儿童肾病综合征合并嗜酸性粒细胞增多的临床分析
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摘要
目的探讨儿童肾病综合征(NS)合并嗜酸性粒细胞增多的临床特点。方法回顾性分析合并嗜酸性粒细胞增多的18例次NS患儿(15例,其中3例于第2次复发时也有嗜酸性粒细胞增多)的临床表现、实验室检查和治疗转归。结果嗜酸性粒细胞轻度增多16例次(89%)、中度增多1例次(6%)、重度增多1例次(6%)。12例次(67%)的嗜酸性粒细胞增多发生在冬春季。9例次(50%)合并感染性疾病:4例肺炎(其中2例为支原体肺炎)、3例EB病毒感染、1例疑似蛲虫感染、1例链球菌感染;5例次(28%)合并过敏性疾病,其中2例表现为荨麻疹,2例表现为过敏性鼻炎,1例表现为湿疹。嗜酸性粒细胞计数与尿蛋白定量、血白蛋白、胆固醇水平均无明显相关性(P>0.05)。8例次初发NS患儿,激素治疗后尿蛋白4周内转阴;10例次复发NS患儿,9例次患儿调整激素治疗后尿蛋白亦转阴。1例次(嗜酸性粒细胞中度增多)合并过敏性鼻炎的NS患儿予以抗过敏等对症治疗后症状缓解、尿蛋白转阴,未恢复激素治疗,嗜酸性粒细胞计数降至轻度增多;余17例次患儿嗜酸性粒细胞均恢复正常。结论 NS合并嗜酸性粒细胞增多多发生于冬春季节,常合并感染或过敏性疾病,嗜酸性粒细胞计数与尿蛋白定量、血白蛋白、胆固醇水平均无明显相关性。
Objective To study the clinical features of nephrotic syndrome(NS) accompanied by eosinophilia in children. Methods A retrospective analysis was performed for the clinical manifestations, laboratory findings and treatment outcomes of 18 cases of eosinophilia(15 children, 3 of whom also had eosinophilia at the second recurrence) in children with NS. Results Of the 18 cases, 16(89%) had mild eosinophilia, 1(6%) had moderate eosinophilia, and 1(6%) had severe eosinophilia. Twelve cases(67%) developed eosinophilia in winter and spring. Nine cases(50%) had infectious diseases: pneumonia(including 2 cases of Mycoplasma pneumonia) in 4 cases, EB virus infection in 3 cases, suspected pinworm infection in 1 case, and Streptococcal infection in 1 case. Five cases(28%) had allergic diseases: urticaria in 2 cases, allergic rhinitis in 2 cases and eczema in 1 case. There was no significant correlation between eosinophil count and the levels of urinary protein, serum albumin and cholesterol(P>0.05). In 8 cases of newly diagnosed NS, urinary protein turned negative within 4 weeks after glucocorticoid treatment. In 10 cases of recurrent NS, urinary protein turned negative in 9 cases after the adjustment of glucocorticoid treatment. In 1 case of recurrent NS(moderate eosinophilia with allergic rhinitis), symptomatic relief and negative urinary protein were achieved after anti-allergic treatment. Glucocorticoid therapy was not administered again in the patient, and the eosinophil count was reduced to a slight increase. The eosinophil counts of the other 17 cases returned to normal. Conclusions NS with eosinophilia in children occurs mostly in winter and spring. This disorder is associated with infection or allergic diseases. There was no significant correlation between eosinophil count and the levels of urinary protein, serum albumin and cholesterol.
Objective To study the clinical features of nephrotic syndrome(NS) accompanied by eosinophilia in children. Methods A retrospective analysis was performed for the clinical manifestations, laboratory findings and treatment outcomes of 18 cases of eosinophilia(15 children, 3 of whom also had eosinophilia at the second recurrence) in children with NS. Results Of the 18 cases, 16(89%) had mild eosinophilia, 1(6%) had moderate eosinophilia, and 1(6%) had severe eosinophilia. Twelve cases(67%) developed eosinophilia in winter and spring. Nine cases(50%) had infectious diseases: pneumonia(including 2 cases of Mycoplasma pneumonia) in 4 cases, EB virus infection in 3 cases, suspected pinworm infection in 1 case, and Streptococcal infection in 1 case. Five cases(28%) had allergic diseases: urticaria in 2 cases, allergic rhinitis in 2 cases and eczema in 1 case. There was no significant correlation between eosinophil count and the levels of urinary protein, serum albumin and cholesterol(P>0.05). In 8 cases of newly diagnosed NS, urinary protein turned negative within 4 weeks after glucocorticoid treatment. In 10 cases of recurrent NS, urinary protein turned negative in 9 cases after the adjustment of glucocorticoid treatment. In 1 case of recurrent NS(moderate eosinophilia with allergic rhinitis), symptomatic relief and negative urinary protein were achieved after anti-allergic treatment. Glucocorticoid therapy was not administered again in the patient, and the eosinophil count was reduced to a slight increase. The eosinophil counts of the other 17 cases returned to normal. Conclusions NS with eosinophilia in children occurs mostly in winter and spring. This disorder is associated with infection or allergic diseases. There was no significant correlation between eosinophil count and the levels of urinary protein, serum albumin and cholesterol.
