十二指肠结节性病变病理分型及诊断17例

Clinical and pathologic features of nodular duodenum:An analysis of 17 cases

目的:确定十二指肠结节性病变组织病理学特征及分型.方法:统计分析经内镜下被确诊为十二指肠结节性病变患者的资料.对其年龄、性别、类型、症状、最后诊断、相关疾病和组织病理学特点等记录进行回顾性研究.同时亦分析患者血红蛋白、平均细胞体积、血清铁蛋白、白蛋白、免疫球蛋白、腹腔自身抗体、贾第虫和粪便OVA寄生虫,ELISA分析贾第虫的特异性抗原水平.结果:筛选出17例经内镜确诊为十二指肠结节性病变的患者.诊断时平均年龄为28.1岁(17-56岁),男9例,女8例.十二指肠结节性病变中,腹痛(47%)是最常见的临床症状,胃窦结节(41%)是最常见的内镜表现.十二指肠结节性病变的组织病理学评估显示,所有患者均有慢性炎症,嗜酸性粒细胞在隐窝间和上皮内增殖占70.5%,47%的患者存在绒毛萎缩.通过组织学检查和/或特定的蓝氏贾第鞭毛虫粪便抗原阳性实验显示有6例患者感染贾第虫.患者的临床诊断显示某些特征,如腹泻、贾第虫病、分泌型IgA缺乏症和幽门螺杆菌(Helicobacter pylori,H.pylori)胃炎,并且他们中的一些与其他的有相关性.结论:十二指肠结节性病变其黏膜有明显淋巴细胞和/或嗜酸性粒细胞浸润,建议应对造成这一显著炎症反应的微生物学和免疫学病因进行进一步研究.

AIM：To investigate the incidence,clinical presentations,histopathological features,natural history,and response to therapy of nodular duodenum.METHODS：The clinical data for 17 patients with nodular duodenum were analyzed retrospectively,including age,sex,disease type,symptoms,final diagnosis,histopathology,hemoglobin,SF,AL,IG,and OVA.RESULTS：Of 17 patients with nodular duodenum,9 were male and 8 were female.Their mean age was 28.1 years.Approximately 47% of patients had stomachache.Sinus tubercle was most frequently seen endoscopically.Histology of duodenal nodules revealed chronic inflam-mation in all cases,intraepithelial eosinophilic granulocyte proliferation in 70.5%of cases,and villous atrophy in 47%of cases.Six patients had flagellate.Clinical diagnostic features included diarrhea,giardiasis,secretory IgA deficiency,and Helicobacter pylori-associated gastritis.CONCLUSION：Nodular duodenum is an endoscopically distinct entity that may respond clinically to antisecretory therapy but is difficult to eradicate.