儿童嗜酸性粒细胞性胃肠炎临床分析

Clinical analysis of eosinophilic gastroenteritis in children

目的探讨儿童嗜酸性粒细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床表现、实验室指标、影像学、内镜及组织病理学特点。方法选取中国医科大学附属盛京医院小儿消化内科病房2012年1月至2017年12月,确诊EG患儿共33例,记录患儿的临床表现、过敏史、实验室检查、内镜及病理特点以及治疗情况。结果EG临床表现主要为腹痛(75.8%)、呕吐(30.3%)和腹泻(21.2%)。7例(21.2%)存在外周血血红蛋白降低,13例(39.4%)嗜酸性粒细胞计数升高,18例(54.5%)总IgE增高,23例(69.7%)存在食物或呼吸特异性IgE阳性,7例(21.2%)大便隐血试验阳性。28例行全腹CT检查,其中盆腔积液13例,淋巴结增大12例,小肠肠壁增厚4例。33例均行内镜检查,主要组织改变为红斑渗出(93.9%),黏膜充血水肿(15.2%),出血(12.1%),黏膜病理改变主要表现为黏膜炎症,伴有大量嗜酸性粒细胞浸润(≥20/高倍视野)。33例患儿经饮食回避、抑酸、抗过敏、白三烯受体拮抗剂治疗后,17例缓解,其中1例复发,其余16例在上述治疗疗效不佳时,加用糖皮质激素后缓解,3例复发。结论儿童EG的临床表现多样且缺乏特异性,临床上血嗜酸性粒细胞计数及IgE水平升高、食物特异性IgE阳性可作为辅证,确诊仍需要黏膜病理嗜酸性粒细胞浸润≥20/高倍视野。治疗上,饮食回避、抑酸剂、抗过敏药、白三烯受体拮抗剂可使部分患儿有效缓解,疗效不佳者经糖皮质激素治疗后可取得满意疗效。

Objective To discuss the clinical manifestations, laboratory indexes, imageological examination results, endoscopic and histopathological features of eosinophilic gastroenteritis(EG) in children. MethodsThirty-three children with EG were collected with clinical manifestations, allergic history, laboratory examination, endoscopic and histopathological features and treatments, who were hospitalized at department of pediatric gastroenterology of Shengjing Hospital of China Medical University between January 2012 and December 2017. ResultsThe main clinical manifestations of EG were abdominal pain(75.8%), vomiting(30.3%)and diarrhea(21.2%). The hemoglobin level decreased in 7 cases(21.2%). The eosinophil count increased in 13 cases(39.4%). Total serum IgE elevated in 18 cases(54.5%), while 23 cases were positive in serum food or respiratory specific IgE.The fecal occult blood test showed positive in 7 cases(21.2%). Among 28 children conducted with whole abdominal CT, there were 13 cases of pelvis fluid, 12 cases of enlarged lymph nodes and 4 cases of thickened intestinal wall.All 33 children went through the endoscopic examination, the main histological change were erythema-exudation(31 cases, 93.9%), mucosal hyperemia edema(5 cases, 15.2%) and hemorrhage(4 cases, 12.1%). The main pathological change was mucosal inflammation with a large number of eosinophil infiltration(≥20 per HPF). Among the 33 cases, 17 cases relieved through treatment of avoiding allergen, antacids, anti-allergic agents and leukotriene receptor antagonist, with 1 case recurrence.The other 16 cases relieved after treatment of glucocorticoid and the above therapy, with 3 cases recurrence. ConclusionThe clinical manifestations of children with EG are various and lack of specificity.In terms of diagnosis, the elevated level of eosinophil count and total serum IgE, or positive in serum food specific IgE may be taken as reference.The definite diagnosis is based on pathological examination (eosinophil infiltration≥20 per HPF). For treatment, avoiding allergen, antacids, anti-allergic agents and leukotriene receptor antagonist are effective in several children.Glucocorticoid can obtain satisfactory curative effect in the uneffective children.