Santos-Ocampo A S, Mandell B F, Fessler B J
Department of Medicine, Makati Medical Center, Makati City, Philippines.
Chest. 2000 Oct;118(4):1083-90. doi: 10.1378/chest.118.4.1083.
To describe our experience with alveolar hemorrhage (AH) in systemic lupus erythematosus (SLE).
Review of medical records and pertinent medical literature using MEDLINE and reference lists from retrieved publications.
Seven patients with SLE admitted with episodes of AH (n = 11).
Six patients were female, and one was male. Mean age at the time of AH was 31.1 years. Mean duration of SLE was 4.5 years. AH occurred within 3 weeks of SLE onset in two patients. Recurrent AH was observed in four patients. Six patients were already receiving treatment for SLE at the time of AH. All patients presented with dyspnea and new pulmonary infiltrates. Hemoptysis occurred in only 54%. All patients had BAL within 48 h of presentation. Temperature > or =39 degrees C (102.2 degrees F) accompanied 82% of episodes. Glomerulonephritis was the most common nonpulmonary SLE manifestation (74%). Treatment with empiric IV antibiotics was initiated in 10 episodes. Initial treatment included high-dose corticosteroids (prednisone, 1 to 3 mg/kg/d [n = 2]; or IV methylprednisolone, 1 g/d [n = 9], with or without oral cyclophosphamide, 2 to 3 mg/kg/d [n = 7]). Plasmapheresis (three to four sessions) was added in five episodes for persistent AH. All patients survived.
AH may mimic pneumonia. Hemoptysis may not be evident. Infection must be aggressively excluded, especially since many patients with AH are already receiving immunosuppressive therapy. AH frequently recurs despite ongoing immunosuppression. Although high mortality rates have been reported with AH in SLE, we observed 100% survival.
描述我们在系统性红斑狼疮（SLE）患者中处理肺泡出血（AH）的经验。
使用MEDLINE检索医疗记录及相关医学文献，并查阅检索到的出版物的参考文献列表。
7例SLE患者因AH发作入院（共11次发作）。
6例为女性，1例为男性。AH发作时的平均年龄为31.1岁。SLE的平均病程为4.5年。2例患者在SLE发病后3周内出现AH。4例患者出现复发性AH。6例患者在AH发作时已在接受SLE治疗。所有患者均出现呼吸困难和新的肺部浸润影。仅54%的患者出现咯血。所有患者在就诊后48小时内均接受了支气管肺泡灌洗。82%的发作伴有体温≥39℃（102.2°F）。肾小球肾炎是最常见的非肺部SLE表现（74%）。10次发作中开始经验性静脉使用抗生素治疗。初始治疗包括大剂量皮质类固醇（泼尼松，1至3mg/kg/d [n = 2]；或静脉注射甲泼尼龙，1g/d [n = 9]），加或不加口服环磷酰胺，2至3mg/kg/d [n = 7]）。5次发作中因持续性AH加用了血浆置换（三至四次）。所有患者均存活。
AH可能类似肺炎。咯血可能不明显。必须积极排除感染，尤其是因为许多AH患者已经在接受免疫抑制治疗。尽管持续进行免疫抑制，AH仍经常复发。虽然SLE患者中AH的死亡率较高，但我们观察到的存活率为100%。
