儿童特发性嗜酸粒细胞增多综合征伴肺栓塞一例并文献复习  

Pediatric idiopathic hypereosinophilic syndrome with pulmonary embolism： a case report and review of literature

作　　者：董娜[1] 董晓艳[1] 

机构地区：[1]上海市儿童医院 上海交通大学附属儿童医院呼吸科,200040

出　　处：《中华儿科杂志》2017年第10期775-779,共5页Chinese Journal of Pediatrics

摘　　要：目的探讨特发性嗜酸粒细胞增多综合征伴肺栓塞的临床特征。方法回顾性分析上海市儿童医院呼吸科2016年9月收治的1例特发性嗜酸粒细胞增多综合征伴肺栓塞患儿的临床资料，并以＂嗜酸粒细胞增多，深静脉血栓形成＂＂idiopathic hypereosinophilic syndrome，deep vein thrombosis＂分别检索万方数据库和PubMed数据库（1985年4月至2017年3月）的相关文献，进行总结。结果患儿男，11岁，以＂发热、咳嗽＂起病。经心脏大血管造影（CTA）确诊肺栓塞，下腔静脉血栓；血管B超提示左下肢深静脉血栓形成，起病前存在持续性嗜酸粒细胞增高，血小板下降。文献检索后经过筛选，共获得相关文献30篇，其中病例报道18篇，共报道病例23例，儿童仅3例，综述及其他类型文章12篇。文献提示嗜酸粒细胞增高可损伤血管内皮细胞，造成高凝状态，引起动静脉血栓形成，抗凝联合糖皮质激素治疗确切有效。结论特发性嗜酸粒细胞增多综合征的临床诊断复杂，可伴血栓形成，在抗凝治疗的同时应使用糖皮质激素降低嗜酸粒细胞计数，减少其对血管内皮的损伤。是否需预防性抗凝治疗，仍需进一步研究。ObjectiveTo explore clinical features of idiopathic hypereosinophilic syndrome combined with pulmonary embolism.MethodA retrospective analysis of a patient with idiopathic hypereosinophilic syndrome and pulmonary embolism diagnosed and treated in the Respiratory Department of Shanghai Children′s Hospital in September 2016 was performed. A literature search was performed with＂Eosinophils increased, thrombosis＂as the Chinese keywords in Wanfang database and＂idiopathic hypereosinophilic syndrome, deep vein thrombosis＂as the English key words in PubMed database. The time interval was from April 1985 to March 2017.ResultThe patient was 11-year-old with fever and cough. Computed tomography angiography （CTA） showed pulmonary embolism, inferior vena cava thrombosis. Ultrasound examination of the left leg demonstrated venous thrombosis. Complete blood count showed eosinophilia and thrombocytopenia. Literature found 30 articles, including eighteen case reports, twelve reviews and other types of articles. A total of 23 cases were reported, only three were pediatric cases. According to the literature that eosinophilia can damage the vascular epithelium, leading to multiple arterial and venous thromboses, anticoagulation and glucocorticoid treatments are effective.ConclusionThe diagnosis of idiopathic hypereosinophilic syndrome is complicated. It may cause multiple thromboses. Anticoagulation and glucocorticoids can reduce eosinophil count and decrease its toxins which can injure vascular endothelium. The effectiveness of preventative anticoagulant therapy is unclear and requires further clinical study.

关 键 词：儿童 嗜酸粒细胞增多 肺栓塞 下肢深静脉血栓形成 

分 类 号：R725[医药卫生—儿科]