Gupta S, Jain A, Warneke C L, Gupta A, Shannon V R, Morice R C, Onn A, Jimenez C A, Bashoura L, Giralt S A, Dickey B F, Eapen G A
Department of Internal Medicine, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
Bone Marrow Transplant. 2007 Jul;40(1):71-8. doi: 10.1038/sj.bmt.1705695. Epub 2007 May 7.
Alveolar hemorrhage (AH) is a frequent, serious complication of hematopoietic stem cell transplantation (HSCT). To study the incidence of AH, its clinical course and outcomes in HSCT patients, a retrospective review of the records of all adult patients who underwent bronchoscopy between January 1, 2002 and December 31, 2004 was carried out and those who underwent bronchoscopy after HSCT identified. A total of 223 patients underwent bronchoscopy after HSCT for diffuse pulmonary infiltrates with respiratory compromise. Eighty-seven (39%) patients had AH. Of these, 53 had AH without any identified organism while 34 had an organism along with hemorrhage on bronchoalveolar lavage (BAL). Six-month survival rate of patients with AH was 38% (95% confidence interval: 27-48%). In 95 of the 223 patients, an organism was isolated from BAL. These patients had poor outcomes compared to patients in whom no organism was identified. Patients with both AH and an organism had the worst prognosis. Mortality of patients with AH is improving and long-term survival of patients with AH is feasible. Isolation of a microbial organism in BAL is a strong predictor of poor outcome.
肺泡出血（AH）是造血干细胞移植（HSCT）常见且严重的并发症。为研究HSCT患者中AH的发生率、临床病程及转归，对2002年1月1日至2004年12月31日期间所有接受支气管镜检查的成年患者记录进行回顾性分析，并确定HSCT后接受支气管镜检查的患者。共有223例HSCT后因弥漫性肺浸润伴呼吸功能不全接受支气管镜检查的患者。其中87例（39%）发生AH。其中，53例AH患者未发现任何病原体，34例支气管肺泡灌洗（BAL）时有病原体伴出血。AH患者的6个月生存率为38%（95%置信区间：27 - 48%）。223例患者中有95例从BAL中分离出病原体。与未发现病原体的患者相比，这些患者预后较差。同时患有AH和病原体的患者预后最差。AH患者的死亡率正在改善，AH患者长期生存是可行的。BAL中分离出微生物病原体是预后不良的有力预测指标。
