嗜酸性粒细胞增多综合征合并外周动脉栓塞患者的临床特点分析  

Analysis of clinical features of hypereosinophilic syndrome complicated with peripheral arterial embolism

作　　者：韩迎东 王嵩 张昀[1] 曾学军[1] HAN Yingdong;WANG Song;ZHANG Yun;ZENG Xuejun(Department of General Internal Medicine,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730;Department of Internal Medicine,Susong County Hospital of Traditional Chinese Medicine,Anqing 246500,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院全科医学科(普通内科),北京100730 [2]宿松县中医院内科,安徽安庆246500

出　　处：《基础医学与临床》2024年第8期1157-1161,共5页Basic and Clinical Medicine

基　　金：北京市临床重点专科项目(2023);北京协和医学院临床医学专业全科医学人才培养项目(201920200106)。

摘　　要：目的分析伴外周动脉栓塞的嗜酸性粒细胞增多综合征(HES)患者的临床特点及治疗效果,以提高临床医生的对该疾病的认识。方法从2012年4月至2021年10月北京协和医院的住院患者中进行入组挑选,通过电子病例系统收集了176例外周动脉栓塞的患者,根据纳入排除标准,共纳入13例HES伴外周动脉栓塞的患者,以上患者均通过影像学检查证实存在外周动脉栓塞。经过年龄及性别匹配,按照1∶3的比例筛选出同期住院的不伴外周动脉栓塞的39例HES患者作为对照组。比较两组患者在临床资料、治疗方案及治疗反应方面的差异。结果病例组13例患者有11例男性。主要栓塞部位为下肢腘动脉、足背动脉及上肢桡动脉、尺动脉。伴外周动脉栓塞组的患者周围神经受累情况显著高于不伴外周动脉栓塞组(P<0.05);胃肠道受累比例(P<0.05)及嗜酸性粒细胞水平(P<0.05)显著低于不伴外周动脉栓塞组。伴外周动脉栓塞组中分别有92.3%、61.5%和76.9%的患者接受抗凝、抗血小板和免疫抑制剂治疗,均显著高于未合并外周动脉栓塞组患者(P<0.05)。根据治疗前后嗜酸性粒细胞水平变化,住院期间病例组和对照组患者分别有84.6%和56.5%的患者完全缓解,部分缓解率分别为15.4%和25.6%。结论伴外周动脉栓塞的HES患者中,周围神经和皮肤为常见受累脏器,血管栓塞以四肢动脉栓塞为主,经过激素、免疫抑制剂及抗凝和/或抗血小板治疗,该组患者预后良好。Objective To improve the understanding of hypereosinophilic syndrome(HES)complicated with peripheral arterial embolism through analyzing the clinical features and therapeutic effect.Methods Among 176 inpatients with peripheral arterial embolism in Peking Union Medical College Hospital from April 2012 to October 2021,13 patients complicated with HES were involved according to the inclusion and exclusion criteria.All patients were diagnosed with peripheral arterial embolism by imaging examination.After gender and age matching,39 HES patients who were hospitalized in the same period but without peripheral arterial embolism were selected as the control with the ratio of 1∶3.Clinical features,therapy response and prognosis were compared between the two groups.Results Eleven of the 13 patients were male.The main involved arteries included popliteal artery,dorsalis pedis artery,ulnar artery and radial artery.The proportion of peripheral nerve involvement in case group was significantly higher than in the control group(P<0.05);and the proportion of gastrointestinal involvement(P<0.05)and eosinophil level(P<0.05)were significantly lower than that of control group.There were 92.3%,61.5%and 76.9%of the patients in case group received anticoagulant therapy,antiplatelet therapy and immunosuppressive therapy respectively,the percentages were significantly higher than that in control group(P<0.01).According to eosinophil counts before and after therapy,84.6%and 56.5%of the patients in the case and control groups achieved complete remission and the partial remission rates were 15.4%and 25.6%respectively.Conclusions Patients with hypereosinophilia syndrome and peripheral arterial embolism commonly experience involvement of the peripheral nerves and skin.Vascular embolism is mainly caused by arterial embolization of the extremities.After treatment with hormones,immunosuppressants,anticoagulants and/or antiplatelet therapy,this group of patients has a good prognosis.

关 键 词：嗜酸性粒细胞综合征 动脉栓塞 周围神经受累 抗凝治疗 

分 类 号：R55[医药卫生—血液循环系统疾病]