Respiratory status deterioration during G-CSF-induced neutropenia recovery.
Respiratory status deterioration during G-CSF-induced neutropenia recovery.
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G-CSF诱导的中性粒细胞减少症的呼吸状态恶化。
DOI：
10.1038/sj.bmt.1705037
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发表时间：
2005-08
影响因子：
4.8
通讯作者：
Azoulay E
中科院分区：
文献类型：
--
作者：
Karlin L;Darmon M;Thiéry G;Ciroldi M;de Miranda S;Lefebvre A;Schlemmer B;Azoulay E
在中性粒细胞减少症恢复期间，先前的肺部受累可能会加剧。粒细胞集落刺激因子 (G-CSF) 相关的肺毒性已在癌症患者中得到记录，实验模型表明 G-CSF 在中性粒细胞减少恢复期间的急性肺损伤中发挥作用。我们回顾了 20 例 G-CSF 诱导的中性粒细胞减少症恢复过程中发生的非心源性急性呼吸衰竭病例。一半患者接受了造血干细胞移植。所有患者在中性粒细胞减少症期间均出现肺部浸润，随后呼吸状况恶化，同时中性粒细胞减少症恢复。中性粒细胞减少症持续时间为 10 (4–22) 天，呼吸道症状与白细胞超过 1000 个/mm3 第一天之间的时间为 1 (-0.5 至 2) 天。 20 名患者中，16 名接受了有创或无创机械通气，其中 14 名患者患有急性呼吸窘迫综合征（ARDS）。 5 名患者死于难治性 ARDS。在中性粒细胞减少症期间出现肺部浸润的患者中，G-CSF诱导的中性粒细胞减少症恢复存在呼吸状态恶化、急性肺损伤或ARDS的风险。临床医生必须对这一诊断保持高度怀疑，这需要消除急性呼吸衰竭的另一个原因、停用G-CSF并转入ICU以进行早期支持管理，包括诊断确认和无创机械通气。
Exacerbation of prior pulmonary involvement may occur during neutropenia recovery. Granulocyte colony-stimulating factor (G-CSF)-related pulmonary toxicity has been documented in cancer patients, and experimental models suggest a role for G-CSF in acute lung injury during neutropenia recovery. We reviewed 20 cases of noncardiac acute respiratory failure during G-CSF-induced neutropenia recovery. Half the patients had received hematopoietic stem cell transplants. All patients experienced pulmonary infiltrates during neutropenia followed by respiratory status deterioration coinciding with neutropenia recovery. Neutropenia duration was 10 (4–22) days, and time between respiratory symptoms and the first day with more than 1000 leukocytes/mm3 was 1 (−0.5 to 2) day. Of the 20 patients, 16 received invasive or noninvasive mechanical ventilation, including 14 patients with acute respiratory distress syndrome (ARDS). Five patients died, with refractory ARDS. In patients with pulmonary infiltrates during neutropenia, G-CSF-induced neutropenia recovery carries a risk of respiratory status deterioration with acute lung injury or ARDS. Clinicians must maintain a high index of suspicion for this diagnosis, which requires eliminating another cause of acute respiratory failure, G-CSF discontinuation and ICU transfer for early supportive management including diagnostic confirmation and noninvasive mechanical ventilation.
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影响因子：
8.8
作者：
Azoulay, E;Alberti, C;Schlemmer, B
通讯作者：
Schlemmer, B
影响因子：
8.4
作者：
Blot, F;Guiguet, M;Escudier, B
通讯作者：
Escudier, B
DOI：
10.1164/rccm.200206-554oc
发表时间：
2003-05-15
影响因子：
24.7
作者：
Azoulay, É;Fieux, F;Schlemmer, B
通讯作者：
Schlemmer, B
影响因子：
120.7
作者：
LeGall, JR;Klar, J;Teres, D
通讯作者：
Teres, D
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F