Service de Pneumologie et Réanimation, Hôpitaux de Paris, Paris, France.
Respiration. 2010;80(4):313-20. doi: 10.1159/000315144. Epub 2010 May 22.
Diffuse alveolar haemorrhage (DAH) is a life-threatening condition due to immune and non-immune causes. Early identification of an underlying immune disorder is essential in order to initiate appropriate treatment.
The purpose of this study was to identify early predictive factors of an immune cause of DAH.
We conducted a retrospective study of 76 immunocompetent patients with DAH to identify early predictive factors of immune-related DAH using clinical, radiological and routine biological data available in the first 24 h after hospital admission.
Multivariate analysis identified 4 parameters which were independently associated with immune-related DAH: (1) onset of first respiratory symptoms ≥11 days, (2) fatigue and/or weight loss during the month prior to presentation, (3) arthralgias or arthritis and (4) proteinuria ≥1 g/l. A simplified scale was constructed using these variables, with an area under the receiver operating characteristic curve of 0.913, for the diagnosis of immune-related DAH.
A simple diagnostic scale can be used to identify an immune-related cause of DAH in immunocompetent patients and may help guide treatment decisions such as initiation of steroid therapy on the day of admission.
弥漫性肺泡出血（DAH）是一种由免疫和非免疫原因引起的危及生命的疾病。早期识别潜在的免疫紊乱对于启动适当的治疗至关重要。
本研究旨在确定 DAH 免疫原因的早期预测因素。
我们对 76 例免疫功能正常的 DAH 患者进行了回顾性研究，以使用入院后 24 小时内获得的临床、影像学和常规生物学数据，确定免疫相关 DAH 的早期预测因素。
多变量分析确定了 4 个与免疫相关 DAH 独立相关的参数：（1）首次呼吸症状发作≥11 天，（2）就诊前 1 个月出现疲劳和/或体重减轻，（3）关节痛或关节炎，（4）蛋白尿≥1g/l。使用这些变量构建了一个简化的评分，其诊断免疫相关 DAH 的受试者工作特征曲线下面积为 0.913。
一个简单的诊断评分可以用于识别免疫功能正常的患者中与免疫相关的 DAH 病因，并可能有助于指导治疗决策，例如在入院当天开始使用类固醇治疗。
