以胸腔积液为首发症状的特发性嗜酸粒细胞增多综合征1例并文献复习  

Idiopathic hypereosinophilic syndrome with an initial manifestation of pleural effusion： a case report and literature review

作　　者：霍震宇[1] 杨长林[1] 彭丽[1] 

机构地区：[1]重庆医科大学附属第一医院呼吸内科,400016

出　　处：《国际呼吸杂志》2016年第20期1555-1560,共6页International Journal of Respiration

基　　金：国家临床重点专科专项资助（卫办医政函[2012]649号）

摘　　要：目的探讨以胸腔积液为首发症状的特发性嗜酸粒细胞增多综合征（㈣opathichypereosinophilic syndrome，IHES）的临床特点及诊治经验，提高广大临床工作者对该病的认识。方法回顾性分析重庆医科大学附属第一医院呼吸内科收治的1例IHES患者的病例资料，并结合国内外文献进行文献复习。以“特发性嗜酸粒细胞增多综合征”为检索词检索中国期刊全文数据库（CNKI）、中文科技期刊数据库（维普）、万方数据库，以“idiopathichypereosinophmc syndrome”、“eosinophilia”、“hypereosinophilia”为检索词检索Embase数据库、MEDLINE数据库（PubMed），检索时间为1990年1月到2015年12月。结果患者为青年男性，2015年10月10日因“反复咳嗽、胸闷、气促2个月，加重半个月”入院，血常规提示嗜酸粒细胞绝对值17．28×10。／L，胸部CT提示左侧胸腔中量积液，右侧胸腔少量积液，最终被诊断为IHES，糖皮质激素治疗2个月后，患者临床症状好转，胸腔积液明显吸收。文献经检索、去重后，共筛选诊断为IHES的国内外病例报道74篇，其中合并胸腔积液的病例报道共25篇。国内已公开报道IHES患者共103例，最常受累的部位包括皮肤（约34．0％），其次为呼吸系统、消化系统，14．6％伴有胸腔积液。结论IHES的临床症状常不典型，易与其他疾病相混淆，诊断较为复杂，只有提高临床工作者对于该病的认识及其临床资料的掌握，才能真正减少误诊误治。Objective To discuss the characteristics, diagnoses and treatments for idiopathic hypereosinophilic syndrome （IHES） with an initial manifestation of pleural effusion, and improve the realization of eosinophilia resulting in atypical presentation. Methods A retrospective analysis and literature review for a case of idiopathic hypereosinophilic syndrome diagnosed and cured by the department of respiratory medicine, the First Affiliated Hospital of Chongqing Medical University. ＂ idiopathiehypereosinophilic syndrome＂, ＂eosinophilia＂, ＂hypereosinophilia＂ as key words and to search the literature in China National Knowledge Infrastructure （CNKI）, Chongqing VIP （CQVIP）, Wanfang, Embase,and MEDLINE （PubMed） databases from January 1990 to December 2015. Results The patient, a 32-year-old male, complained cough, chest distressand anhelation for 2 months, and exacerbated in 15 days. Blood routine examination showed hypereosinophilia, chest computed tomography （CT） showed bilateral pleural effusion, and this patient was diagnosed idiopathic hypereosinophilic syndrome finally. After 2 months of treatment with glucocorticoids, the clinical manifestationsand pleural effusion of this case were disappeared. Literature review included 74 references after screened, 25 cases were reported with the manifestation of pleural effusion. In China, 103 IHES cases were reported in pubic publications,the most commonly affected systems were dermal system （about 34.0%）, respiratory system and digestive system, 14.6% IHES cases presented with pleural effusion. Conclusions The diagnosis of idiopathic hypereosinophilic syndrome is complex, and the clinical manifestalions are various and atypical. Only when the realization of idiopathic hypereosinophilic syndrome is improved, the clinical misdiagnosis and mistherapy will decrease.

关 键 词：嗜酸粒细胞增多综合征 胸腔积液 

分 类 号：R557.5[医药卫生—血液循环系统疾病]