{"id":28748,"date":"2025-08-27T04:05:00","date_gmt":"2025-08-26T20:05:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=28748"},"modified":"2025-08-27T05:43:27","modified_gmt":"2025-08-26T21:43:27","slug":"nejm%e4%b8%b4%e5%ba%8a%e5%8c%bb%e5%ad%a6%e5%bd%b1%e5%83%8f%ef%bc%9aanca%e7%9b%b8%e5%85%b3%e8%a1%80%e7%ae%a1%e7%82%8e%e6%82%a3%e8%80%85%e7%9a%84%e5%bc%a5%e6%bc%ab%e6%80%a7%e8%82%ba%e6%b3%a1%e5%87%ba","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=28748","title":{"rendered":"[NEJM\u4e34\u5e8a\u533b\u5b66\u5f71\u50cf]\uff1aANCA\u76f8\u5173\u8840\u7ba1\u708e\u60a3\u8005\u7684\u5f25\u6f2b\u6027\u80ba\u6ce1\u51fa\u8840"},"content":{"rendered":"\n<p><a href=\"https:\/\/www.nejm.org\/browse\/nejm-media-type\/images-in-clinical-medicine\">IMAGES IN CLINICAL MEDICINE<\/a><\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Diffuse Alveolar Hemorrhage in ANCA-Associated Vasculitis<\/h1>\n\n\n\n<h3 class=\"wp-block-heading\">Irene S.\u00a0Lee<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">N Engl J Med\u00a02025;393:72<\/h3>\n\n\n\n<h3 class=\"wp-block-heading\">DOI: 10.1056\/NEJMicm2416576<\/h3>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/www.nejm.org\/cms\/10.1056\/NEJMicm2416576\/asset\/e9038bcb-4b3c-4288-b241-56f7a6807876\/assets\/images\/large\/nejmicm2416576_f1.jpg\" alt=\"\"\/><\/figure>\n\n\n\n<p>A 57-year-old man with hypertension presented to the emergency department with a 2-week history of worsening shortness of breath. His oxygen saturation was 68% while he was breathing ambient air. He was confused and unable to speak. Physical examination was notable for diffuse crackles in both lungs. Tracheal intubation was performed. A chest radiograph showed dense, perihilar airspace opacities in both lungs in a \u201cbatwing\u201d distribution (Panel A). Computed tomography of the chest also showed well-demarcated airspace opacities that spared the subpleural regions. A \u201ccrazy-paving pattern\u201d (ground-glass opacities with superimposed septal thickening) was seen in the right upper lobe (Panel B, asterisk). Laboratory studies were notable for a hemoglobin level of 5.3 g per deciliter (reference range, 14.0 to 18.0) and a creatinine level of 6.9 mg per deciliter (610 \u03bcmol per liter; reference range, 0.7 to 1.3 mg per deciliter [62 to 115 \u03bcmol per liter]). Urinalysis revealed substantial hematuria and proteinuria. Given the patient\u2019s clinical presentation and radiographic findings, diffuse alveolar hemorrhage was suspected and was subsequently confirmed by serial bronchoalveolar lavage, which produced progressively bloodier aliquots of lavage fluid (Panel C). On the basis of this finding, antineutrophil cytoplasmic antibody (ANCA) titers, and a renal biopsy, a final diagnosis of ANCA-associated vasculitis was later made. Despite treatment with glucocorticoids, cyclophosphamide, and plasma exchange as well as renal-replacement therapy, the patient died 23 days after admission.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>IMAGES IN CLINICAL MEDICINE Diffuse Alveolar Hemorrhage [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[16,13],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28748"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=28748"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28748\/revisions"}],"predecessor-version":[{"id":28749,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/28748\/revisions\/28749"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=28748"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=28748"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=28748"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}