Underner M, Perriot J, Peiffer G, Urban T, Jaafari N
Unité de recherche clinique Pierre-Deniker, centre hospitalier Laborit, université de Poitiers, 370, avenue Jacques-Coeur, CS 10587, 86021 Poitiers cedex, France.
Dispensaire Émile-Roux, CLAT-63, centre de tabacologie, 63100 Clermont-Ferrand, France.
Rev Mal Respir. 2023 Jun;40(6):506-519. doi: 10.1016/j.rmr.2023.03.007. Epub 2023 Apr 20.
Cannabis is the most widely used illicit psychoactive substance in France. It can be responsible for numerous pulmonary complications, including diffuse alveolar hemorrhage (DAH). The objective of this systematic review of the literature was to present data concerning the relationship between cannabis smoking and DAH, which has rarely been reported in the literature. The review was based on a Medline search covering the 1980-2022 period and utilizing data drawn from 10 articles. DAH diagnosis is based on an association of hemoptysis, anemia and diffuse alveolar opacities on chest radiography with siderophages in the Bronchoalveolar Lavage Fluid (BAL). The 11 patients identified in this review were daily or regular cannabis smokers; in 4 cases they presented recent or recurrent hemoptysis with anemia; imaging revealed diffuse alveolar opacities in 10 of them, while BAL endoscopy highlighted a diffuse hemorrhage in the bronchial tree, and siderophages were observed in 6 cases. While evolution was favorable when cannabis consumption was discontinued, resumption occasioned DAH recurrence, and one patient died. Advice to quit should systematically be accompanied by addictological follow-up.
大麻是法国使用最广泛的非法精神活性物质。它可能导致许多肺部并发症，包括弥漫性肺泡出血（DAH）。本系统文献综述的目的是呈现关于吸食大麻与DAH之间关系的数据，而这在文献中鲜有报道。该综述基于对1980 - 2022年期间的Medline搜索，并利用了从10篇文章中提取的数据。DAH的诊断基于咯血、贫血以及胸部X线片上的弥漫性肺泡混浊与支气管肺泡灌洗（BAL）液中的含铁血黄素巨噬细胞相关联。本综述中确定的11名患者均为每日或经常吸食大麻者；其中4例出现近期或反复咯血伴贫血；影像学检查显示10例有弥漫性肺泡混浊，而BAL内镜检查突出显示支气管树弥漫性出血，6例观察到含铁血黄素巨噬细胞。虽然停止吸食大麻后病情好转，但恢复吸食导致DAH复发，1例患者死亡。应系统性地建议戒烟，并伴有成瘾学随访。
