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  济宁医学院学报  2017, Vol. 40 Issue (6): 411-413  DOI:10.3969/j.issn.1000-9760.2017.06.006
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张永超, 孔令斌. 嗜酸性粒细胞性胃肠炎30例诊治分析[J]. 济宁医学院学报, 2017, 40(6): 411-413. DOI: 10.3969/j.issn.1000-9760.2017.06.006.
[复制中文]
ZHANG Yongchao, KONG Lingbin. Diagnosis and treatment of eosinophilic gastroenteritis: An analysis of 30 cases[J]. Journal Of Jining Medical University, 2017, 40(6): 411-413. DOI: 10.3969/j.issn.1000-9760.2017.06.006.
[复制英文]

作者简介

张永超, 济宁医学院2016级研究生

通信作者

孔令斌, E-mail:klb3904@163.com;

文章历史

收稿日期:2017-09-20
嗜酸性粒细胞性胃肠炎30例诊治分析
张永超, 孔令斌    
济宁医学院; 济宁医学院临床医学院, 济宁 272067
摘要: 目的 分析嗜酸性粒细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床特点、诊治经过,以提高对EG的诊治效果。方法 回顾性分析2008年1月至2017年3月于济宁医学院附属医院首次确诊为EG的30例住院患者,总结分析其病史、临床症状及体征、实验室检查、影像学检查、病理诊断的特点,评估其治疗结果和预后。结果 30例患者中10例(33.3%)有明确诱因或过敏史者,28例(93.3%)患者具有腹痛,30例均有不同程度的嗜酸性粒细胞增高,10例(33.3%)D-二聚体升高,7例(23.3%)大便肠道菌群失调。30例EG全腹部增强发现,12例(40%)发现腹膜后多发淋巴结肿大,消化道壁略增厚;10例(33.3%)患者有腹腔、盆腔积液;1例(3%)患者有肠梗阻。所有EG患者内镜下均无特异性表现。所有EG患者糖皮质激素初次治疗有效,其中13.3%的患者复发,复发后再次使用糖皮质激素仍然有效。结论 EG的临床表现复杂多样,特异性不强。诊断时,除仔细询问病史外,要高度重视内镜下诊断及活检;治疗上,一旦确诊,及时规范使用激素。
关键词: 嗜酸性粒细胞性胃肠炎    诊断    治疗    
Diagnosis and treatment of eosinophilic gastroenteritis: An analysis of 30 cases
ZHANG Yongchao, KONG Lingbin    
Jining Medical University; School of Clinical Medicine, Jining Medical University, Jining 272067, China
Abstract: Objective The clinical characteristics, diagnosis and treatment of eosinophilic gastroenteritis (eosinophilic gastroenteritis, EG) were analyzed in order to improve the therapeutic effect on the diagnosis and treatment of EG. Methods A retrospective analysis of 30 hospitalized patients who first diagnosed as EG were selected in the Affiliated Hospital of Jining Medical University from January 2008 to March 2017, and summarized the characteristics of their history, clinical symptoms and body disease, laboratory examination, imaging examination and pathological diagnosis, and evaluated the treatment outcome and prognosis. Results Among 30 patients, 10 cases (33.3%) had clear inducements or allergies; 28 cases (93.3%) had abdominal pain; 30 cases had increased eosinophils in different degrees; 10 cases (33.3%) had D-two aggregates; and 7 cases (23.3%) had bowel dysentery.30 cases of EG total abdominal enhancement found that 12 cases (40%) found multiple retroperitoneal lymph nodes, slightly thickened the digestive tract wall; 10 cases (33.3%) had abdominal cavity and pelvic effusion; 1 cases (3%) had intestinal obstruction.All EG patients had no specific findings under endoscopy.The first treatment of glucocorticoids in all EG patients was effective, of which 13.3% of the patients relapsed and reused corticosteroids were still effective after recurrence. Conclusion The clinical manifestations of EG are complex and varied, and the specificity is not strong.In the diagnosis, in addition to the careful inquiry of the medical history, we should pay high attention to the diagnosis and biopsy of the endoscopy.In the treatment, once the diagnosis is confirmed, the hormone is used in time.
Key words: Eosinophilic gastroenteritis    Diagnosis    Treatment    

嗜酸性粒细胞性胃肠炎(eosinophilic gastroenteritis, EG)是一种以嗜酸性粒细胞浸润胃肠道为特征的疾病,临床上极其少见。近年来,由于环境的不断恶化,该病呈逐年增加的趋势,其原因可能与过敏原接触胃肠组织后发生抗原抗体反应后胃肠壁释放组胺类血管活性物质有关[1],但其确切病因和发病机制尚不明确。临床表现复杂多样,极易误诊误治,为了提高其诊治水平,本文对我院既往诊治的30例患者的诊治过程进行了分析总结,现报告如下。

