嗜酸性肉芽肿性多血管炎15例临床特征分析

Clinical characteristics analysis of 15 cases of eosinophilic granulomatous polyangiitis

目的探讨嗜酸性肉芽肿性多血管炎的特点,为临床诊断和治疗提供依据。方法回顾性分析15例嗜酸性肉芽肿性多血管炎的流行病学、临床表现、实验室检查、影像学和病理学特点及治疗效果。结果15例嗜酸性肉芽肿性多血管炎患者年龄(50.7±17.2)岁,从发病至确诊时间为5 d至36个月,中位时间182.5 d,13例患者以呼吸道症状为首诊症状,另2例分别以皮肤损害及神经系统损害首诊,这些患者均伴有外周血嗜酸性粒细胞增多,波动在10.6%~60.94%,13例患者存在呼吸道的症状,主要为咳嗽咳痰、喘息气短,胸部CT表现多样,组织病理学或肺泡灌洗液亦有嗜酸性粒细胞增多改变。结论嗜酸性肉芽肿性多血管炎临床表现多样,常累及呼吸系统,也可以累及循环系统、消化系统、神经系统、泌尿系统、皮肤等多个系统,但因其早期经常表现为喘息,往往被误诊为难治性哮喘,提高对嗜酸性肉芽肿性多血管炎的认识,提高早期诊断水平有助于改善患者预后。

Objective To explore the characteristics of eosinophilic granulomatous polyangiitis(EGPA)and provide a basis for clinical diagnosis and treatment.Methods A retrospective analysis was conducted on the epidemiology,clinical manifestations,laboratory tests,imaging and pathological characteristics,and treatment outcomes of 15 cases of eosinophilic granulomatous vasculitis.Results Fifteen patients with eosinophilic granulomatous vasculitis were aged(50.7±17.2)years old,with a median time of 182.5 days from onset to diagnosis.Thirteen patients presented with respiratory symptoms as the initial diagnosis,while the other two presented with skin and nervous system damage.These patients were all accompanied by an increase in peripheral blood eosinophils,fluctuating between 10.6%and 60.94%.Thirteen patients had respiratory symptoms,mainly cough,sputum production,shortness of breath,and varied chest computed tomography(CT)findings.Histopathology or alveolar lavage fluid also showed changes in eosinophil count.Conclusions The clinical manifestations of eosinophilic granulomatous vasculitis are diverse,often involving the respiratory system,as well as multiple systems such as the circulatory system,digestive system,nervous system,urinary system,and skin.However,due to its frequent early manifestations of wheezing,it is often misdiagnosed as refractory asthma.Improving the understanding of eosinophilic granulomatous vasculitis and improving the level of early diagnosis can help improve the prognosis of patients.