嗜酸性粒细胞增多性皮炎21例临床分析

Analysis of 21 cases with hypereosinophilic dermatitis

目的探讨嗜酸性粒细胞增多性皮炎(HED)的临床特点。方法回顾性分析2002年8月至2010年3月我科收治的21例HED患者的临床表现、实验室检查和辅助检查的结果、治疗及预后。结果本组男17例(80.95%),女4例(19.05%);男性平均发病年龄(67.65±6.49)岁,女性平均发病年龄(52.25±8.38)岁,患者以老年男性占多数。皮损为多形性、瘙痒剧烈。血常规、外周血涂片、骨髓涂片及骨髓活检均显示嗜酸性粒细胞增多。嗜酸性粒细胞(EOS)百分比为13.5%～72.0%,EOS绝对计数为(0.61～13.02)×109/L;10例行外周血涂片者外周血EOS均增多,为11%～61%;13例行骨髓穿刺涂片者均提示骨髓增生活跃,EOS比例增高,占10.5%～55%。16例患者血清总IgE显著升高(155～5000IU/ml)、16例乳酸脱氢酶升高、10例尿素氮升高、10例白蛋白降低。皮肤组织病理示真皮浅中层血管周围较多淋巴组织细胞和嗜酸性粒细胞浸润。主要使用糖皮质激素和免疫抑制剂治疗,患者对治疗的反应差异较大。结论 HED应早期诊断,根据不同病因采取个体化治疗方案,并密切随访。

Objective To investigate the clinical characteristics of patients with hypereosinophilic dermatitis （HED）. Methods Twenty-one hospitalized patients with HED in the Peking Union Medical College Hospital from August 2002 to March 2010 were included. Their clinical and laboratory data were analyzed retrospectively. Results The patients in this group were mostly senior men who had generalized, polymorphic skin lesions with severe itching. All had blood and bone marrow eosinophilia. Most patients showed raised serum total IgE, lactate dehydrogenase, blood urea nitrogen and hypoalbuminemia. The histology of skin lesions revealed perivascular infiltration of lymphocytes, histocytes and eosinophils in the superficial and middle level of dermis. Conclusion Patients with HED should be early diagnosed, and the treatment regimens should be based on the causes of hypereosinophilia.