Martínez-Martínez Marco Ulises, Oostdam David Alejandro Herrera-van, Abud-Mendoza Carlos
Faculty of Medicine, Universidad Autónoma San Luis Potosí and Hospital Central "Dr. Ignacio Morones Prieto", Avenida Venustiano Carranza 2395, Zona Universitaria, 78290, San Luis Potosí, San Luis Potosí, Mexico.
Hospital General de Zona No. 1, Instituto Mexicano del Seguro Social, San Luis Potosí, San Luis Potosí, Mexico.
Curr Rheumatol Rep. 2017 May;19(5):27. doi: 10.1007/s11926-017-0651-y.
The present paper establishes a narrative and analytical review of diffuse alveolar hemorrhage (DAH) in ANCA-associated vasculitis, systemic lupus erythematosus, and antiphospholipid syndrome.
Recent studies found a frequent association between DAH and infections and systemic lupus erythematosus and its associated factors. Biological therapies like rituximab have demonstrated benefit mainly in patients with ANCA-associated vasculitis. Main clinical manifestations of diffuse alveolar hemorrhage in these three diseases include dyspnea, pulmonary infiltrates, cough, and hypoxemia. The presence of hemorrhagic bronchoalveolar lavage, hemosiderin containing macrophages, or an increase of carbon monoxide diffusing capacity have been described in some series as helpful findings for the diagnosis. Hemoptysis has been seen mainly in systemic lupus erythematosus. The cornerstone of therapy includes glucocorticoids and cyclophosphamide, and recent findings in ANCA-associated vasculitis suggest the similar benefit of rituximab. Future evaluations and systematic reviews will help to define the real benefit for therapies that appeared to be controversial at the moment.
本文对ANCA相关性血管炎、系统性红斑狼疮和抗磷脂综合征中的弥漫性肺泡出血进行了叙述性和分析性综述。
近期研究发现弥漫性肺泡出血与感染、系统性红斑狼疮及其相关因素之间存在频繁关联。利妥昔单抗等生物疗法主要在ANCA相关性血管炎患者中显示出疗效。这三种疾病中弥漫性肺泡出血的主要临床表现包括呼吸困难、肺部浸润、咳嗽和低氧血症。在一些系列研究中，出血性支气管肺泡灌洗、含铁血黄素巨噬细胞的存在或一氧化碳弥散能力的增加被描述为有助于诊断的发现。咯血主要见于系统性红斑狼疮。治疗的基石包括糖皮质激素和环磷酰胺，近期在ANCA相关性血管炎中的发现表明利妥昔单抗有类似疗效。未来的评估和系统评价将有助于确定目前看似有争议的治疗方法的实际疗效。
