目的：总结血液系统疾病患者弥漫性肺泡出血的诊断及治疗经验。方法分析2004年10月-2014年10月本院血液科21例继发于血液系统疾病的弥漫性肺泡出血患者的临床资料。结果21例中急性非淋巴细胞白血病14例，急性淋巴细胞白血病5例，重型再生障碍型贫血2例。15例发生于白血病化疗中或化疗后，3例发生于异基因造血干细胞移植预处理期或移植后，4例发生于保守治疗期。临床表现：呼吸困难100%(21/21)，低氧血症100%(21/21)，发热90.5%(19/21)，痰中带血71.4%(15/21)，咯血19.1%(4/21)。胸部影像学：15例呈双肺实质弥漫性渗出，6例呈双肺磨玻璃样间质改变，7例合并双侧少量胸腔积液。死亡率76.2%(16/21)。结论继发于血液系统疾病的弥漫性肺泡出血致死率高，呼吸困难、发热、痰中带血、咯血及肺部弥漫性浸润影为诊断提供线索，及早识别及治疗方能改善预后。%Objective To summarize the experience of diagnosis and treatment on diffuse alveolar hemorrhage (DAH) in patients with hematopoietic system diseases.Methods Clinical data about 21 cases with diffuse alveolar hemorrhage secondary to hematopoietic system diseases from October 2004 to October 2014 in department of hematology, Navy General Hospital, were retrospectively analyzed.Results Of the 21 cases, 14 cases were acute non-lymphoblastic leukemia, 5 cases were acute lymphoblastic leukemia, and 2 cases were severe aplastic anemia. The onset time of this disease was during or after leukemia chemotherapy in 15 cases, pre-conditioning or post- transplantation in 3 cases, and during palliative treatment in 4 cases. Clinical presentations included dyspnea (100%), hypoxaemia (100%), fever (90.5%), bloody-sputum (71.4%), and hemoptysis (19.1%). Chest image: 15 cases showed diffuse parenchymal exudates, 6 cases showed ground-glass interstitial change and 7 cases showed a small amount of bilateral pleural effusion. The mortality rate was 76.2% (16/21).Conclusion DAH secondary to hematopoietic system diseases shows high mortality. Dyspnea, fever, bloody sputum, hemoptysis, and diffuse lung infiltration provide clues for diagnosis. Early identification and treatment may improve outcomes.
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