嗜酸性胃肠炎临床分析

Clinical study of eosinophilic gastroenteritis

目的探讨嗜酸性胃肠炎（EG）的临床表现、诊断及治疗方法。方法对北京宣武中医医院44例EG患者的临床表现、实验室检查、内镜表现、治疗情况进行回顾分析。结果37例EG患者以腹痛为首发症状。EG患者内镜下胃肠黏膜以充血水肿、糜烂及黏膜增厚为主，活检可见大量嗜酸粒细胞浸润（〉20个／高倍视野）。激素治疗效果好、作用迅速，但相比之下，根据患者不同的症型，采用口服中药及灌肠治疗，其中中药组22例患者，用药后临床症状缓解的有20例，治疗过程中症状反复4例，总治愈16例；相比之下激素组的18例患者临床症状缓解17例，治疗过程中症状复发的6例，治愈12例。在临床症状缓解率、复发率及治愈率方面两组比较差异均无统计学意义（均P〉0．05），但更易被患者接受。结论EG临床少见，临床和内镜表现无特异性，外周血、腹水、胃肠黏膜组织中嗜酸粒细胞增高是诊断的关键，激素治疗作用迅速、效果好，但中医具有更好的治疗前景。

Objective To study the clinical symptoms, diagnosis and treatment of eosinophilic gastroenteritis （EG）. Methods A total of 44 cases of EG admitted to our hospital were studied respectively in clinical manifestations, laboratory examinations, endoscopic signs and treatment. Results （1） The presenting symptoms of EG patients was abdominal pain. （2） The endoscopic signs of EG were mucosal pathological changes of hyperemia, erosion and hyperplasia. A certain number of eosinophilic granulocytes were detected in pathological examination. （3）The hormones were effective and had quick onsets. While, based on different clinical symptoms, the traditional medicine was dosed by oral administration and intestinal enema. In TCM group （n = 22） , 20 patients had a relief of clinical symptoms, 4 cases of recurrence and 16 of cure. In comparison, in hormone group （n = 18）, 17 patients had a relief of clinical symptoms, 6 cases of recurrence and 12 of cure. The results showed that two groups had no statistical difference in relief of clinical symptoms, recurrence and hormonal cure （ all P 〉 0.05 ）. But it will be more readily accepted. Conclusions The incidence of EG is low in clinical practice because of its non-specific clinical and endoscopic manifestations. An elevated count of eosinophilic graunlocytes in peripheral blood, ascitic fluid and tissues of mucous membrane are key diagnostic points. The hormonal treatment is both fast and effective. But traditional medicine will have a brighter clinical prospect.