嗜酸细胞性胃肠炎临床分析

Clinical Analysis of Eosinophilic Gastroenteritis

背景:嗜酸细胞性胃肠炎(EG)是一种少见的良性消化道疾病,临床表现无特异性,误诊率较高。目的:通过对EG的一般情况、发病诱因、临床表现、辅助检查、诊断分型、误诊情况以及治疗和预后进行分析,以提高对该病的认识,避免误诊误治,减少患者痛苦。方法:对中国人民解放军总医院消化疾病中心的4例EG以及以"嗜酸细胞,胃肠炎"为关键词在中国医院知识仓库医学专题全文数据库(CHKD)中检索得到的1997～2007年发表的文献中169例EG的临床特点进行分析。结果:本组资料显示,44.5%的EG与过敏有关,常见临床表现为腹痛(94.2%)、腹泻(60.7%)、恶心(56.1%)、呕吐(51.5%)、腹胀(38.2%)、腹水(28.3%)。嗜酸性粒细胞(EOS)升高在外周血、骨髓和腹水中的阳性率分别为74.0%、98.2%和90.3%。胃镜和结肠镜黏膜活检发现EOS浸润胃黏膜和肠黏膜分别占88.2%和64.6%。诊断以黏膜型EG最为多见(65.3%),误诊率为40.5%。77.5%的EG患者接受糖皮质激素治疗,疗效良好。结论:EG是一种易误诊的少见病,临床表现无特异性,确诊应从提高对该病的认识、适时行血常规、骨髓和腹水EOS检查、胃肠道黏膜活检病理检查等方面入手。糖皮质激素治疗EG有效,预后良好。

Background： Eosinophilic gastroenteritis （EG） is a rare, benign gastrointestinal disorder. As its clinical manifestation is unspecific, the misdiagnosis rate is high. Ainm： To analyze the general health status, inducing factors, clinical manifestations, auxiliary examinations, diagnosis, causes of misdiagnosis, treatment and prognosis of EG for improving the recognition of this disease, avoiding misdiagnosis and mistreatment and relieving patients＇ distress. Methods： Four cases of EG hospitalized in Digestive Disease Center, China PLA General Hospital were analyzed together with literature review of 169 cases retrieved from China Hospital Knowledge Database （CHKD） using eosinophils, gastroenteritis as key words from 1997 to 2007. Results： About 44.5% of the EG patients were associated with allergy. The common clinical presentations were abdominal pain （94.2%）, diarrhea （60.7%）, nausea （56.1%）, vomiting （51.5%）, abdominal distension （38.2%） and ascites （28.3%）. The rates of eosinophils （EOS） in peripheral blood, bone marrow and peritoneal fluid were elevated in 74.0%, 98.2% and 90.3%, respectively. Eosinophilic infiltration was detected in 88.2% and 64.6% of gastric and intestinal mucosa, respectively. Mucosal type was the most commonly seen type of EG （65.3%）. The misdiagnosis rate was 40.5%. Glucocorticoids was administrated in 77.5% of the patients with good effects. Conclusions： EG is a rare disease with non-specific manifestations and is misdiagnosed frequently. Recognition of this disease as well as taking complete blood count, counting EOS in bone marrow and ascitic fluid, and histopathologic examination of gastrointestinal mucosa are important for the diagnosis of EG. Glucocorticoids is effective for EG and its prognosis is good.