Bahrami Soon, Malone Janine C, Webb Kelli G, Callen Jeffrey P
Department of Pathology, University of Louisville School of Medicine, Louisville, KY 40292, USA.
Arch Dermatol. 2006 Feb;142(2):155-61. doi: 10.1001/archderm.142.2.155.
To determine whether tissue eosinophilia is a reliable indicator of a drug-induced etiology in biopsy samples demonstrating leukocytoclastic vasculitis.
Retrospective medical record review with concurrent histopathologic analysis.
University-affiliated dermatology practice.
Sixty-three patients with cutaneous small-vessel vasculitis meeting specific inclusion criteria were divided into drug-induced (n = 16) and non-drug-induced (n = 47) groups.
Corresponding histopathologic material was reviewed by a dermatopathologist masked to the etiologic associations. An eosinophil ratio was calculated for each patient, derived from the mean eosinophil score (averaging eosinophil counts from 10 high-power histologic fields), and expressed in relation to the intensity of inflammation in the histopathologic slides examined. Eosinophilia ratios were compared for both groups using the Mann-Whitney test.
A significant difference was found in mean eosinophil ratios in the drug-induced vs non-drug-induced groups (5.20 vs 1.05; P = .01). Vascular fibrin deposition was present in both groups and was not found to be significantly different (P = .78). Clinical evidence of systemic vasculitis was present in 2 patients (13%) in the drug-induced group vs 15 (32%) in the non-drug-induced group. Fourteen patients (88%) in the drug-induced group had a short-term disease course vs 27 (57%) in the non-drug-induced group.
Tissue eosinophilia is established as a reliable indicator of drug induction in cutaneous small vessel vasculitis. Drug-induced small-vessel vasculitis generally follows a short-term disease course without development of systemic involvement. This information may be useful for guiding management decisions, especially when the etiology is unclear.
确定在显示白细胞破碎性血管炎的活检样本中，组织嗜酸性粒细胞增多是否是药物性病因的可靠指标。
回顾性病历审查并同时进行组织病理学分析。
大学附属医院皮肤科诊所。
63例符合特定纳入标准的皮肤小血管炎患者被分为药物性（n = 16）和非药物性（n = 47）两组。
由对病因关联不知情的皮肤病理学家审查相应的组织病理学材料。计算每位患者的嗜酸性粒细胞比率，该比率来自平均嗜酸性粒细胞评分（对10个高倍组织学视野中的嗜酸性粒细胞计数求平均值），并根据所检查的组织病理学切片中的炎症强度表示。使用Mann-Whitney检验比较两组的嗜酸性粒细胞增多比率。
药物性组与非药物性组的平均嗜酸性粒细胞比率存在显著差异（5.20对1.05；P = 0.01）。两组均存在血管纤维蛋白沉积，且未发现有显著差异（P = 0.78）。药物性组有2例患者（13%）出现系统性血管炎的临床证据，而非药物性组有15例患者（32%）出现。药物性组14例患者（88%）病程较短，而非药物性组为27例患者（57%）。
组织嗜酸性粒细胞增多被确定为皮肤小血管炎中药物诱导的可靠指标。药物性小血管炎通常病程较短，不会发展为系统性受累。这些信息可能有助于指导管理决策，尤其是在病因不明时。
