Jin Sang-Man, Yim Jae-Joon, Yoo Chul-Gyu, Kim Young-Whan, Han Sung-Koo, Shim Young-Soo, Lee Sang-Min
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Respirology. 2009 Mar;14(2):290-4. doi: 10.1111/j.1440-1843.2008.01444.x. Epub 2008 Dec 11.
Connective tissue diseases are the most common disorders causing diffuse alveolar haemorrhage (DAH) confirmed by open lung biopsy. However, it is not known whether these diseases are also the most common causes of DAH in patients presenting with the features of ARDS/acute lung injury (ALI). This study evaluated the frequency of concomitant disease in patients with ARDS/ALI and DAH.
The sampling frame comprised all patients in a tertiary referral hospital diagnosed with ARDS/ALI and who underwent BAL between January 2000 and July 2006. The medical records of those patients who had BAL fluid findings compatible with DAH were reviewed.
Of the 97 patients diagnosed with ARDS/ALI and who underwent BAL, 27 had BAL fluid findings compatible with DAH. Sixteen of the 27 patients did not have connective tissue diseases (59%); of these 12 patients had concomitant haematological malignancies or solid tumours. Of the seven patients who presented with DAH and no known underlying disease, only two were subsequently diagnosed with a connective tissue disorder. The in-hospital mortality rate was 55% and 63% for patients with DAH with and without connective tissue diseases, respectively (P = 0.710).
The majority of patients with DAH presenting with the features of ARDS/ALI did not have underlying connective tissue diseases. Concomitant malignancies were found frequently in these patients. The outcome did not differ between patients with DAH with or without connective tissue diseases.
结缔组织病是经开胸肺活检确诊的导致弥漫性肺泡出血（DAH）的最常见疾病。然而，这些疾病是否也是呈现急性呼吸窘迫综合征（ARDS）/急性肺损伤（ALI）特征的患者发生DAH的最常见原因尚不清楚。本研究评估了ARDS/ALI合并DAH患者中伴发疾病的发生率。
抽样框架包括2000年1月至2006年7月期间在一家三级转诊医院被诊断为ARDS/ALI并接受支气管肺泡灌洗（BAL）的所有患者。对BAL液检查结果符合DAH的患者的病历进行回顾。
在97例被诊断为ARDS/ALI并接受BAL的患者中，27例BAL液检查结果符合DAH。27例患者中有16例没有结缔组织病（59%）；这16例患者中有12例伴有血液系统恶性肿瘤或实体瘤。在7例出现DAH且无已知基础疾病的患者中，只有2例随后被诊断为结缔组织病。伴有和不伴有结缔组织病的DAH患者的院内死亡率分别为55%和63%（P = 0.710）。
大多数呈现ARDS/ALI特征的DAH患者没有潜在的结缔组织病。这些患者中经常发现合并恶性肿瘤。伴有或不伴有结缔组织病的DAH患者的结局无差异。
