138例儿童弥漫性肺泡出血临床特点及病因分析

摘要

Objective To analyze the clinical feature and common etiology of diffuse alveolar hemorrhage (DAH) in children. Methods Clinical data from 138 children with initially diagnosed DAH were retrospectively analyzed. The etiology, diagnosis, treatment, and prognosis had been summarized. Results Among 138 children, 76 were male and 62 were female. The clinical features are pallor ( 130 cases, 94 . 2%), cough ( 86 cases, 62 . 3%), fever ( 74 cases, 53 . 6%), anhelation ( 67 cases, 48 . 6%), hemoptysis ( 59 cases, 42 . 8%) and dyspnea ( 43 cases, 31 . 2%). Chest imaging changes were mainly patch shadow and ground glass shadow. Moreover, the detection rate of hemosiderin cells in sputum, gastric juice and bronchoalveolar lavage lfuid was 90 . 8%( 79/87 ). The common underlying diseases that caused DAH were idiopathic pulmonary hemosiderosis ( 65 cases), hematological system disease ( 22 cases), vascular inlfammatory diseases ( 15 cases), infectious diseases ( 14 cases) and cardiovascular disease ( 5 cases). The mortality rate in acute phase of DHA was 23 . 2%( 32/138 ). Conclusions DHA is a life-threatening clinical emergency disease, its cause was complex and diverse, and the acute mortality rate is high. Glucocorticoid is the ifrst choice of treatment for majority of patients.%目的：分析儿童弥漫性肺泡出血（DAH）的临床特点及其常见病因。方法回顾性分析138例首次诊断DAH患儿的临床资料，总结病因、诊治经过及预后。结果138例患儿中男76例、女62例；临床表现为面色苍白130例（94.2%），咳嗽86例（62.3%），发热74例（53.6%），气促67例（48.6%），咯血59例（42.8%），呼吸困难43例（31.2%）；胸部影像学改变以斑片影及磨玻璃样影为主；痰液、胃液及支气管肺泡灌洗液含铁血黄素巨噬细胞检出率90.8%（79/87）。引起DAH常见基础疾病分别为特发性肺含铁血黄素沉着症65例，血液系统疾病22例，血管炎性疾病15例，感染性疾病14例，心血管疾病5例。DHA患儿急性期病死率23.2%（32/138）。结论 DAH是危及生命的临床急重症，病因复杂多样，急性期病死率高，糖皮质激素是多数患者的首选治疗方法。