嗜酸细胞性胃肠炎合并急性胰腺炎1例并文献复习

Eosinophilic gastroenteritis complicated with acute pancreatitis : A case report and literature review

目的提高对儿童嗜酸细胞性胃肠炎(EG)的认识。方法报告1例EG合并急性胰腺炎患儿的诊断和治疗过程,系统检索文献并汇总复习类似病例相关报道,分析总结EG合并急性胰腺炎的临床特征。结果男,14岁,以"反复腹痛、腹泻1周"主诉入院。初步诊断为急性胰腺炎,入院后查血嗜酸性粒细胞(EOS)0.62,血清IgE 393 U·mL^(-1),骨髓细胞学检查示EOS比例增加,内镜下显示胃肠道黏膜慢性炎症,病理活检显示十二指肠黏膜EOS浸润,诊断为EG。经泼尼松抗炎和抗过敏药物等治疗1周后病情缓解,血EOS降至正常,随访2年患儿病情稳定无反复。在万方、中国知网、EMBASE和Pub Med等数据库系统检索相关文献11篇,汇总EG合并急性胰腺炎14例(儿童病例4例),均以急性胰腺炎表现起病而误诊,以腹痛、恶心和呕吐等非特异性临床表现为主,外周血EOS均明显升高,腹腔积液EOS比例对诊断EG合并急性胰腺炎有重要提示意义,14例均有不同程度的胃、十二指肠黏膜异常改变。13例明确诊断后接受糖皮质激素治疗预后良好;1例手术切除胰腺后复发,诊断EG后予糖皮质激素治疗缓解。结论 EG合并急性胰腺炎罕见,对不明原因急性胰腺炎,且伴血EOS增多或常规抑酶抑酸治疗后临床转归差者,应警惕EG可能,完善内镜病理活检可以明确诊断。

Objective To improve the recognition of eosinophilic gastroenteritis（ EG） in children. Methods The data of clinical manifestation,imageological examination,diagnosis and management from a 14-year-old boy with eosinophilic gastroenteritis presenting as acute pancreatitis were retrospectively analyzed. Clinical features of similar cases from published literatures were summarized. And related literatures were also reviewed systematically. Results A 14-year-old boy was admitted to our hospital due to abdominal pain and diarrhea for 1 week. He was early diagnosed as acute pancreatitis. Test results showed significant increase of eosinophils proportion（ 62%）,serum IgE（ 393 U · mL^（-1） and proportion of eosinophils in bone marrow cytology.Esophagogastroduodenoscopy indicated eosinophilic infiltration in duodenum. Furtherly,he was confirmed eosinophilic gastroenteritis by duodenal mucosa biopsy which showed eosinophilic infiltration. After the therapy of prednisone and anti- allergic drugs,he had complete remission 1 week later. And the peripheral eosinophils proportion was decreased to normal. And the boy didn＇t have a relapse more than two years. The Wanfang digital knowledge service platform,CNKI,Elsevier,and Pub Med were searched for relevant articles. 11 studies were included and 14 cases were summarized. All patients were misdiagnosed due to the initial performance of acute pancreatitis. All patients had nonspecific clinical manifestations such as abdominal pain, nausea and vomiting,but with peripheral blood EOS significantly increased. The proportion of EOS in ascites had important significance to the diagnosis of EG complicated with acute pancreatitis. All patients had different degrees of abnormal changes of stomach and duodenum mucosa. 13 patients receiving glucocorticoid treatment after diagnosis had good prognosis. One case replased after surgical removal of the pancreas,and treating with glucocorticoid after diagnosis had good prognosis. Conclusion Children with EG complicated with acute pancreatitis are rare. Acute pancreatitis with unknown causes and accompanied with eosinophilia or bad clinical outcome after conventional treatment of enzyme or acid inhibition may indicate the possibility of eosinophilic gastroenteritis.Endoscope pathology biopsy should be taken as early as possible to confirm the diagnosis.