自身免疫病相关性肺泡出血的里程碑式治疗_血管炎传染

作者：Martínez-MartínezMU

翻译：北医三院邓晓莉校正：张警丰刘湘源

摘要：在自身免疫病中，ANCA相关性小血管炎、系统性红斑狼疮、抗磷脂综合征与弥漫性肺泡出血有一定相关性，尤其是系统性红斑狼疮合并弥漫性肺泡出血近年来屡有报道。生物制剂例如利妥昔单抗对于ANCA相关性小血管炎合并的弥漫性肺泡出血有帮助。这三种疾病相关的肺泡出血临床表现主要有呼吸困难、肺部浸润影、咳嗽以及低氧血症。出血性肺泡灌洗液、吞噬含铁血黄素的巨噬细胞或者一氧化碳弥散功能增加有助于肺泡出血的诊断。咯血主要见于系统性红斑狼疮。该类自身免疫病相关的肺泡出血里程碑式的治疗是激素和环磷酰胺以及后来在ANCA相关性小血管炎中证实有效的利妥昔单抗。

附原文:PURPOSEOFREVIEW:Thepresentpaperestablishesanarrativeandanalyticalreviewofdiffusealveolarhemorrhage(DAH)inANCA-associatedvasculitis,systemiclupuserythematosus,andantiphospholipidsyndrome.RECENTFINDINGS:RecentstudiesfoundafrequentassociationbetweenDAHandinfectionsandsystemiclupuserythematosusanditsassociatedfactors.BiologicaltherapieslikerituximabhavedemonstratedbenefitmainlyinpatientswithANCA-associatedvasculitis.Mainclinicalmanifestationsofdiffusealveolarhemorrhageinthesethreediseasesincludedyspnea,pulmonaryinfiltrates,cough,andhypoxemia.Thepresenceofhemorrhagicbronchoalveolarlavage,hemosiderincontainingmacrophages,oranincreaseofcarbonmonoxidediffusingcapacityhavebeendescribedinsomeseriesashelpfulfindingsforthediagnosis.Hemoptysishasbeenseenmainlyinsystemiclupuserythematosus.Thecornerstoneoftherapyincludesglucocorticoidsandcyclophosphamide,andrecentfindingsinANCA-associatedvasculitissuggestthesimilarbenefitofrituximab.Futureevaluationsandsystematicreviewswillhelptodefinetherealbenefitfortherapiesthatappearedtobecontroversialatthemoment.

引自：Martínez-MartínezMU,OostdamDAH,Abud-MendozaC.DiffuseAlveolarHemorrhageinAutoimmuneDiseases.CurrRheumatolRep.May;19(5):27.

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