| Objective Investigate and analysis the clinical features of30cases ofdiffuse alveolar hemorrhage (DAH) in patients with diffuse connective tissuedisease (CTD), summarizes the characteristics of clinical manifestations andauxiliary examination, to investigate the relationship between the treatment andprognosis, improve the understanding of the disease.Methods Retrospective analysis the clinical material of30cases of CTDpatients with DAH in the first affiliated hospital of Guangxi Medical Universityduring January2006to December2013. Extraction a control group in the ratioof1:2of60contemporary cases in the diagnosis of CTD without DAHrandomly, according to gender and age. By using retrospective review onclinical manifestations,diagnosis,treatment and prognosis,comparing thedifferences between the two groups.Results1.20cases out of3932hospitalized SLE patients were diagnosedwith DAH,the incidence was0.51%,14cases of patients died after activetreatment, the case fatality rate70%;10cases out of284hospitalized AASVpatients was diagnosed with DAH, the incidence was3.52%, among them6cases died, the case fatality rate of60%. Female were more common with SLE compared with AASV (90%:40%, P=0.004), SLE patients with DAH wereyounger and had lower incidence (22.9±14.27:48.8±19.11, P=0.000), but therewas no statistical significance between the fatality rate of the two groups(70%:60%, P=0.584).2. Coughing was observed in all DAH patients, eightpatients (26.67%) in the course of the disease didn’t have blood sputum orhemoptysis. Other common signs and symptoms were hypoxemia (96.67%),choking sensation in chest (96.67%), lung rale(93.33%), dyspnea (86.67%),stethalgia(13.33%).3. CTD patients with DAH were easier to have fever, edema,fatigue, serous cavity effusion, renal damage, the digestive and hematologicalsystem involvement than the control group. The nervous system involvement inSLE patients was higher than the incidence of AASV patients (40%:0%,P=0.02). All DAH patients had three or more than three system involved, andthe incidence of renal damage was100%.4. The anemia and thrombocytopeniaratio of the CTD patients with DAH was higher than the control group. Urineprotein positive rate between the two groups have no difference, but DAHpatients’ type tube urine were significantly higher than the control group. Theserum transaminase, creatinine, creatine kinase of the DAH group weresignificantly higher than the control group. The incidence of hypocalcemia ofDAH patients was higher, and the blood calcium was much more lower than thecontrol group(1.86±0.25than2.07±0.21, P=0.000).5. The incidence of fever andserous cavity effusion of SLE patients with DAH was found significantly higher,and were easier to merge with renal, hematological and digestive system damage,the incidence of elevated serum creatinine was higher, calcium was lower thanthe control group; SLEDAI score was14~31points when DAH occured, andwas significantly higher.6. The renal pathologic of the CTD patients with DAHwere mesangial proliferation (85.71%), crescent formation (35.71%), glomerular sclerosis (35.71%), renal interstitial fibrosis (7.14%).The8cases of SLEpatients’ renal pathologic types were IV (37.5%), V (37.5%), III (12.5%), V+IV (12.5%). All3SLE patients with DAH,whose renal pathological type of IVsurvived, while the other three types of renal pathology of patients died.7. Tocompare the patients treated with MP1g/d and MP0.5g/d respectively withpatients treated without glucocorticoid pulse, found that the former survival ratewas significantly higher(66.7%:15.4%, P=0.013), while the latter survival ratewas no obvious difference (28.6%:15.4%, P=0.489). The survival rate wassignificantly higher in patients treated with CTX pulse (60%:7.1%, P=0.005).8.13of29cases of treated patients with DAH chose department of rheumatism,others were department of ICU, pediatrics, nephrology, respiration anddermatology. The ratio of patients who chose department of rheumatism treatedwith glucocorticoid pulse and CTX pulse was obviously higher, and themortality of specialized treated patients was significantly lower,which meansspecialized treatment was more positive and had better prognosis.9. Theincidence of hypocalcemia in death group was obviously higher than thesurvival group, and platelet value was lower.The patients of survival groupreceived MP1g/d, CTX pulse is significantly higher, and the rate of mechanicalventilation in dead group is significantly higher, and no above factors werefound for risk factors related to death.Conclusions1. CTD patients with DAH were easier to have fever, edema,fatigue, renal and digestive system involvement than the control group; somecases didn’t have blood sputum or hemoptysis in the course of the disease.2.The incidence of type tube urine, serum transaminase, creatinine, creatine kinase,hypocalcemia of the DAH were significantly higher than the control group, andthe blood calcium was much lower.3.The incidence of hypocalcemia and mechanical ventilation in death group were higher than the survival group, andplatelet value was lower, and noabove factors were found for risk factors relatedto death.4.Treating with MP1g/d and CTX pulse therapy can improve thesurvival rate, and the effect of MP1g/d is better than MP0.5g/d.5. AcceptingSpecialized treatment is beneficial to improving the prognosis of the CTDpatients with DAH. |
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