李校荣, 王文娟, 李承新. 外周血嗜酸性粒细胞计数对嗜酸性粒细胞增多综合征与特应性皮炎的鉴别诊断及疗效评估研究[J]. 解放军医学院学报, 2024, 45(7): 753-757, 769. DOI: 10.12435/j.issn.2095-5227.2024.066
引用本文: 李校荣, 王文娟, 李承新. 外周血嗜酸性粒细胞计数对嗜酸性粒细胞增多综合征与特应性皮炎的鉴别诊断及疗效评估研究[J]. 解放军医学院学报, 2024, 45(7): 753-757, 769. DOI: 10.12435/j.issn.2095-5227.2024.066
LI Xiaorong, WANG Wenjuan, LI Chengxin. Peripheral blood eosinophil count in differentiate diagnosis and prognosis prediction between eosinophilia syndrome and atopic dermatitis[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2024, 45(7): 753-757, 769. DOI: 10.12435/j.issn.2095-5227.2024.066
Citation: LI Xiaorong, WANG Wenjuan, LI Chengxin. Peripheral blood eosinophil count in differentiate diagnosis and prognosis prediction between eosinophilia syndrome and atopic dermatitis[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2024, 45(7): 753-757, 769. DOI: 10.12435/j.issn.2095-5227.2024.066

外周血嗜酸性粒细胞计数对嗜酸性粒细胞增多综合征与特应性皮炎的鉴别诊断及疗效评估研究

Peripheral blood eosinophil count in differentiate diagnosis and prognosis prediction between eosinophilia syndrome and atopic dermatitis

  • 摘要:
    背景 嗜酸性粒细胞增多综合征(hypereosinophilia syndrome,HES)是一组以血液和(或)组织中嗜酸性粒细胞(eosinophil,EOS)异常增多为特征的疾病,临床表现多样,易漏诊或误诊为其他伴嗜酸性粒细胞增多的皮炎瘙痒性疾病,其中特别需与特应性皮炎(atopic dermatitis,AD)进行鉴别诊断。
    目的 评估外周血EOS计数在嗜酸性粒细胞增多综合征与特应性皮炎鉴别中的作用。
    方法 2015年1月—2022年12月解放军总医院第一医学中心皮肤科收治的诊断明确的HES和AD患者为样本,通过受试者工作特征曲线法计算曲线下面积并评估外周血EOS的鉴别诊断效能。2023年6—12月收治的诊断明确的HES患者和外周血EOS计数>0.5 × 109/L的AD患者为后续研究对象,比较二者非激素系统治疗2周内外周血EOS计数变化趋势。
    结果 HES组58例,男49例,女9例,中位年龄46(IQR:23 ~ 67)岁;AD组133例,男74例,女59例,中位年龄55(IQR:38 ~ 69)岁;HES组患者年龄更大、男性比例更高(P<0.05)。HES组中位白细胞计数M(IQR):10.78(8.97 ~ 13.75) × 109/L vs 6.61(5.44 ~ 8.55) × 109/L和中位外周血嗜酸性粒细胞计数M(IQR):3.29(1.77 ~ 5.15) × 109/L vs 0.60(0.35 ~ 1.05) × 109/L均高于AD组,差异有统计学意义(P<0.05)。HES鉴别AD诊断预测模型的ROC曲线结果提示:EOS鉴别诊断最佳阈值为1.52 × 109/L,敏感度为83.2%,特异度为91.8%。后续研究中10例HES患者,治疗前EOS均值(4.51 ± 1.22) × 109/L,给予2周非激素系统治疗,治疗后EOS均值(5.56 ± 1.31) × 109/L,无显著下降趋势。10例AD患者,经非激素系统治疗后第4 ~ 8天外周血EOS可降至正常水平(<0.5 × 109/L),下降程度平均值为(72.10% ± 17.12%)。
    结论 HES和AD患者外周血EOS计数分布范围不等,且大部分AD患者给予非激素系统治疗后短期内外周血EOS计数可显著下降,可为HES与AD初步鉴别诊断提供参考,迅速启动干预治疗,对HES在不可逆的器官损伤发生之前减少EOS浸润,进而降低器官损伤的风险。

     

    Abstract:
    Background Hypereosinophilia syndrome (HES) is a group of diseases characterized by abnormal increase of eosinophil in the blood and/or tissues, with heterogeneous clinical manifestations, which is easy to be missed or misdiagnosed as other eosinophilia-associated pruritic dermatitis, in which differential diagnosis with atopic dermatitis (AD) is required.
    Objective To evaluate the role of altered peripheral blood eosinophil counts in the differentiation of hypereosinophilia syndrome from AD.
    Methods Patients with definite diagnosis of HES and AD admitted to the Department of Dermatology of the First Medical Center of Chinese PLA General Hospital from January 2015 to December 2022 were used as the samples for constructing the diagnostic model. The area under the curve (AUC) was calculated and differential diagnostic efficacy was evaluated by the receiver operation characteristic (ROC) method. Patients with definite diagnosis of HES and AD patients with peripheral blood eosinophil counts >0.5 × 109/L admitted from June 2023 to December 2023 were used as the follow-up study subjects to compare the trends of 2-week peripheral blood eosinophil counts after 2-week non-hormonal systemic therapy in both patients.
    Results There were 58 cases in the HES group, including 49 males and 9 females, with median age of 55 (IQR: 23-67) years old; and 133 cases in the AD group, including 74 males and 59 females, with age of 55 (IQR: 38-69) years old. Patients in the HES group were older and had more males (P < 0.05). Furthermore, white blood cells counts M(IQR): 10.78 (8.97-13.75) × 109/L vs 6.61(5.44-8.55) × 109/L and peripheral blood eosinophil counts M(IQR): 3.29 (1.77-5.15 ) × 109/L vs 0.6(0.35-1.05) × 109/L in the HES group were significantly higher than those in the AD group (P < 0.05). AUC of EOS to differentially diagnose HES and AD was 0.944 (95% CI: 0.910-0.977), with the optimal threshold was 1.52 × 109/L, sensitivity of 83.2% and specificity of 91.8%. In the follow-up study, the mean value of 10 HES patients EOS was (4.51 ± 1.22) × 109/L before treatment, and after 2 weeks of non-hormonal systemic treatment, the mean value of EOS was (5.56 ± 1.31) × 109/L, without significant decreasing trend. After non-hormonal systemic treatment, the 10 AD patients EOS decreased to normal level (<0.5 × 109/L) on about the 4th-8th day, and the degree of decline was (72.10 ± 17.12)%.
    Conclusion HES and AD eosinophilic distribution range is not equal, and the majority of patients with AD receive a nonhormonal systemic treatment in a short period of time, the peripheral blood eosinophilic counts decrease significantly, which can be used as a reference for the preliminary differential diagnosis of HES and AD. The intervention therapy can be initiated rapidly to reduce eosinophil infiltration in HES before irreversible organ damage occurs, thereby reducing the risk of organ damage.

     

/

返回文章
返回