25例门诊嗜酸性粒细胞增多症患儿临床分析

发布时间：2018-03-03 19:05

本文选题：嗜酸性粒细胞增多症　切入点：泼尼松　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析25例门诊嗜酸性粒细胞增多症患儿的临床特点及治疗疗效,旨在给临床医生在制定治疗策略上提供有益帮助及依据。方法:回顾性分析2013年1月至2017年1月在广西医科大学第一附属医院儿科门诊就诊的25例嗜酸性粒细胞增多症患儿临床资料,应用SPSS20.软件进行统计学分析。结果:1.在25例嗜酸性粒细胞增多症患儿中,男孩18例,女孩7例,男女比例约为2.57:1。25例患儿诊断时的年龄为2~13岁,平均年龄5.8岁。2.外周血嗜酸性粒细胞数轻度增多3例(12%),中度增多12例(48%),重度增多10例(40%)。外周血AEC增高程度与性别、年龄无关(P0.05)。3.病因包括感染6例(24%),其中EB病毒感染1例(4%),寄生虫感染5例(20%),包括钩虫感染2例,人芽囊原虫1例,2例临床诊断寄生虫感染;过敏性荨麻疹2例(8%);病因不明确17例(68%)。4.25例患儿中以皮肤受累表现多见,为17例(68%),全身表现为9例(36%),呼吸系统及消化系统表现各为8例(32%)、5例(20%)。5.25例患儿外周血AEC范围为1.1~25.84×109/L,平均值为8.30×109/L,其中17例(68%)患儿白细胞计数明显升高。6.5例寄生虫感染患儿,予驱虫药治疗1个月后,4例获得满意疗效,1例患儿治疗过程中复查AEC再次升高。2例过敏性疾病患儿予地氯雷他定治疗后症状和外周血均获得缓解。7例患儿采用泼尼松单药治疗,总治疗25有效者6例(85.7%)。9例患儿予地氯雷他定治疗,总治疗有效者有2例(22.2%)。有2例患儿分别予泼尼松联合环孢素、泼尼松联合复方甘草酸苷治疗,均获得PR。25例患儿中有6例因疗效欠佳而更改治疗方案,4例患儿更换泼尼松治疗后疗效得到提升;2例患儿改用伊马替尼治疗,其中1例在用伊马替尼6个月后获得CR,另1例在予伊马替尼联合泼尼松治疗后2个月获得PR。结论:1.在嗜酸性粒细胞增多症儿童中男孩发病率高于女孩,以学龄前期多见,幼儿期次之。2.嗜酸性粒细胞增多症症状以皮肤受累多见,消化系统及呼吸系统次之,但临床表现缺乏特异性。3.多数嗜酸性粒细胞增多症患儿泼尼松治疗有效。4.嗜酸性粒细胞增多症患儿在予糖皮质激素治疗无效时,可考虑使用伊马替尼治疗。
[Abstract]:Objective: to analyze the clinical characteristics and therapeutic effect of 25 outpatients with eosinophilia. The purpose of this study was to provide a useful basis for clinicians in formulating treatment strategies. Methods: a retrospective analysis of 25 cases of eosinophils in pediatric outpatient clinic of the first affiliated Hospital of Guangxi Medical University from January 2013 to January 2017 was conducted. Clinical data of children with polyplasia, Results of 25 cases of eosinophilia, 18 were boys and 7 were girls. The ratio of male to female was about 2.57: 1.25. The age at the time of diagnosis was 21 to 13 years. The mean age was 5.8 years old. The number of eosinophils in peripheral blood increased slightly in 3 cases, in 12 cases, in 12 cases, in 12 cases, in 10 cases, in 10 cases, in 40 cases. The etiology included 6 cases of infection, including 1 case of Epstein-Barr virus infection, 5 cases of parasitic infection, including 2 cases of hookworm infection, 1 case of human bud cyst protozoa and 2 cases of clinical diagnosis of parasitic infection. There were 2 cases with allergic urticaria and 8 cases with irritable urticaria, 17 cases with unclear etiology and 4.25 cases with allergic urticaria showed skin involvement. In 17 cases, there were 9 cases with total body manifestations and 3 with 36%, 8 cases with respiratory system and 5 cases with digestive system, respectively. The range of AEC in peripheral blood of 5 cases was 1.1 ~ 25.84 脳 10 ~ 9 / L, with an average of 8.30 脳 10 ~ (9 / L), of which 17 cases had a significant increase in the white blood cell count of 6.5 cases of parasitic infection, and the mean value was 8.30 脳 10 ~ (9) / L, and the leukocyte count was significantly increased in 6.5 cases of parasitic infection. One month after the treatment, 4 patients received satisfactory curative effect. During the course of treatment, 2 patients with allergic diseases were treated with desloratadine. 7 patients were treated with prednisone alone after the treatment of desloratadine, and the symptoms were alleviated by desloratadine. The total treatment was effective in 6 cases (85.7%) with desloratadine, 2 cases (22.2%) with total treatment and 2 cases with prednisone combined with cyclosporine and prednisone combined with compound glycyrrhizin. Among all the patients with PR.25, 6 patients were treated with imatinib because of poor therapeutic effect. 4 patients were treated with prednisone and 2 patients were treated with imatinib after replacement of prednisone. One case got CRR after 6 months of treatment with imatinib, the other one got PR2 months after treatment with imatinib combined with prednisone. Conclusion: 1.The incidence of Eosinophilia in boys is higher than that in girls, especially in pre-school children. The symptoms of eosinophilia were mainly caused by skin involvement, followed by digestive and respiratory systems. But the clinical manifestation is lack of specificity .3.Most children with eosinophilia can be treated effectively by prednisone .4. the children with eosinophil may consider using imatinib when the glucocorticoid therapy is ineffective.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.5

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