1 资料与方法 1.1 临床资料

选取2008年1月至2017年3月我院首次确诊的新发EG住院患者30例,其中男20例,女10例;年龄19~74岁,平均年龄(40.8±13.9)岁;病程2d~6a。所有患者均符合Talley诊断标准[2]

1.2 方法

回顾性分析30例EG患者的一般情况、临床症状和体征、实验室检查、影像学检查、内镜诊断、病理活检、治疗方法及预后等。

2 结果 2.1 病史分析

结果显示10例(33.3%)发病前有明确诱因或过敏史者,其中7例对鱼虾、蛋奶等食物过敏,哮喘病史1例,皮肤过敏史1例,头孢过敏史1例。

2.2 临床症状及体症

28例(93.3%)患者具有腹痛,其余依次为恶心、呕吐、食欲下降,消化道梗阻,大便次数增多,体重减轻,腹胀,腹水,发热,呕吐和脓血便见表 1

表 1 30例不同类型EG患者的主要临床表现(n)
表 2 EG患者胃及结肠镜检查病变部位及E浸润情况(n)
2.3 实验室检查

本文30例EG患者均有不同程度的嗜酸性粒细胞增高,其中有8例(26.7%)白细胞计数升高,8例(26.7%)C反映蛋白升高,10例(33.3%)D-二聚体升高,7例(23.3%)大便肠道菌群失调。10例腹水患者CA125均不同程度增高,李凡他试验阳性,腹水浑浊,腹腔积液脱落细胞学见大量E。6例(20%)骨髓穿刺骨髓三系增生良好,仅嗜酸性粒细胞比例增高。

2.4 影像学检查

对30例EG患者行全腹增强CT检查,结果发现12例(40%)患者有腹膜后多发淋巴结,消化道壁略增厚,10例(33.3%)患者有腹腔、盆腔积液,1例(3%)患者有肠梗阻,7例未见明显变化。

2.5 病理诊断

EG患者均进行了胃镜检查,镜下可见黏膜皱襞粗大、充血、水肿、溃疡或结节,病变多在胃窦,表现无特异性,但胃窦活检均可见大量E浸润。结肠镜检查发现多数EG患者末端回肠及回盲部可见粘膜充血水肿,镜下多点活检可见病变部位大量E浸润。所有胃镜检查EG患者均行快速尿素酶实验,发现Hp感染阳性4例(13.3%)。

2.6 治疗及预后

30例EG患者在确诊之后均及时脱离过敏源,每天口服糖皮质激素20~40mg加用质子泵抑制剂(PPI)抑制胃酸、胃粘膜保护剂治疗1~2周。结果发现,3例患者于服用激素次日不适症状有所缓解;27例患者用药后1~2周腹部疼痛显著缓解,腹泻减轻或消失,其中2例大量腹水患者给予以上常规治疗和激素同时放腹水1次,7~10d后腹水完全消失,1例肌型患者病理示大量嗜酸性粒细胞性浸润,手术治疗后给予糖皮质激素治疗,患者病情好转;4例患者激素治疗不能完全消除症状,加用硫唑嘌呤(每日50~100mg) 1-2周,症状明显改善,外周血嗜酸性粒细胞降至正常水平。30例患者,随访1年后发现4例复发,再次应用糖皮质激素治疗仍有效。

3 讨论

EG是一种极少见的疾病,1937年首次由Kaijiser报告了3例EG病人。近期美国报道,其患病率估计为28/100000[3],较以往有所增多,认为可能与当前的地区、环境、饮食变化、压力增大有关[4-5]。典型的EG以胃肠道的嗜酸粒细胞浸润、胃肠道黏膜水肿增厚为特点;本病缺乏临床特异性表现,症状与病变的部位和浸润程度有关[6],EG是一种自限性变态反应性疾病,虽可多次反复发作,但预后良好;目前其诊断主要依据临床表现、血象、放射学和内镜及病理检查结果。

本文结果显示,30例EG患者多数有明显的诱因或过敏源,大多数有腹痛、腹胀、恶心、大便习惯改变,且均有不同程度的嗜酸性粒细胞增高,与相关文献报道的EG患者中约80%的患者伴有外周血嗜酸性粒细胞性的升高一致[7]。该研究还发现,EG患者消化道内镜下多点(正常与异常部位)活检多有明确的病变,且有部分HP感染,与国外研究结果一致[8-10]。提示我们在临床诊治中,要注意搜集病史,特别是过敏史,注重消化道症状和体征,强调血常规中嗜酸性粒细胞的检测、常规行消化内镜检查并行多点多部位活检,对有腹水患者,及时行腹水及骨髓穿刺检查,如发现大量嗜酸性粒细胞浸润多可明确诊断该病。目前有关EG的治疗,本文进一步证实,及时脱离过敏源,对症处理,早期规范使用糖皮质激素为其治疗的关键。

参考文献
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