplastic anemia%diagnosis%therapy
目的：总结血液系统疾病患者弥漫性肺泡出血的诊断及治疗经验。方法分析2004年10月-2014年10月本院血液科21例继发于血液系统疾病的弥漫性肺泡出血患者的临床资料。结果21例中急性非淋巴细胞白血病14例，急性淋巴细胞白血病5例，重型再生障碍型贫血2例。15例发生于白血病化疗中或化疗后，3例发生于异基因造血干细胞移植预处理期或移植后，4例发生于保守治疗期。临床表现：呼吸困难100%(21/21)，低氧血症100%(21/21)，发热90.5%(19/21)，痰中带血71.4%(15/21)，咯血19.1%(4/21)。胸部影像学：15例呈双肺实质弥漫性渗出，6例呈双肺磨玻璃样间质改变，7例合并双侧少量胸腔积液。死亡率76.2%(16/21)。结论继发于血液系统疾病的弥漫性肺泡出血致死率高，呼吸困难、发热、痰中带血、咯血及肺部弥漫性浸润影为诊断提供线索，及早识别及治疗方能改善预后。
目的：總結血液繫統疾病患者瀰漫性肺泡齣血的診斷及治療經驗。方法分析2004年10月-2014年10月本院血液科21例繼髮于血液繫統疾病的瀰漫性肺泡齣血患者的臨床資料。結果21例中急性非淋巴細胞白血病14例，急性淋巴細胞白血病5例，重型再生障礙型貧血2例。15例髮生于白血病化療中或化療後，3例髮生于異基因造血榦細胞移植預處理期或移植後，4例髮生于保守治療期。臨床錶現：呼吸睏難100%(21/21)，低氧血癥100%(21/21)，髮熱90.5%(19/21)，痰中帶血71.4%(15/21)，咯血19.1%(4/21)。胸部影像學：15例呈雙肺實質瀰漫性滲齣，6例呈雙肺磨玻璃樣間質改變，7例閤併雙側少量胸腔積液。死亡率76.2%(16/21)。結論繼髮于血液繫統疾病的瀰漫性肺泡齣血緻死率高，呼吸睏難、髮熱、痰中帶血、咯血及肺部瀰漫性浸潤影為診斷提供線索，及早識彆及治療方能改善預後。
목적：총결혈액계통질병환자미만성폐포출혈적진단급치료경험。방법분석2004년10월-2014년10월본원혈액과21례계발우혈액계통질병적미만성폐포출혈환자적림상자료。결과21례중급성비림파세포백혈병14례，급성림파세포백혈병5례，중형재생장애형빈혈2례。15례발생우백혈병화료중혹화료후，3례발생우이기인조혈간세포이식예처리기혹이식후，4례발생우보수치료기。림상표현：호흡곤난100%(21/21)，저양혈증100%(21/21)，발열90.5%(19/21)，담중대혈71.4%(15/21)，각혈19.1%(4/21)。흉부영상학：15례정쌍폐실질미만성삼출，6례정쌍폐마파리양간질개변，7례합병쌍측소량흉강적액。사망솔76.2%(16/21)。결론계발우혈액계통질병적미만성폐포출혈치사솔고，호흡곤난、발열、담중대혈、각혈급폐부미만성침윤영위진단제공선색，급조식별급치료방능개선예후。
Objective To summarize the experience of diagnosis and treatment on diffuse alveolar hemorrhage (DAH) in patients with hematopoietic system diseases.Methods Clinical data about 21 cases with diffuse alveolar hemorrhage secondary to hematopoietic system diseases from October 2004 to October 2014 in department of hematology, Navy General Hospital, were retrospectively analyzed.Results Of the 21 cases, 14 cases were acute non-lymphoblastic leukemia, 5 cases were acute lymphoblastic leukemia, and 2 cases were severe aplastic anemia. The onset time of this disease was during or after leukemia chemotherapy in 15 cases, pre-conditioning or post- transplantation in 3 cases, and during palliative treatment in 4 cases. Clinical presentations included dyspnea (100%), hypoxaemia (100%), fever (90.5%), bloody-sputum (71.4%), and hemoptysis (19.1%). Chest image: 15 cases showed diffuse parenchymal exudates, 6 cases showed ground-glass interstitial change and 7 cases showed a small amount of bilateral pleural effusion. The mortality rate was 76.2% (16/21).Conclusion DAH secondary to hematopoietic system diseases shows high mortality. Dyspnea, fever, bloody sputum, hemoptysis, and diffuse lung infiltration provide clues for diagnosis. Early identification and treatment may improve outcomes.
