在二级医疗机构中，外周血嗜酸性粒细胞增多的原因。
The causes of a peripheral blood eosinophilia in a secondary care setting.
机构信息
Department of Respiratory Sciences, College of Life Sciences, Institute for Lung Health, NIHR Leicester Biomedical Research Centre (Respiratory theme), University of Leicester and Respiratory and Allergy Services, University Hospitals of Leicester NHS Trust, Leicester, UK.
Department of Haematology, University Hospitals of Leicester NHS Trust, Leicester, UK.
出版信息
Clin Exp Allergy. 2021 Jul;51(7):902-914. doi: 10.1111/cea.13889. Epub 2021 Jun 3.
BACKGROUND
A peripheral blood eosinophilia of greater than 1.0 × 10 /L is relatively unusual and offers a clue to the underlying diagnosis. In 2003, we established a specialist service to diagnose unexplained eosinophilia.
OBJECTIVE
To describe the causes of an eosinophilia in our service and the diagnostic algorithm we developed.
METHODS
Subjects were referred by physician colleagues across a range of specialties and undertook standard investigations following a semi-structured protocol. Data were extracted from a bespoke database.
RESULTS
Three hundred and eighty two subjects were referred over a 17-year period. Average age was 54 years and 183 (48%) of subjects were female, with 21 of 25 (84%) females in the idiopathic eosinophilic pneumonia group (p < 0001), 22 of 30 (73%) females in the gastrointestinal disease group (p < .008), but 11 of 37 (30%) females in the eosinophilic granulomatosis with polyangiitis group (p < .04). A diagnosis was assigned after systematic evaluation using a pre-defined algorithm in 361 (94.5%) of cases. Fungal allergy (82 subjects: 21%), parasitic infection (61 subjects: 16%) and severe eosinophilic asthma (50 subjects: 13%) were the three commonest individual diagnoses. Hypereosinophilic syndrome (HES) disease including eosinophilic granulomatosis with polyangiitis (EGPA) accounted for 85 subjects (20%) of which seven subjects (2%) had myeloproliferative disease (M-HES). A high IgE was common, and 79 (91%) of subjects with complete data who had an IgE of ≥1000 IU/L had fungal allergy or parasite infection. The serum tryptase was raised in 44 of 302 (14.5%) of individuals across all diagnostic groups, though none had mastocytosis.
CONCLUSION
A diagnosis of an unexplained eosinophilia can usually be determined using as semi-structured algorithm. Parasitic infection and fungal allergy often with severe eosinophilic asthma were common causes, whereas HES, particularly myeloproliferative, disease was relatively rare.
背景
外周血嗜酸性粒细胞大于 1.0×10 /L 相对不常见，可为潜在诊断提供线索。2003 年，我们建立了一个专门的服务来诊断不明原因的嗜酸性粒细胞增多症。
目的
描述我们服务中嗜酸性粒细胞增多的原因和我们开发的诊断算法。
方法
通过一系列专业的医师同事转诊，根据半结构化方案进行标准检查。数据从一个定制的数据库中提取。
结果
在 17 年的时间里，有 382 名患者被转诊。平均年龄为 54 岁，183 名（48%）为女性，其中特发性嗜酸性肺炎组 25 名女性中有 21 名（84%）（p<0.0001），胃肠道疾病组 30 名女性中有 22 名（73%）（p<.008），但嗜酸性粒细胞肉芽肿伴多血管炎组 37 名女性中有 11 名（30%）（p<.04）。在使用预定义算法对系统性评估后，361 例（94.5%）患者被诊断出病因。真菌感染过敏（82 例：21%）、寄生虫感染（61 例：16%）和严重嗜酸性哮喘（50 例：13%）是三种最常见的单一诊断。高嗜酸性粒细胞综合征（HES）疾病，包括嗜酸性粒细胞肉芽肿伴多血管炎（EGPA），占 85 例（20%），其中 7 例（2%）患者患有骨髓增生性疾病（M-HES）。高 IgE 很常见，79 例（91%）具有完整数据且 IgE 水平≥1000 IU/L 的患者有真菌感染过敏或寄生虫感染。在所有诊断组中，302 例患者中有 44 例（14.5%）血清胰蛋白酶升高，尽管没有肥大细胞增多症。
结论
使用半结构化算法通常可以确定不明原因的嗜酸性粒细胞增多的诊断。寄生虫感染和真菌感染过敏，常伴有严重的嗜酸性哮喘，是常见的病因，而 HES，特别是骨髓增生性疾病，相对较少见。
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