Chanswangphuwana Chantiya, Uaprasert Noppacharn, Moonla Chatphatai, Rojnuckarin Ponlapat
Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand.
Asian Pac J Allergy Immunol. 2024 Dec;42(4):403-408. doi: 10.12932/AP-221220-1021.
Hypereosinophilia (HE), defined by blood eosinophils > 1.5 ? 109/L persisting over one month, is commonly found in clinical practice.
This study aimed to explore etiologies, clinical characteristics, and outcome of HE.
The HE patients from a single center in Thailand during 2014-2019 were retrospectively reviewed.
Among 166 HE patients, 102 (61.5%) cases had reactive HE (HER) of which 52% was due to parasitic infestations. Two-thirds of these patients were diagnosed based on the patients' response to empirical anti-parasite therapy. Without secondary causes, eosinophil-related symptoms were found in 20 (12.0%) patients (Hypereosinophilic syndrome: HES) of which three of them had myeloid neoplasms (HESN) and one case had lymphocytic variant HES (L-HES). Among 11 of 16 idiopathic HES (HESI) patients who were treated with systemic steroid, nine (81.8%) patients responded well, and two cases obtained symptom improvement with stable eosinophilia. There was 44 (26.5%) asymptomatic HE of undetermined significance (HEUS) and 37 (84.1%) of them had HE for more than 6 months before diagnosis. Marked eosinophilia (> 10 ? 109/L) was more common in HES (37.5%), but it was also found in HER (16.7%) and HEUS (11.4%). During the median follow-up period of 16 months, 82.9% (34/41) of HEUS cases remained asymptomatic while seven (17.1%) patients spontaneously recovered.
A therapeutic trial of anti-parasite is reasonable for asymptomatic HE in tropical countries. Most HESI responded to systemic corticosteroids and HEUS showed benign courses without therapy.
高嗜酸性粒细胞增多症（HE）定义为血液嗜酸性粒细胞>1.5×10⁹/L且持续超过1个月，在临床实践中较为常见。
本研究旨在探讨HE的病因、临床特征及预后。
回顾性分析2014 - 2019年泰国某单一中心的HE患者。
166例HE患者中，102例（61.5%）为反应性HE（HER），其中52%由寄生虫感染引起。这些患者中有三分之二是根据对经验性抗寄生虫治疗的反应而确诊。无继发原因时，20例（12.0%）患者出现嗜酸性粒细胞相关症状（高嗜酸性粒细胞综合征：HES），其中3例患有髓系肿瘤（HESN），1例为淋巴细胞变异型HES（L - HES）。16例特发性HES（HESI）患者中有11例接受了全身糖皮质激素治疗，9例（81.8%）患者反应良好，2例症状改善且嗜酸性粒细胞计数稳定。有44例（26.5%）意义未明的无症状HE（HEUS），其中37例（84.1%）在诊断前HE持续超过6个月。明显嗜酸性粒细胞增多（>10×10⁹/L）在HES中更常见（37.5%），但在HER（16.7%）和HEUS（11.4%）中也有发现。在中位随访期16个月期间，82.9%（34/41）的HEUS病例仍无症状，7例（17.1%）患者自发缓解。
对于热带国家无症状HE患者，进行抗寄生虫治疗试验是合理的。大多数HESI对全身糖皮质激素有反应，且HEUS未经治疗显示出良性病程。
