88例嗜酸性粒细胞增多症住院患儿的临床表现及病因分析

发布时间：2018-03-09 03:05

本文选题：嗜酸性粒细胞增多症　切入点：病因　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:嗜酸性粒细胞增多症(hypereosinophilia,HE)病因极其复杂,可涉及多个学科以及系统,导致临床医师对该疾病认识有限,误诊率高。其临床表现亦多样化,若症状轻可以无任何异常,症状重则除了累及血液系统外,还可导致全身其他系统受损;病因也多样化,给诊断和治疗带来困惑。因此了解嗜酸性粒细胞增多征的临床特点和病因分析,对临床诊治指导非常重要。尽管已有较多成人HE相关文献,但国内儿童HE文献较少,而且儿童有别于成人,随着近年来环境的改变,以及医学检测技术的提升,HE的病因也可能发生改变。目的:通过儿童嗜酸性粒细胞增多症的临床特点及病因构成,为临床提供诊治依据,以便提高对该病的认识。方法:收集2009年4月～2015年5月共6年来自浙江大学医学院附属儿童医院的88例嗜酸性粒细胞增多症住院患儿的临床资料。回顾性分析其临床表现,病因构成及外周血嗜酸性粒细胞增多程度与病因之间的关系。结果:临床表现以发热19人(占21.6%),腹痛15人(占17.0%),咳嗽,气急14人(占15.9%),皮疹13人(占14.8%),便血11人(占12.5%),腹泻6人(占6.8%)等为主,病因以感染性疾病28例(31.8%),其中呼吸道感染11例,寄生虫感染9例,败血症4例,泌尿系感染2例,蜂窝织炎1例,胆囊炎并胰腺炎1例;变态反应性疾病25例(28.4%),嗜酸细胞胃肠炎20例(22.7%),免疫缺陷病3例(3.4%,均呈中重度外周血嗜酸细胞增多),因新生儿溶血症,血液系统肿瘤导致各2例(各占2.3%),因嗜酸细胞膀胱炎,嗜酸性血管性肉芽肿,肾病综合征各1例;不明原因5例5.7%)。结论:儿童HE最常见病因是感染,其次为变态反应性疾病及嗜酸性粒细胞胃肠炎等。住院患儿HE临床症状以发热,腹痛,咳嗽和或气急较为常见;感染、变态反应性疾病及嗜酸细胞性胃肠炎是其常见病因,寄生虫为最常见的明确病原;外周血嗜酸性粒细胞正常亦不能排除HE,部分有组织浸润,需行组织病理学检查明确诊断;外周血嗜酸性粒细胞中重度增多患儿有原发性免疫缺陷可能。
[Abstract]:Background: the etiology of eosinophilia hypereosinophilia (HEH) is extremely complex, involving multiple disciplines and systems, resulting in limited knowledge of the disease and high misdiagnosis rate among clinicians. Its clinical manifestations are also diverse, and if the symptoms are mild, there can be no abnormalities. Serious symptoms, in addition to involving the blood system, can also lead to damage to other systems throughout the body; the etiology is also diverse, leading to confusion in diagnosis and treatment. Therefore, to understand the clinical characteristics and etiological analysis of eosinophilia, It is very important for clinical diagnosis and treatment guidance. Although there are more literatures on HE in adults, there are few papers on HE in children in China, and children are different from adults. With the change of environment in recent years, The etiology of eosinophilia in children may also change with the improvement of medical detection technique. Objective: to provide evidence for diagnosis and treatment of eosinophilia in children. Methods: from April 2009 to May 2015, 88 hospitalized children with eosinophilia were collected from the Children's Hospital of Zhejiang University School of Medicine. Results: the clinical manifestations of 19 patients with fever (21.662%), 15 patients with abdominal pain (17.0%), cough, cough, and other factors were as follows: the etiology of the disease and the degree of eosinophilia in peripheral blood were related to the etiology. There were 14 patients (15.9m) with acute qi, 13 (14.8m) with rash, 11 (12.5m) with blood, 6 (6.8cm) with diarrhea. The etiology was 28 cases of infectious diseases, including 11 cases of respiratory tract infection, 9 cases of parasitic infection, 4 cases of septicemia, 2 cases of urinary tract infection, and so on, the main causes of which were respiratory tract infection (11 cases), parasitic infection (9 cases), septicemia (4 cases) and urinary tract infection (2 cases). One case of cellulitis, one case of cholecystitis with pancreatitis, 25 cases of allergic diseases (28.4%), 20 cases of eosinophilic gastroenteritis (22.7%) and 3 cases of immunodeficiency disease (3.4%), all presented moderate and severe peripheral blood acidophilia, due to neonatal hemolysis. There were 2 cases of hematologic neoplasms (2.3% each, 1 case of eosinophilic cystitis, 1 case of eosinophilic vascular granuloma, 1 case of nephrotic syndrome, 5 cases of unknown cause). Conclusion: infection is the most common cause of HE in children. The clinical symptoms of HE in hospitalized children were fever, abdominal pain, cough or shortness of breath, infection, allergic disease and eosinophilic gastroenteritis were the common causes. The parasites were the most common pathogen, the eosinophils in peripheral blood could not be excluded from HEE, and some of them were infiltrated in tissues, so histopathological examination was needed to make a definite diagnosis. Peripheral blood eosinophils may have primary immune deficiency in children with moderate or severe eosinophilia.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.5

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