Sisson J H, Thompson A B, Anderson J R, Robbins R A, Spurzem J R, Spence P R, Reed E C, Armitage J O, Vose J M, Arneson M A
Department of Medicine, University of Nebraska Medical Center, Omaha 68198-2465.
Am Rev Respir Dis. 1992 Aug;146(2):439-43. doi: 10.1164/ajrccm/146.2.439.
We determined risk factors present in patients with Hodgkin disease that predicted the development of diffuse alveolar hemorrhage syndrome (DAH) during autologous bone marrow transplantation (BMT). One hundred twenty-three patients with Hodgkin disease prospectively underwent bronchoscopy with bronchoalveolar lavage (BAL) before receiving BMT. The bronchitis index (BI) of the airways and bronchial and alveolar cell counts and differentials were determined in all patients and compared with 20 normal nonsmoking volunteers. Logistic regression analysis was used to determine factors that predicted for the development of DAH. Visual evidence of bronchial injury was observed regardless of smoking history (BI = 7.8 +/- 0.5 for BMT versus 2.3 +/- 0.5 for volunteers, p = 0.001). BMT patients who developed DAH (n = 14) had significantly greater numbers of bronchial neutrophils and eosinophils compared with DAH-negative (n = 109) patients (bronchial polymorphonuclear leukocytes (PMN), 33 +/- 7% versus 14 +/- 2%, p = 0.006; bronchial eosinophils, 0.9 +/- 0.3% versus 0.4% +/- 0.07%, p = 0.02). Logistic regression analysis revealed that the presence of bronchial PMN > 20% or bronchial eosinophils > zero% were predictive of DAH (p = 0.005 and 0.05, respectively). When both predictors were positive, the rate of DAH was 10 times greater than when both predictors were negative (43% versus 4% DAH occurrence). Survival was also significantly reduced when these predictors were positive. This study demonstrates that bronchial inflammation is present with or without intraluminal inflammatory cells in the majority of patients with Hodgkin disease before BMT. The subgroup of these patients with increased bronchial inflammatory cells are at greatly increased risk for development of DAH and death.
我们确定了霍奇金病患者中存在的风险因素，这些因素可预测自体骨髓移植（BMT）期间弥漫性肺泡出血综合征（DAH）的发生。123例霍奇金病患者在接受BMT前前瞻性地接受了支气管镜检查及支气管肺泡灌洗（BAL）。测定了所有患者气道的支气管炎指数（BI）以及支气管和肺泡细胞计数及分类，并与20名正常不吸烟志愿者进行比较。采用逻辑回归分析来确定预测DAH发生的因素。无论吸烟史如何，均观察到支气管损伤的视觉证据（BMT患者的BI = 7.8±0.5，而志愿者为2.3±0.5，p = 0.001）。与未发生DAH的患者（n = 109）相比，发生DAH的BMT患者（n = 14）支气管中性粒细胞和嗜酸性粒细胞数量显著更多（支气管多形核白细胞（PMN），33±7%对14±2%，p = 0.006；支气管嗜酸性粒细胞，0.9±0.3%对0.4%±0.07%，p = 0.02）。逻辑回归分析显示，支气管PMN>20%或支气管嗜酸性粒细胞>0%可预测DAH（p分别为0.005和0.05）。当两个预测指标均为阳性时，DAH发生率比两个预测指标均为阴性时高10倍（DAH发生率分别为43%和4%）。当这些预测指标为阳性时，生存率也显著降低。本研究表明，大多数霍奇金病患者在BMT前，无论管腔内是否存在炎性细胞，均存在支气管炎症。这些支气管炎性细胞增多的患者亚组发生DAH和死亡的风险大大增加。
