儿童嗜酸性膀胱炎的超声诊断及临床分析

Ultrasonic diagnosis and clinical analysis of eosinophilic cystitis in children

目的 探讨儿童嗜酸性膀胱炎的超声诊断及临床分析,提高对本病的认识及诊断水平.方法 收集南京医科大学附属南京儿童医院2007年7月至2013年5月临床确诊为嗜酸性膀胱炎的9例患儿,对其临床资料及超声声像图表现进行回顾性分析,总结其声像图特征并复习相关文献.结果 9例患儿的超声声像图表现：4例表现为膀胱壁弥散性增厚,2例表现为局限性团块状增厚,3例表现为前壁及两侧壁明显增厚.9例患儿外周血嗜酸性粒细胞均增多.其中6例行膀胱镜检查＋活检术,提示膀胱壁黏膜红斑及绒毛样改变,组织病理提示嗜酸性粒细胞及炎性细胞浸润程度与嗜酸性膀胱炎相一致.3例经抗感染、碱化尿液治疗后症状缓解;6例患儿给予激素（0.5 ～1.0 mg/kg）及抗过敏对症治疗,症状缓解2周后激素逐渐减量并停药.9例患儿均定期复查B超及血常规、尿常规,无复发病例.结论 超声声像图提示膀胱壁增厚结合外周血嗜酸性粒细胞增高,高度提示嗜酸性膀胱炎,必要时仍需行膀胱镜检查及活检确诊.抗组胺药物及激素应用是治疗嗜酸性膀胱炎最主要的方法。

Objective To explore the ultrasound imaging and the clinical analysis of eosinophilic cystitis in children and to improve the understanding of this very rare clinical disease.Methods The ultrasound imaging of 9 patients who were diagnosed as eosinophilic cystitis in Nanjing Children＇s Hospital Affiliated to Nanjing Medical University from Jul.2007 to May 2013 were analyzed retrospectively,and the relevant literatures were reviewed.Results The ultrasound imaging of the 9 patients were described as follows：4 cases showed a diffuse thickening bladder wall,2 cases showed a localized mass-like thickening bladder wall,and 3 cases showed a markedly thickening anterior bladder wall and bilateral bladder wall.Laboratory studies showed that all the patients were presented with eosinophilia.Six patients underwent cystoscopy that showed an erythematous,and velvety appearance of the bladder mucosa.Histopathology disclosed a bladder mucosal tissue with dense interstitial eosinophilic infiltration consistent with eosinophilic cystitis.Three patients had clinical resolution under the treatment of anti-infections and urine alkalinization.Other 6 patients received prednisone at 0.5-1.0 mg/kg and an antihistamine treatment.Prednisone was eventually tapered off after 2-week reemission.Regular follow-up by urinary bladder ultrasound and urine routine did not show any disease recurrence in 9 children.Conclusions The combination of bladder wall thickening and peripheral eosinophilia may suggest the likely diagnosis of eosinophilic cystitis.Cystoscopy with bladder biopsy is the most important step in the diagnosis of eosinophilic cystitis.Anti-histamines and corticosteroids can be used as the primary management and have good results.