88例嗜酸性粒细胞增多症住院患儿临床表现及病因分析

Clinical characteristics and etiology of children with hypereosinophilia

目的：分析嗜酸性粒细胞增多症患儿临床特征及病因构成，以提高对该病的认识。方法：收集2009年4月至2015年4月在浙江大学医学院附属儿童医院诊断为嗜酸性粒细胞增多症88例住院患儿的临床资料，回顾性分析临床表现、病因构成、外周血嗜酸性粒细胞增多程度与病因的关系。结果：临床表现为发热19例（21．6％），腹痛15例（17．0％），咳嗽和／或气急14例（15．9％），皮疹13例（14．8％），便血11例（12。5％），腹泻6例（6．8％）；因感染导致28例（31．8％），其中急性支气管肺炎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，胆囊炎合并胰腺炎1例；因变态反应性疾病导致25例（28．4％）；因嗜酸细胞性胃肠炎导致20例（22．7％）；因免疫缺陷病导致3例（3．4％，均呈中重度外周血嗜酸性粒细胞增多），因新生儿溶血症、血液系统肿瘤导致各2例（各占2．3％），因嗜酸细胞性膀胱炎、嗜酸细胞性肉芽肿性血管炎、肾病综合征导致各1例；不明原因5例（5．7％）。结论：住院嗜酸性粒细胞增多症患儿临床症状以发热、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中重度增多患儿有原发性免疫缺陷病可能。

Objective： To analyze the clinical characteristics and etiology of hypereosinophilia in children. Methods： Clinical data of 88 children with hypereosinophilia admitted in Children＇s Hospital of Zhejiang University School of Medicine during April 2009 and May 2015 were retrospectively reviewed. The clinical manifestations, etiologies, and the correlation of disease severity with different etiologies were analyzed. Results：The main clinical manifestations were fever, abdominal pain, cough and/or tachypnea, skin rash, hemafecia and diarrhea, which were observed in 19 （21.6%）, 15 （17.0%）, 14 （15.9%）, 13 （14.8%）, ll （12.5%） and 6 （6.8%） cases, respectively. For etiologies, there were 28 cases （31.8%） induced by infections, including 11 cases of acute bronchial pneumonia, 9 cases of parasite infection, 4 cases of septicemia, 2 cases of urinary system infection, 1 case of cellulitis and 1 case of cholecystitis complicated with pancreatitis. The etiologies for the rest cases were allergic diseases （25 cases, 28.4% ）, eosinophilic gastroenteritis （20 cases, 22. 7% ）, immunodeficiency （3 cases, 3.4%, all were moderate to severe eosinophilia） , ABO hemolysis （2 cases, 2.3%）, hematologic neoplasms （2 cases, 2.3% ） , eosinophilic cystitis （ 1 case, 1.1% ） , eosinophilic granulomatosis with polyangitis （1 case, 1.1%）, nephrotic syndrome （1 case, 1.1%）, and 5 cases （5.7%） were of unknown causes. Conclusions：Fever, abdominal pain, cough and/or tachypnea are the most common clinical manifestations in children with hypereosinophilia. Infection, allergic diseases and eosinophilic gastroenteritis are the most common etiologies, and parasites are the most common pathogen identified. Differential diagnosis of primary immunodeficiency should be considered in children with moderate to severe eosinophilia.