| Objective:By describing the clinical characteristics of diffuse alveolar hemorrhage(DAH)in patients with systemic lupus erythematosus(SLE)and ANCA associated vasculitis(AAV),we can increase the understanding of autoimmune diseases complicated with DAH,and find the similarities and differences between the two autoimmune diseases complicated with DAH.By analyzing the death risk factors of patients with autoimmune diseases complicated with DAH,the aim is to guide the clinical diagnosis and treatment and improve the prognosis of patients.Methods:The inpatient and outpatient follow-up data of all patients with autoimmune diseases complicated with DAH who were admitted to the Affiliated Hospital of Qingdao University from January 2012 to December 2019 were retrospectively collected.The clinical data of patients with autoimmune diseases complicated with DAH were summarized and analyzed,and they were divided into SLE-DAH group and AAV-DAH group according to the primary disease types,and the clinical characteristics between the two groups were compared and analyzed.Then,the patients with autoimmune diseases complicated with DAH were divided into the death group and the survival group,and the clinical data of the two groups were compared and analyzed.Logistic regression analysis was used to analyze the death risk factors of the patients with autoimmune diseases complicated with DAH.Results:1.There were 42 patients with autoimmune diseases complicated with DAH,including22 patients in the SLE-DAH group and 20 patients in the AAV-DAH group.There were statistically significant differences in gender(x~2=23.100,P=0.000)and age(t=-2.625,P=0.015)between the two groups(P < 0.05).2.SLE-DAH group had a SLEDAI score of 12～27(mean 17.91±4.40)and AAV-DAH group had a BVAS score of 15～36(mean 21.30±5.71).3.Among the patients with autoimmune diseases complicated with DAH,16 patients died and 26 patients survived.There were 9 deaths in SLE-DAH patients(9/22)and 7deaths in AAV-DAH patients(7/20).There was no significant difference in gender,age and primary disease between the survival group and death group(P>0.05).The time between the diagnosis of primary disease and DAH occurrence(z =-2.858,P=0.04)was statistically significant(P<0.05).4.There was no significant difference in respiratory failure,kidney damage or heart failure between the survival group and the death group(P>0.05).5.There were statistically significant differences between the survival group and the death group in patients with encephalopathy(x~2=7.580,P=0.006),high-dose glucocorticoid shock therapy(x~2=4.747,P=0.029),use of cyclophosphamide(x~2=8.077,P=0.004),and use of mechanical ventilation(x~2=6.528,P=0.011)(P<0.05).6.Logistic regression analysis showed that combined encephalopathy(OR=28.659,95%CI=2.446-335.769,P=0.008)and the use of mechanical ventilation(OR=10.043,95%CI=1.227-82.193,P=0.031)were significantly associated with mortality in patients with autoimmune diseases complicated with DAH.Conclusion:1.Among patients with autoimmune diseases complicated with DAH,AAV-DAH is more likely to occur in middle-aged and elderly male patients,while SLE-DAH is more likely to occur in young and middle-aged female patients,which are considered to be related to the primary disease of DAH patients.2.SLE and AAV are in the active stage of disease when they are complicated with DAH.3.The mortality of patients with autoimmune diseases complicated with DAH was not related to the primary disease type,gender,age,respiratory failure,renal damage and heart failure.4.Both high-dose glucocorticoid shock therapy and the use of cyclophosphamide can reduce the mortality of patients with autoimmune diseases complicated with DAH.The increased fatality rate was associated with longer time from primary diagnosis to DAH onset,associated encephalopathy,and use of mechanical ventilation.5.The occurrence of encephalopathy and the use of mechanical ventilation may be independent predictors of mortality risk factors in patients with autoimmune diseases associated with DAH.Patients with autoimmune diseases complicated with DAH may not have an ideal prognosis if they have complicated encephalopathy or if they require mechanical ventilation. |
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