儿童肺嗜酸性粒细胞增多症的临床特征研究
Clinical characteristics of eosinophilic lung diseases in children
徐筱蕾 1殷菊 1刘军 1刘秀云 1胡英惠 1沈惠青 2王国丽 2张晶 2张蕊 3苏雁 3吴润晖 3徐保平1
作者信息
- 1. 国家儿童医学中心,国家呼吸系统疾病临床医学研究中心,首都医科大学附属北京儿童医院呼吸科,中国医学科学院儿童危重感染诊治创新单元,儿科重大疾病研究教育部重点实验室,北京 100045
- 2. 国家儿童医学中心,首都医科大学附属北京儿童医院消化科,北京 100045
- 3. 国家儿童医学中心,首都医科大学附属北京儿童医院血液科,北京 100045
- 折叠
摘要
目的 分析儿童肺嗜酸性粒细胞增多症(ELD)的临床特征,以提高儿科医师对ELD相关疾病的认识.方法 通过回顾性横断面研究,收集2007年4月1日至2022年3月31日首都医科大学附属北京儿童医院收治的符合ELD诊断标准的患儿149例,应用卡方检验、Fisher's精确概率法、Mann Whitney U检验以及Kruskal-Wallis检验进行数据分析,总结归纳临床特征;采用Spearman相关性分析分析外周血与支气管肺泡灌洗液嗜酸性粒细胞的相关性,采用卡方检验、Kappa—致性检验比较支气管肺泡灌洗液或肺活检与血嗜酸性粒细胞增高伴胸部影像学异常诊断结果的差异性和一致性.结果 1.儿童ELD中单纯肺部受累最常见病因为变应性支气管肺曲霉病(9例),合并其他系统受累的最常见病因为特发性嗜酸粒细胞增多综合征(89例).2.主要的呼吸系统表现为咳嗽(90例,60.4％)、咯痰(41例,27.5％),23.5％(35例)无呼吸系统症状;消化系统(50.3％)以及皮肤(40.9％)为常见合并受累器官.3.外周血与支气管肺泡灌洗液嗜酸性粒细胞相关系数r=0.3,P＜0.05;支气管肺泡灌洗液或肺活检与血嗜酸性粒细胞增高伴胸部影像学异常诊断结果卡方检验P＜0.05,一致性检验Kappa＜0.2.结论 儿童中ELD多种病因均可致病,变应性支气管肺曲霉病为单纯肺部受累最常见病因.其常见表现为咳嗽、咯痰.肺外常见的受累器官为消化系统和皮肤.外周血与支气管肺泡灌洗液嗜酸性粒细胞水平相关性较差.
Abstract
Objective To analyze the clinical characteristics of eosinophilic lung diseases(ELD)in children to enhance pediatricians'understanding of ELD.Methods In this retrospective cross-sectional study,a total of 149 children with ELD were recruited from Beijing Children's Hospital,Capital Medical University between April 1,2007 and March 31,2022.Chi-square test,Fisher's exact test,Mann-Whitney U test and Kruskal-Wallis test were used to analyze data and conclude clinical characteristics.Spearman correlation was used to analyze the correlation between eosinophils in peripheral blood and bronchoalveolar lavage fluid.Chi-square test and Kappa consistency test were used to compare the differences and consistency in diagnostic results between bronchoalveolar lavage fluid or lung biopsy and eosinophil elevation with chest imaging abnormalities.Results(1)The isolated lung involvement was mostly caused by allergic bronchopulmonary aspergillosis(9 patients),and other system involvement by idiopathic hypereosinophilic syndrome(89 patients).(2)The main respiratory manifestations included coughing(90 cases,60.4％)and expectoration(41 cases,27.5％),while 23.5％(35 cases)of patients had no respiratory symptoms;50.3％had digestive system involvement,and 40.9％had skin involvement.These were the two most commonly affected organs.(3)Spearman correlation was performed between eosinophils in peripheral blood and bronchoalveolar lavage fluid(r=0.3,P＜0.05).Chi-square test was performed to compare ELD diagnosed by bronchoalveolar lavage fluid or lung biopsy with peripheral blood eosinophilia accompanied by abnormal chest imaging(P＜0.05).Kappa consistency test(Kappa＜0.2)showed poor consistency between the two diagnostic methods.Conclusions ELD are present in children,and multiple etiologies may be pathogenic.Among children with ELD,the isolated lung involvement is mainly caused by allergic bronchopulmonary aspergillosis.The digestive system and skin are the most commonly affected organs,except for lungs.The correlation between eosinophil levels in peripheral blood and bronchoalveolar lavage fluid is poor.
关键词
肺嗜酸性粒细胞增多症/儿童/临床特征/诊断/治疗Key words
Eosinophilic lung diseases/Child/Clinical characteristics/Diagnosis/Treatment引用本文复制引用
基金项目
国家呼吸系统疾病临床医学研究中心呼吸专项(HXZX-202101)
出版年
2024
NETL
NSTL
万方数据