Esumi Ryo, Kaneko Tadashi, Ito Asami, Ieki Yohei, Yamamoto Yoshiki, Nakajima Ayako, Imai Hiroshi
Emergency and Critical Care Center, Mie University Hospital, Japan.
Department of Rheumatology, Center for Rheumatic Diseases, Mie University Hospital, Japan.
Respir Med Case Rep. 2021 Sep 11;34:101513. doi: 10.1016/j.rmcr.2021.101513. eCollection 2021.
Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is sometimes complicated by diffuse alveolar hemorrhage (DAH), which may cause respiratory failure. Venovenous extracorporeal membrane oxygenation (VV-ECMO) without an anticoagulant because of hemorrhagic status, showed the effectiveness for severe respiratory failure by DAH with AAV. A 44-year-old woman developed DAH with bowel bleeding following the onset of AAV, with positive anti-proteinase-3 (PR3) antibodies. Although ventilator management could not support her respiratory status, VV-ECMO was performed. The patient was given immunosuppressive therapy comprising a steroid pulse, plasma exchange, and cyclophosphamide. After about 10 days of VV-ECMO and immunosuppressive therapy, VV-ECMO was withdrawn, and on day 12, ventilator support was stopped. Although a thrombus developed within the inferior vena cava (IVC), which required IVC filtration, the patient was discharged on day 51. VV-ECMO support was effective for treating DAH in this patient with new-onset AAV, which takes some time to achieve remission with immunosuppressive therapy.
抗中性粒细胞胞浆抗体相关性血管炎（AAV）有时会并发弥漫性肺泡出血（DAH），这可能导致呼吸衰竭。由于出血状态而未使用抗凝剂的静脉-静脉体外膜肺氧合（VV-ECMO），对AAV合并DAH所致的严重呼吸衰竭显示出有效性。一名44岁女性在AAV发病后出现DAH并伴有肠道出血，抗蛋白酶3（PR3）抗体呈阳性。尽管呼吸机管理无法维持其呼吸状态，但仍进行了VV-ECMO治疗。给予患者包括类固醇冲击、血浆置换和环磷酰胺在内的免疫抑制治疗。在进行VV-ECMO和免疫抑制治疗约10天后，撤掉了VV-ECMO，在第12天停止了呼吸机支持。尽管下腔静脉（IVC）内形成了血栓，需要进行IVC滤过，但患者在第51天出院。VV-ECMO支持对该新发AAV患者的DAH治疗有效，免疫抑制治疗需要一些时间才能实现缓解。
