嗜酸细胞性胃肠炎11例

Eosinophilic Gastroenteritis in 11 Children

目的分析小儿嗜酸细胞性胃肠炎(EG)的临床特点、诊断要点、治疗预后和误诊原因。方法本院2006-2008年收治EG患儿11例,对其病史、临床特点、实验室检查、内镜表现和治疗、随访情况进行回顾性分析,应用SPSS10.0软件进行统计学分析。结果1.EG患儿的临床表现多样,包括腹痛(5例)、腹泻(7例)、便血(5例)、低热(2例)等。2.EG患儿中54.55%的过敏体质与EG发病密切相关。3.所有患儿中,18.18%外周血中嗜酸性粒细胞(EOS)计数增高明显,可随症状缓解而下降。4.患儿内镜表现均无明显特异性,可见到黏膜片状糜烂、浅溃疡、散在充血斑或出血点,以胃窦、十二指肠、回肠末端、回盲部最明显,活检可见大量EOS浸润。5.影像学检查无特异性,10例(90.91%)黏膜型CT或消化道钡餐检查无特殊发现,1例(9.09%)肌型肠壁肌层受累时见不全梗阻。6.激素为治疗EG的一线药物,可迅速缓解症状,并使EOS恢复正常。7.本病是一种自限性变应性疾病,虽可反复发作,但长期随访未见恶变,多数预后良好。结论EG的临床表现和内镜表现均无特异性,胃肠黏膜组织中EOS增多是诊断的关键。本病极易造成误诊,明确诊断需依靠活组织病理检查,并结合临床特点来证实。

Objective To investigate clinical feature, diagnosis and prognosis of eosinophilic gastroenteritis （ EG ）, and to analyze the causes of misdiagnosis. Methods Eleven children diagnosed as EG were studied. Their history, clinical manifestations, laboratory tests and endoscopies and treatment, follow - up data were analyzed. The data were analyzed by SPSS 10.0 software. Results 1. The children with EG usually had abdominal pain（5 cases） ,diarrhea（7 cases） ,hemafecia（5 cases） and sometimes with fever（2 cases）. 2. EG and allergy in children was closely related with disease （54.55%）. 3. Peripheral blood eosinophil （EOS） count increased significantly, and declined when symptoms eased（ 18. 18% ）. 4. Endoscopic manifestations were not specific, the mucosa could see sheet erosion, shallow ulcers, congestive spots or bleeding spots, mainly in antrum, duodenum, terminal ileum,ileocecal junction. The biopsy showed that a large number of EOS infiltration. 5. Imaging were not specific, CT or gastrointestinal barium meal examination did not show special often（90.91% ）. When muscular wall was affected（9.09% ） ,imaging presentations of EG could be partly obstructive. 6. Glucocorticoid therapy could relieve symptoms and EOS. Symptoms probably recured by good prognosis. 7. EG was a self - limiting allergic diseases, although the attack may be repeated. After long - term hallow - up, most had good prognosis and without malignant. Conclusions Clinical and endoscopic presentations of EG are not specific, therefore the presence of EOS in gastrointestinal mucosa strongly indicate the diagnosis. It was easy to misdiagnosis. Biopsy pathology and clinical characteristics are the key to diagnosis.