Clinical Analysis Of Eosinophilic Granulomatosis With Polyangiitis:A Restrospective Study

OBJECTIVE:To summarize the clinical features of eosinophilic granulomatosis with polyangiitis(EGPA),and to summarize the clinical diagnosis process.METHODS:We retrospectively analyzed the clinical features of 14 EGPA cases admitted to the first affiliated hospital of Guangxi medical university from January 2009 to Febrary 2015.RESULTS:Our study included 5 males and 9 females,median age was 45.5(29,69)years and median duration was 30(1,480)months.12 cases had respiratory symptoms:wheezing,cough,sputum,nasal congestion and runny nose.11 cases had fever,weigh loss,and fatigue.8 cases had nervous system symptom.7 cases had rashes.6 cases had tachycardia.4 cases had stomachache or diarrhea.3 cases had joint and muscle pain.6 cases had lymph node enlargement.2 cases had edema.All cases had elevated peripheral eosnophils value with a median of 2.32 ×109/L.13 cases had increased erythrocyte sedimentation rate.12 cases had increased C-reactive protein.6 cases had increased globulin and 14 cases had decreased albumin.3 cases had positive ANCA.4 cases in 8 had hypoxemia.Pulmonary function tests showed ventilatory dysfunction(mainly obstruction),positive diastolic test,while 5 cases in them had mild-moderate diffuse dysfunction.5 cases showed abnormalities in paranasal sinus CT.Computed tomography scan demonstrated GGO,consolidation,nodular and bronchial dilatation and/or bronchial wall thickening and so on.Eosnophils in bronchoalveolar lavage fluid could be elevated.Eosnophils infiltrations were found in all the 17 specimens,then necrotizing vasculitis were found in 8 specimens and granulomatosis were found in only 5 specimens.All 14 cases were treated with glucocorticoid,and half of cases were treated with combination of immunosuppressant,and they all got some improvement.Five cases with asthmatic symptom did not showed improvement.CONCLUSIONS:(1)EGPA involving lungs is the most common and earliest,which present as intistitial symptom of asthmatic,obstructive ventilatory dysfunction,diastolic test positive,finally accompanied by increased eosinophils,systemic inflammation and multiple organ damage.Chest CT findings showed diversity and demonstrated GGO,consolidation,nodular and bronchial dilatation and/or bronchial wall thickening and so on.The pathological features are increased infiltration,necrotizing vasculitis,and granuloma formation.The typical clinical disease process(asthma firstly,eosinophil infiltration,then vasculitis signs appear),good effect of systemic corticosteroids along or combining with immunosuppressant,and excluding other disease may have increased eosinophil,can lead to the diagnosis of EGPA.