Robbins R A, Linder J, Stahl M G, Thompson A B, Haire W, Kessinger A, Armitage J O, Arneson M, Woods G, Vaughan W P
Department of Internal Medicine, University of Nebraska, Omaha.
Am J Med. 1989 Nov;87(5):511-8. doi: 10.1016/s0002-9343(89)80606-0.
The purpose of our work was to evaluate pulmonary complications in autologous bone marrow transplant recipients.
A total of 141 consecutive autologous bone marrow transplant recipients were evaluated. In 29 patients, a clinical syndrome characterized by progressive dyspnea, hypoxia, cough, diffuse consolidation on chest roentgenography, and characteristic bronchoalveolar lavage findings developed over one to seven days.
In 29 patients, bronchoalveolar lavage performed by sequential instillation and aspiration of 20-ml aliquots of normal saline resulted in recovered lavage fluid that became progressively bloodier with each recovered aliquot. Autopsy and bronchoalveolar lavage in these patients revealed no pathogens that accounted for the clinical findings. Since the later aliquots sample predominantly alveolar material, this syndrome was termed diffuse alveolar hemorrhage (DAH). DAH was associated with a high inpatient mortality rate (23 of 29 died versus 14 of 112 without DAH, p less than 0.001) and was associated with age over 40 years, solid malignancies, high fevers, severe mucositis, white blood cell recovery, and renal insufficiency (p less than 0.05, compared with patients without DAH). However, DAH was not associated with prolonged prothrombin or partial thromboplastin times or decreased platelet counts compared with patients without DAH.
DAH is a frequent cause of respiratory compromise and a major cause of mortality in autologous bone marrow transplant recipients.
我们这项工作的目的是评估自体骨髓移植受者的肺部并发症。
对连续141例自体骨髓移植受者进行了评估。29例患者在1至7天内出现了以进行性呼吸困难、低氧血症、咳嗽、胸部X线片显示弥漫性实变以及特征性支气管肺泡灌洗结果为特征的临床综合征。
29例患者通过依次注入和抽吸20毫升等份生理盐水进行支气管肺泡灌洗，回收的灌洗液随着每次回收的等份液体而变得越来越血性。这些患者的尸检和支气管肺泡灌洗未发现可解释临床症状的病原体。由于后期等份样本主要为肺泡物质，因此该综合征被称为弥漫性肺泡出血（DAH）。DAH与住院死亡率高相关（29例中有23例死亡，而无DAH的112例中有14例死亡，p<0.001），并且与年龄超过40岁、实体恶性肿瘤、高热、严重黏膜炎、白细胞恢复以及肾功能不全相关（与无DAH的患者相比，p<0.05）。然而，与无DAH的患者相比，DAH与凝血酶原时间或部分凝血活酶时间延长或血小板计数降低无关。
DAH是自体骨髓移植受者呼吸功能受损的常见原因和主要死亡原因。
