乙型肝炎相关性肺泡出血1例
|
摘要
<正>1 病例资料患者,男,49岁,因"夜间干咳1月余,咯血1周"于2017年3月6日收入广州中医药大学第一附属医院。患者于2017年2月出现无明显诱因夜间干咳,无痰,无发热恶寒,无胸闷胸痛,未作治疗;3月1日咳嗽加重,痰中带血,至外院就诊,胸部CT(图1a)提示右肺及左肺下叶多发斑片状模糊影,经抗感染(哌拉西林钠他唑巴坦钠)、止咳止血、控制血压、输血浆等对症处理后,患者仍持续咯血;3月4日复查CT(图1b)提示渗出灶扩大,血分析提示血红
A 49-year-old male patient had a history of hepatitis B for more than 30 years. He was admitted to the hospital for hemorrhage. after symptomatic treatment, CT scan showed that the lung exudation expanded rapidly. After hormone therapy, the patient improved and was diagnosed as diffuse alveolar hemorrhage by bronchoalveolar lavage. This case suggests that we should identify diffuse alveolar hemorrhage as soon as possible, actively treat and avoid death.
A 49-year-old male patient had a history of hepatitis B for more than 30 years. He was admitted to the hospital for hemorrhage. after symptomatic treatment, CT scan showed that the lung exudation expanded rapidly. After hormone therapy, the patient improved and was diagnosed as diffuse alveolar hemorrhage by bronchoalveolar lavage. This case suggests that we should identify diffuse alveolar hemorrhage as soon as possible, actively treat and avoid death.
引文
[1] Martínez-Martínez MU,Oostdam DAH,Abud-Mendoza C.Diffuse alveolar hemorrhage in autoimmune diseases[J].Curr Rheumatol Rep,2017,19(5):27.
[2] 倪磊,李庆云.应重视弥漫性肺泡出血综合征的诊治策略[J].内科理论与实践,2016,11(4):202-204.
[3] Serifoglu I,Er Dedekarginoglu B,Ayvazoglu Soy EH,et al.[J].Exp Clin Transplant,2018,16 Suppl 1(Suppl 1):70-74.
[4] Quadrelli S,Dubinsky D,Solis M,et al.Immune diffuse alveolar hemorrhage:Clinical presentation and outcome[J].Respir Med,2017,129:59-62.
[5] 李凯,龙莉玲,邓东,等.不同年龄组的弥漫性肺泡出血的MSCT探析[J].临床放射学杂志,2017,36(10):1433-1436.
[6] 欧阳钦.临床诊断学[M].北京:人民卫生出版社,2010:412-414.
[7] Mazzaro C,Dal Maso L,Urraro T,et al.Hepatitis B virus related cryoglobulinemic vasculitis:A multicentre open label study from the Gruppo Italiano di Studio delle Crioglobulinemie-GISC[J].Dig Liver Dis,2016,48(7):780-784.
[8] Naniwa T,Maeda T,Shimizu S,et al.Hepatitis B virus-related polyarteritis nodosa presenting with multiple lung nodules and cavitary lesions[J].Chest,2010,138(1):195-197.
[9] Uchiyama M,Ikeda T.Diffuse alveolar hemorrhage after unrelated cord blood transplantation[J].Bone Marrow Transplant,2010,45(4):789-790.
[10] Quadrelli S,Dubinsky D,Solis M,et al.Immune diffuse alveolar hemorrhage:Clinical presentation and outcome[J].Respir Med,2017,129:59-62.
[11] 陈平,诸兰艳.呼吸系统疑难病例解析[M].北京:人民卫生出版社,2013:295-298.
[12] Guo X,Gopalan R,Ugbarugba S,et al.Hepatitis B-related polyarteritis nodosa complicated by pulmonary hemorrhage[J].Chest,2001,119(5):1608-1610.
[13] 李丕宝.老年重症医院获得性肺炎并发弥漫性肺泡出血综合征15例临床分析[J].临床急诊杂志,2016,17(1):77-78.
[2] 倪磊,李庆云.应重视弥漫性肺泡出血综合征的诊治策略[J].内科理论与实践,2016,11(4):202-204.
[3] Serifoglu I,Er Dedekarginoglu B,Ayvazoglu Soy EH,et al.[J].Exp Clin Transplant,2018,16 Suppl 1(Suppl 1):70-74.
[4] Quadrelli S,Dubinsky D,Solis M,et al.Immune diffuse alveolar hemorrhage:Clinical presentation and outcome[J].Respir Med,2017,129:59-62.
[5] 李凯,龙莉玲,邓东,等.不同年龄组的弥漫性肺泡出血的MSCT探析[J].临床放射学杂志,2017,36(10):1433-1436.
[6] 欧阳钦.临床诊断学[M].北京:人民卫生出版社,2010:412-414.
[7] Mazzaro C,Dal Maso L,Urraro T,et al.Hepatitis B virus related cryoglobulinemic vasculitis:A multicentre open label study from the Gruppo Italiano di Studio delle Crioglobulinemie-GISC[J].Dig Liver Dis,2016,48(7):780-784.
[8] Naniwa T,Maeda T,Shimizu S,et al.Hepatitis B virus-related polyarteritis nodosa presenting with multiple lung nodules and cavitary lesions[J].Chest,2010,138(1):195-197.
[9] Uchiyama M,Ikeda T.Diffuse alveolar hemorrhage after unrelated cord blood transplantation[J].Bone Marrow Transplant,2010,45(4):789-790.
[10] Quadrelli S,Dubinsky D,Solis M,et al.Immune diffuse alveolar hemorrhage:Clinical presentation and outcome[J].Respir Med,2017,129:59-62.
[11] 陈平,诸兰艳.呼吸系统疑难病例解析[M].北京:人民卫生出版社,2013:295-298.
[12] Guo X,Gopalan R,Ugbarugba S,et al.Hepatitis B-related polyarteritis nodosa complicated by pulmonary hemorrhage[J].Chest,2001,119(5):1608-1610.
[13] 李丕宝.老年重症医院获得性肺炎并发弥漫性肺泡出血综合征15例临床分析[J].临床急诊杂志,2016,17(1):77-78.