嗜酸细胞性胃肠炎的临床诊治

Clinical diagnosis and therapy of the enosinophilic gastroenteritis

目的探讨嗜酸细胞性胃肠炎(enosinophilic gastroenteritis,EG)的临床特点和诊断治疗。方法对40例EG患者的临床特点、诊断和治疗情况进行分析。结果 1黏膜型27例,肌型5例,浆膜型8例。2黏膜型EG患者常以腹痛、腹泻和体质量减轻为主要症状,肌型以肠梗阻表现为主,浆膜型以腹水为首发症状。3外周血中嗜酸细胞计数明显增高,三型分别为4949.6±2075.0(27/27),2659.2±1344.0(4/5)和5876.0±1515.9(6/8),各型间差异无统计学意义(P>0.05)。4内镜下活检阴性者,胃窦10例次(10/22),十二指肠7例次(7/30),结直肠7例次(7/16),反复做胃肠镜检查确诊者3例。5治疗以激素为主,可迅速缓解症状,但病情可有反复。结论诊断时尽可能内镜多次、多灶取活检,以提高诊断率,治疗仍以激素为主,长期小剂量激素治疗是预防病情复发值得推荐的治疗方案。

Objective To study clinical characteristics of the patients with enosinophilic gastroenteritis （EG）. Methods Forty cases of EG were studied in clinical characteristics, diagnosis and therapy. Results ① Patients were divided into three groups according to the Klein classification： predominant mucosal （27 cases） , muscular （5 cases） , subserosal disease （8 cases）. ② EG patients had a various clinical spectrumm. The mucosal layer disease presented with epigastric pain, diarrhea and weight loss, the serosal layer disease with ascites, the muscular layer disease with bowel obstruction. ③ Enosinophilic counts in peripheral blood was higher than normal： 4949.6 ＋ 2075.0 （27/27） , 2659.2 ＋ 1344.0 （4/5） and 5876.0 ＋ 1515.9 （6/8） in three types, and there was no difference among three groups. ④ Mueosa biopsies failed in sinus ventrieuli for 10/22 times, duodenum 7/30, large intestinal 7/16, 3 patients were definited after endoscopy repeatedly. ⑤ Glucocortieoid was the main therapy, symptom was remission, hut always re- lapse. Conclusion The biopsy of the gastrointestinal tract mucosa in more than one time and more places are necessary. Glueoeorticoid for the maintain therapy is recommended.