嗜酸细胞性胃肠炎的诊断和治疗

Eosinophilic gastroenteritis: a clinicopathological study

目的探讨嗜酸细胞性胃肠炎(EG)的诊断要点和治疗预后。方法对7例EG患者的临床特点、实验室检查、内镜表现和治疗随诊情况进行分析。结果(1)粘膜型EG患者常以腹痛和腹泻为首发症状,而浆膜型以腹痛和腹胀为首发症状,可伴恶心呕吐、低热等。(2)外周血和骨髓中嗜酸细胞计数明显增高(45.0%±22.4%和35.5%±2.6%),以成熟型为主,并随症状的有无而增减。(3)血沉、C反应蛋白、纤维蛋白原等指标正常,IgG可下降。(4)腹水为渗出液,可见嗜酸细胞。(5)内镜表现多为粘膜片状糜烂和水肿,以胃窦和回盲部明显,活检可证实大量嗜酸细胞浸润。(6)激素可在1周内迅速缓解症状,并使嗜酸细胞恢复正常。(7)病情可有反复,但预后良好。结论EG临床和内镜表现无特异性,外周血嗜酸细胞、腹水嗜酸细胞,尤其是胃肠粘膜组织中嗜酸细胞增多是诊断的关键。

Objective To evaluate the clincopathological presentation of eosinophilic gastroenteritis(EG). Methods Seven patients with EG were studied. their clinical manifestation, laboratory tests, endoscopy, treatment and prognosis were analyzed from the hospital records. Results (1) The patients of predominant mucosal type were presented with abdominal pain and diarrhea, and those of serosal type with abdominal pain and bloating.Some accompanied with nausea, vomiting and low fever.(2) Peripheral and bone marrow eosinophilia were presented in all seven patients. Eosinophil counts waxed and waned with symptoms and dramatically responsed to steroid therapy.(3) ESR, C-reactive protein and fibrinogen were in normal range, and the level of IgG was decreased.(4) The ascites were exudative with eosinophilia.(5) Some patchy lesions such as erosion and edema in antrum, duodenum and cecum were presented in endoscopy.Biopsy showed predominant eosinophil infiltration in mucosa.(6) It responsed to steroid therapy, and all symptoms and eosinophilia would be relieved within one week.(7) Symptoms may relapse but with good prognosis.Conclusion Eosinophilic gastroenteritis should be considered in the differential diagnosis of unexplained gastrointestinal symptoms especially in the presence of peripheral eosinophilia. Mucosal biopsy would be helpful to establish the diagnosis.