[系统性红斑狼疮的胸膜肺部表现]

Shen Min, Wang Yu, Xu Wen-bing, Zeng Xue-jun, Zhang Feng-chun

Department of Rheumatology and Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.

Zhonghua Yi Xue Za Zhi. 2005 Dec 21;85(48):3392-5.

OBJECTIVE

To analyze the incidence, clinical features, and prognosis of pleuropulmonary involvement in patients with systemic lupus erythematosus (SLE).

METHODS

The medical records of 320 SLE inpatients hospitalized in Peking Union Medical College Hospital 2004, 50 males and 270 females, aged 33 +/- 14 (8-75), were retrospectively analyzed.

RESULTS

Pleuropulmonary involvement occurred in 142 cases with an incidence rate of 44.4%. The incidence of pleural involvement was 25% (80/320) and the incidence of pulmonary parenchyma involvement was 33.8% (108/320). The mortality rate of the SLE patients with thoracic involvement was 7.0%, significantly higher than that of the SLE patients without thoracic involvement (1.0%, P = 0.006). The incidence of acute lupus pneumonitis (ALP) was 1.3% and the survival rate of ALP was 100%. The clinical manifestations of ALP included hypoxemia, dyspnea, fever, and cough and chest radiograph characteristically showed unilateral or bilateral patchy acinar infiltrates predominantly in the lower lung zone. The incidence of diffuse alveolar hemorrhage (DAH) was 1.9% with a mortality rate of 66.7%. The clinical manifestations of DAH included hemoptysis, hypoxemia, cough, anemia and bloody bronchoalveolar lavage and the chest radiographic findings included new acinar infiltrates that were typically diffuse and bilateral and might be patchy. The other common pleuropulmonary complications of SLE included pleural disease (25%), chronic interstitial pneumonitis (6.9%), pulmonary hypertension (15.3%), pulmonary embolism (1.9%), and pulmonary infection (19.1%).

CONCLUSION

SLE may affect all components of the respiratory system. Thoracic involvement is an adverse prognostic sign. Life-threatening pulmonary involvement is not uncommon. The clinicoradiographic features of the SLE-associated pulmonary syndromes overlap. Aggressive diagnostic evaluations such as blood culture, sputum culture, fibreoptic bronchoscopy, and lung biopsy are very important.

目的

分析系统性红斑狼疮（SLE）患者胸膜肺受累的发生率、临床特征及预后。

方法

回顾性分析2004年在北京协和医院住院的320例SLE患者的病历资料，其中男性50例，女性270例，年龄33±14岁（8 - 75岁）。

结果

142例出现胸膜肺受累，发生率为44.4%。胸膜受累发生率为25%（80/320），肺实质受累发生率为33.8%（108/320）。有胸部受累的SLE患者死亡率为7.0%，显著高于无胸部受累的SLE患者（1.0%，P = 0.006）。急性狼疮性肺炎（ALP）发生率为1.3%，生存率为100%。ALP的临床表现包括低氧血症、呼吸困难、发热、咳嗽，胸部X线特征性表现为单侧或双侧斑片状腺泡浸润，以下肺野为主。弥漫性肺泡出血（DAH）发生率为1.9%，死亡率为66.7%。DAH的临床表现包括咯血、低氧血症、咳嗽、贫血以及血性支气管肺泡灌洗，胸部X线表现为新出现的腺泡浸润，通常为弥漫性双侧性，也可能呈斑片状。SLE其他常见的胸膜肺并发症包括胸膜疾病（25%）、慢性间质性肺炎（