發(fā)布時(shí)間：2018-03-09 03:05

  本文選題：嗜酸性粒細(xì)胞增多癥　切入點(diǎn)：病因　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:嗜酸性粒細(xì)胞增多癥(hypereosinophilia,HE)病因極其復(fù)雜,可涉及多個(gè)學(xué)科以及系統(tǒng),導(dǎo)致臨床醫(yī)師對(duì)該疾病認(rèn)識(shí)有限,誤診率高。其臨床表現(xiàn)亦多樣化,若癥狀輕可以無(wú)任何異常,癥狀重則除了累及血液系統(tǒng)外,還可導(dǎo)致全身其他系統(tǒng)受損;病因也多樣化,給診斷和治療帶來(lái)困惑。因此了解嗜酸性粒細(xì)胞增多征的臨床特點(diǎn)和病因分析,對(duì)臨床診治指導(dǎo)非常重要。盡管已有較多成人HE相關(guān)文獻(xiàn),但國(guó)內(nèi)兒童HE文獻(xiàn)較少,而且兒童有別于成人,隨著近年來(lái)環(huán)境的改變,以及醫(yī)學(xué)檢測(cè)技術(shù)的提升,HE的病因也可能發(fā)生改變。目的:通過(guò)兒童嗜酸性粒細(xì)胞增多癥的臨床特點(diǎn)及病因構(gòu)成,為臨床提供診治依據(jù),以便提高對(duì)該病的認(rèn)識(shí)。方法:收集2009年4月～2015年5月共6年來(lái)自浙江大學(xué)醫(yī)學(xué)院附屬兒童醫(yī)院的88例嗜酸性粒細(xì)胞增多癥住院患兒的臨床資料�；仡櫺苑治銎渑R床表現(xiàn),病因構(gòu)成及外周血嗜酸性粒細(xì)胞增多程度與病因之間的關(guān)系。結(jié)果:臨床表現(xiàn)以發(fā)熱19人(占21.6%),腹痛15人(占17.0%),咳嗽,氣急14人(占15.9%),皮疹13人(占14.8%),便血11人(占12.5%),腹瀉6人(占6.8%)等為主,病因以感染性疾病28例(31.8%),其中呼吸道感染11例,寄生蟲(chóng)感染9例,敗血癥4例,泌尿系感染2例,蜂窩織炎1例,膽囊炎并胰腺炎1例;變態(tài)反應(yīng)性疾病25例(28.4%),嗜酸細(xì)胞胃腸炎20例(22.7%),免疫缺陷病3例(3.4%,均呈中重度外周血嗜酸細(xì)胞增多),因新生兒溶血癥,血液系統(tǒng)腫瘤導(dǎo)致各2例(各占2.3%),因嗜酸細(xì)胞膀胱炎,嗜酸性血管性肉芽腫,腎病綜合征各1例;不明原因5例5.7%)。結(jié)論:兒童HE最常見(jiàn)病因是感染,其次為變態(tài)反應(yīng)性疾病及嗜酸性粒細(xì)胞胃腸炎等。住院患兒HE臨床癥狀以發(fā)熱,腹痛,咳嗽和或氣急較為常見(jiàn);感染、變態(tài)反應(yīng)性疾病及嗜酸細(xì)胞性胃腸炎是其常見(jiàn)病因,寄生蟲(chóng)為最常見(jiàn)的明確病原;外周血嗜酸性粒細(xì)胞正常亦不能排除HE,部分有組織浸潤(rùn),需行組織病理學(xué)檢查明確診斷;外周血嗜酸性粒細(xì)胞中重度增多患兒有原發(fā)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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.5

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