일개 대학병원 환자에서 과다호산구증가증의 빈도 및 원인 분석
Incidence and Causes of Hyperosinophilia in the Patients of a University Hospital
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배경 : 호산구증가증은 다양한 원발성 또는 이차적 원인으로 발생하는 것으로 알려져있다. 최근 악성종양이나 만성퇴행성질 환 등의 유병률 변화에 따라 호산구증가증의 빈도 및 원인의 변 화가 예상된다. 본 연구는 호산구증가증의 빈도 및 원인을 후향적으로 분석하고, 각 원인 질환별로 호산구증가증의 정도를 비 교하였다. 대상 및 방법 : 호산구증가증은 말초혈액 호산구 수가 500/μL 이상인 경우로 정의하였고, 이 중에서 특히 호산구 수가 1,500/ μL 이상인 경우를 과다호산구증가증으로 정의하고 원인을 분석 하였다. 클론성 호산구증가증의 확진을 위해 FISH, RT-PCR 및 직접엽기서열분석을 실시하였다. 결과 : 전체 41,137명 중 호산구증가증을 보인 환자는 5,019 명(12.2%)이었고, 과다호산구증가증환자는 373명으로 전체 환 자의 0.9%였다. 이 중 원인을 추정하거나 확인할 수 있었던 경 우는 227예(60.9%)였다. 과다호산구증가증의 주요 원인은 악성 종양 80예(35.2%), 알레르기 및 피부질환 41예(18.1%), 감염증 35예(15.4%), 간담췌질환 17예(7.5%), 골수의 클론성질환과 기 생충감염이 각각 15예(6.6%) 순이었다. 또한, 다발성골수종 환 자에서 병발한 FIP1L1/PDGFRα유전자재배열을 갖는 만성호 산구백혈병 1예를 관찰하였다. 결론 : 과다호산구증가증의 원인이 기존의 국내 보고와 차이 가 있었고, 악성종양이 주요한 원인임을 알 수 있었다. 한편, 다 발성골수종과 함께 병발한 분자유전학적검사로 확진된 만성호 산구백혈병을 보고하는 바이다.
Abstract
Background : Eosinophilia may be associated with various primary and reactive conditions. The incidence and the causes of eosinophilia might have been changed according to the changes in the incidence of diseases such as cancer, chronic degenerative diseases, etc. We have conducted a retrospective study to investigate the incidence and causes of eosinophilia. Methods : Eosinophilia and hypereosinophilia were defined when absolute eosinophil count was greater than 500/μL and 1,500/μL, respectively. Patient’s clinical records were reviewed to find out the underlying clinical conditions responsible for causes of hypereosinophilia. Conventional chromosomal analysis, reverse transcriptase PCR and FISH for gene rearrangement were performed to check the presence of clonal eosinophilia. Results : Out of 41,137 patients who had a hematology profile performed, 5,019 (12.2%) and 373 patients (0.9%) were found to have eosinophilia and hypereosinophilia, respectively. Among patients with hypereosinophilia, 227 patients (60.9%) had identifiable and/or possible causes. The major causes of hypereosinophilia were malignancy (35.2%), allergy and skin diseases (18.1%), infectious diseases (15.4%), hepatobiliary diseases (7.5%), bone marrow clonal diseases (6.6%) and parasite infections (6.6%). We also found a rare case of FIP1L1-PDGFRαpositive chronic eosinophilic leukemia combined with light chain multiple myeloma. Conclusions : We found a difference in the distribution of causes of hypereosinophilia in comparison with previous Korean studies, and the most common cause of hypereosinophilia in the current study was malignancy. A rare case of clonal eosinophilia (chronic eosinophilic leukemia) associated with multiple myeloma was confirmed using molecular studies.
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