肺结节病外周血嗜酸性粒细胞增多意义的临床观察

doi:10.3969/j.issn.1006-7795.2020.03.028

摘要/Abstract

摘要： 目的探讨肺结节病患者外周血嗜酸性粒细胞增多的临床意义。方法选择2004年1月至2018年1月于首都医科大学附属北京同仁医院首次就诊的肺结节病患者为研究对象，其中外周血嗜酸性粒细胞增多（peripheral blood eosinophilia，PBE）者为PBE组，非嗜酸性粒细胞增多者为非PBE组。PBE组21例，非PBE组24例。对比分析两组患者的一般资料、临床表现、肺外脏器受累情况、实验室检查结果、肺功能、支气管肺泡灌洗液（bronchoalveolar lavage fluid，BALF）细胞计数分类、胸部影像学特征，并对治疗方案及疾病转归进行随访。结果 PBE组中存在肺部结节影、团块及实变影的患者比例高于非PBE组（80.95% vs 50%，57.14% vs 25.00%；P<0.05）。PBE组与非PBE组分别有14例及17例患者应用系统性糖皮质激素治疗，激素治疗1周后复查，两组患者外周血嗜酸性粒细胞均较治疗前显著减少（P<0.05）。PBE组与非PBE组分别有16例、23例患者完成随访，随访中位时间分别为23.5和21个月。与非PBE组相比，PBE组患者疾病更易复发（31.25% vs 4.35%，P<0.05）。PBE组复发患者外周血嗜酸性粒细胞数较激素治疗1周后显著增多（P<0.05）。结论肺结节病外周血嗜酸性粒细胞增多与肺部病变活动相关，该类患者疾病复发率高，需密切随访、监测病情变化。

关键词: 结节病, 嗜酸性粒细胞, 放射学, 治疗, 预后

Abstract: Objective To investigate the clinical significance of peripheral blood eosinophilia in patients with pulmonary sarcoidosis. Methods The clinical data of patients with treatment-naïve pulmonary sarcoidosis admitted to Beijing Tongren Hospital from January 2004 to January 2018 were selected as study subjects. According to the percentage and number of eosinophils in peripheral blood, the patients were divided into two groups:peripheral blood eosinophilia group (PBE group) and non-peripheral blood eosinophilia group (non-PBE group). There were 21 cases in PBE group and 24 cases in non-PBE group. The general data were compared and analyzed, which include clinical manifestations, extrapulmonary involved organs, laboratory results, lung function, bronchoalveolar lavage fluid(BALF) cell count classification, chest imaging features of the two groups. The therapeutic regimen and prognosis of the disease were followed up. Results The percentage of patients with nodular pattern and patchy consolidation in PBE group was higher than that in non-PBE group (80.95% vs 50%, 57.14% vs 25.0%; P<0.05). There were 14 patients in PBE group and 17 patients in non-PBE group were treated with systemic glucocorticoid,respectively. After one week of glucocorticoid treatment, the value of eosinophils in peripheral blood of the two groups was significantly lower than that before treatment (P<0.05). 16 patients in PBE group and 23 patients in non-PBE group completed follow-up,with a median follow-up time was 23.5 months and 21 months, respectively. Compared with non-PBE group, PBE patients were more prone to relapse (31.25% vs 4.35%, P<0.05). The peripheral blood eosinophil levels in the recurrent patients were significantly higher than that after one week of glucocorticoid treatment in PBE group. Conclusion Pulmonary active lesions of sarcoidosis are more common in patients with peripheral blood eosinophilia,as well as the recurrence rate of the disease is higher. It is necessary to closely monitor the condition of this kind of patients during therapy and follow-up.

Key words: sarcoidosis, eosinophils, radiology, therapy, prognosis

中图分类号:

R563

盛海燕, 刘晓芳, 金建敏, 胥杰, 刘涌. 肺结节病外周血嗜酸性粒细胞增多意义的临床观察[J]. 首都医科大学学报, 2020, 41(3): 475-481.

Sheng Haiyan, Liu Xiaofang, Jin Jianmin, Xu Jie, Liu Yong. Clinical observation of the significance of peripheral blood eosinophilia in pulmonary sarcoidosis[J]. Journal of Capital Medical University, 2020, 41(3): 475-481.

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