引文
[1]陈小红,徐益萍,卢美萍.88例嗜酸性粒细胞增多症住院患儿临床表现及病因分析[J].浙江大学学报(医学版),2016,45(3):292-296.
[2]中华医学会儿科学分会肾脏病学组.儿童激素敏感、复发/依赖肾病综合征诊治循证指南(2016)[J].中华儿科杂志,2017,55(10):729-734.
[3]Tefferi A.Blood eosinophilia:A new paradigm in disease classification,diagnosis,and treatment[J].Mayo Clin Proc,2005,80(1):75-83.
[4]Tefferi A,Patnaik MM,Pardanani A.Eosinophilia:Secondary,clonal and idiopathic[J].Br J Haematol,2006,133(5):468-492.
[5]彭新丽.9000例患儿肠道寄生虫卵检测结果分析[J].中国实验诊断学,2008,12(2):255.
[6]Klion AD,Mejia R,Cowen EW,et al.Chronic active EpsteinBarr virus infection:a novel cause of lymphocytic variant hypereosinophilic syndrome[J].Blood,2013,121(12):2364-2366.
[7]滕源,谢娟娟,谢国强,等.小儿急性支气管肺炎支原体抗体与嗜酸性粒细胞的关系[J].天津医药,2007,35(9):693-694.
[8]叶云,李莲.儿童外周血涂片白细胞检查的临床应用价值探讨[J].国际检验医学杂志,2013,34(17):2322-2323.
[9]Y?lmaz D,Yenigün A,S?nmez F,et al.Evaluation of children with steroid-sensitive nephrotic syndrome in terms of allergies[J].Ren Fail,2015,37(3):387-391.
[10]钟燕兰,党西强.儿童嗜酸性粒细胞增多症伴肾病综合征1例[J].中国当代儿科杂志,2011,13(10):850-851.
[11]Xu X,Fu J,Fang Y,et al.Kimura disease in children:A case report and a summary of the literature in Chinese[J].J Pediatr Hematol Oncol,2011,33(4):306-311.
[12]张闽,王兴东,李晓未,等.儿童Kimura病5例临床病理分析[J].中华实用儿科临床杂志,2013,28(24):1909-1911.
[13]李志娟,张小鸽,包瑛,等.儿童Kimura病合并肾病综合征临床、病理及预后分析[J].临床儿科杂志,2017,35(3):183-186.
[14]陈嘉林.对嗜酸细胞增多症的认识[J].中华全科医师杂志,2014,13(11):891-892.
[2]中华医学会儿科学分会肾脏病学组.儿童激素敏感、复发/依赖肾病综合征诊治循证指南(2016)[J].中华儿科杂志,2017,55(10):729-734.
[3]Tefferi A.Blood eosinophilia:A new paradigm in disease classification,diagnosis,and treatment[J].Mayo Clin Proc,2005,80(1):75-83.
[4]Tefferi A,Patnaik MM,Pardanani A.Eosinophilia:Secondary,clonal and idiopathic[J].Br J Haematol,2006,133(5):468-492.
[5]彭新丽.9000例患儿肠道寄生虫卵检测结果分析[J].中国实验诊断学,2008,12(2):255.
[6]Klion AD,Mejia R,Cowen EW,et al.Chronic active EpsteinBarr virus infection:a novel cause of lymphocytic variant hypereosinophilic syndrome[J].Blood,2013,121(12):2364-2366.
[7]滕源,谢娟娟,谢国强,等.小儿急性支气管肺炎支原体抗体与嗜酸性粒细胞的关系[J].天津医药,2007,35(9):693-694.
[8]叶云,李莲.儿童外周血涂片白细胞检查的临床应用价值探讨[J].国际检验医学杂志,2013,34(17):2322-2323.
[9]Y?lmaz D,Yenigün A,S?nmez F,et al.Evaluation of children with steroid-sensitive nephrotic syndrome in terms of allergies[J].Ren Fail,2015,37(3):387-391.
[10]钟燕兰,党西强.儿童嗜酸性粒细胞增多症伴肾病综合征1例[J].中国当代儿科杂志,2011,13(10):850-851.
[11]Xu X,Fu J,Fang Y,et al.Kimura disease in children:A case report and a summary of the literature in Chinese[J].J Pediatr Hematol Oncol,2011,33(4):306-311.
[12]张闽,王兴东,李晓未,等.儿童Kimura病5例临床病理分析[J].中华实用儿科临床杂志,2013,28(24):1909-1911.
[13]李志娟,张小鸽,包瑛,等.儿童Kimura病合并肾病综合征临床、病理及预后分析[J].临床儿科杂志,2017,35(3):183-186.
[14]陈嘉林.对嗜酸细胞增多症的认识[J].中华全科医师杂志,2014,13(11):891-892.