Andy J J, Ogunowo P O, Akpan N A, Odigwe C O, Ekanem I A, Esin R A
Department of Medicine, College of Medicine, University of Calabar, Nigeria.
Acta Trop. 1998 May;69(2):127-40. doi: 10.1016/s0001-706x(97)00125-3.
There should be a recognisable trend between the incidence of hypereosinophilia and the duration of tropical endomyocardial fibrosis (EMF), if the hypothesis, that EMF is the burnt out phase of eosinophil associated heart disease, is correct. We tested this hypothesis in a prospective study of 89 consecutive EMF cases over an 18 year period at two Nigerian locations (Ife in South West and Calabar in South East). We carefully dated the duration of EMF symptoms at first presentation and screened for hypereosinophilia (eosinophilia > or = 1500/mm3), and their causes. When no cause was identified for hypereosinophilia we gave a therapeutic trial with diethylcarbamazine to the patients. An eosinophil count > or = 1000/mm3 was recorded in 80% of 24 cases seen within 6 months; 55% of 46 cases seen 0-24 months; 54% of 18 cases seen 25-48 months and 21% of 25 cases seen more than 49 months of onset of symptoms: while the respective distribution of eosinophil count > or = 1500/mm3 for similar periods were 66, 44, 27 and 21%. This reflects a highly significant (P < 0.001) inverse relationship between hypereosinophilia and the duration of EMF and strengthens the concept that EMF (without eosinophilia) represents the late stage of eosinophilic heart disease. The localisation of endemic EMF to the low-lying tropical rain forest Zone and its predominant occurrence among rural dwellers and farmers suggest a vector borne etiologic agent. Microfilaria was the most likely cause of hypereosinophilia in the cases presented.
如果热带心内膜心肌纤维化（EMF）是嗜酸性粒细胞相关性心脏病的终末期这一假说是正确的，那么嗜酸性粒细胞增多症的发生率与热带心内膜心肌纤维化（EMF）的病程之间应该存在可识别的趋势。我们在尼日利亚两个地区（西南部的伊费和东南部的卡拉巴尔）进行了一项为期18年的前瞻性研究，对89例连续的EMF病例进行了测试。我们仔细确定了首次出现EMF症状的病程，并筛查了嗜酸性粒细胞增多症（嗜酸性粒细胞计数>或=1500/mm³）及其病因。当未发现嗜酸性粒细胞增多症的病因时，我们对患者进行了乙胺嗪治疗试验。在症状出现后6个月内就诊的24例病例中，80%的嗜酸性粒细胞计数>或=1000/mm³；在0 - 24个月就诊的46例病例中，55%；在25 - 48个月就诊的18例病例中，54%；在症状出现超过49个月就诊的25例病例中，21%：而在相似时间段内嗜酸性粒细胞计数>或=1500/mm³的相应分布分别为66%、44%、27%和21%。这反映了嗜酸性粒细胞增多症与EMF病程之间存在高度显著的（P < 0.001）负相关关系，并强化了EMF（无嗜酸性粒细胞增多症）代表嗜酸性粒细胞性心脏病晚期的概念。地方性EMF定位于低洼的热带雨林地区，且主要发生在农村居民和农民中，这提示存在一种媒介传播的病原体。在所呈现的病例中，微丝蚴是嗜酸性粒细胞增多症最可能的病因。
