目的 探讨使用抗胸腺细胞球蛋白(ATC)治疗后出现少见血清病反应一急性肺损伤(ALI)的临床特点,以提高对本病的认识.方法 回顾性分析1例重型再生障碍性贫血患儿第二次使用ATG后合并ALI的临床资料,并对相关文献进行复习.结果 本例患儿于第二次使用ATG后10 d,出现发热、关节痛、肌痛、皮疹等临床表现,伴随突发烦躁、呼吸困难、低氧血症,肺部CT提示双肺弥漫毛玻璃影,临床诊断为ALI,应用甲泼尼龙治疗好转.通过文献检索发现8例类似报道,病死率较高.结论 早期诊断和及时应用糖皮质激素治疗对于ATG相关ALI至关重要.%Objective To investigate the clinical characteristics of acute lung injury ( ALI) after antithymocyte globulin treatment ( ATG) in pediatric severe aplastic anemia. Methods A retrospective study was conducted to analyze the clinical characteristics of a 9-year-old girl who was treated for severe aplastic anemia by pig antithymocyte globulin. Results Fifteen days after being started on antithymocyte globulin treatment, the patient developed fever, gross hematuria, arthralgia, rash, and ALI. This patient presented typical clinical features of ALI, including (Ⅰ ) pulmonary insufficiency accompanied by profound hypoxemia, ( Ⅱ ) chest radiographic evidence consistent with pulmonary edema, (Ⅲ) acute onset of the symptoms with serum sickness-like reactions, and (Ⅳ) no clinical evidence for other pulmonary dysfunction. The patient's symptoms were resolved with a short course of low-dose methylprednisolone for 3 days, followed by a methylprednisolone taper. Conclusions Acute lung injury is rare serum sickness following thymoglobulin treatment for pediatric severe aplastic anemia. Treatment with steroids can relieve symptoms rapidly.
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