以急性肺栓塞广泛下肢静脉血栓形成为首发症状的嗜酸粒细胞增多综合征一例并文献复习

Hypereosinophilic syndrome with first presentation of pulmonary embolism and extensive venous thrombosis ：a case report and literature review

目的 探讨以血栓栓塞为首发症状的嗜酸粒细胞增多综合征的临床特点和治疗措施.方法 回顾性分析解放军总医院心血管内科收治的1例嗜酸粒细胞增多综合征患者的临床资料并进行相关文献复习.以＂嗜酸粒细胞增多综合征＂为检索词检索万方数据库和中国期刊网全文数据库（CNKI）,以＂hypereosinophilic syndrome＂、＂hypereosinophilia＂、＂eosinophilia＂为检索词检索PubMed、Embase数据库,检索时间为1975年1月至2013年12月.结果 患者男,31岁,2013年8月因＂双下肢肿胀1个月,胸痛伴痰中带血1周＂入院.临床表现为双下肢肿胀,胸痛伴痰中带血,肺动脉CT提示多发肺叶、肺段水平动脉栓塞,下肢静脉CT及超声提示多发下肢静脉血栓形成,血常规提示持续性嗜酸粒细胞增多伴暂时性血小板减少.文献检索后经过筛选剔除,共检索出相关文献41篇,其中综述8篇,病例报告29篇,其他类型文献4篇.结论 嗜酸粒细胞增多综合征的临床诊断较为复杂,应针对疾病不同亚型采取不同治疗措施.对出现血栓栓塞并发症的患者应采取积极有效的抗凝治疗,预防性抗凝治疗的有效性、安全性和抗凝治疗需要持续的时间目前并不十分清楚,仍需进一步探究.

Objective To study the diagnosis and treatment of hypereosinophilic syndrome complicated with thromboembolism.Methods A retrospective analysis of a patient with hypereosinophilic syndrome diagnosed and treated in the Department of Cardiology, PLA General Hospital was performed.A literature research was performed with ＂hypereosinophilic syndrome＂ as the Chinese key word in Wanfang database and China national knowledge internet and ＂ hypereosinophilic syndrome, hypereosinophilia, eosinophilia＂ as the English key words in PubMed and Embase database.The time interval was from January 1975 to December 2013.Results The patient was a 31 year old male with a history of bilateral lower limb swelling and a history of chest pain accompanied with blood-stained sputum.Computed tomography pulmonary arteriography （CTPA） on admission showed multiple filling defects at lobular and segmental arteries.CT venography （CTV） and ultrasound examination of the legs demonstrated multiple venous thrombosis.Literature review found 41 articles, including 8 reviews, 29 case reports and 4 other type articles.Conclusions The clinical manifestations of hypereosinophilic syndrome were varied, and therefore the disease should be managed differently according to different subtypes with glucocorticoids as the main therapy.Effectively reducing the eosinophil count could decrease the incidence of thrombotic complications.Anticoagulant therapy should be used in patients with thrombotic complications.The effectiveness of preventative anticoagulation and duration of anticoagulation are less clear and require further clinical study.