儿童嗜酸细胞性膀胱炎4例临床分析

Eosinophilic cystitis in the pediatric population:An analysis of four cases

目的探讨儿童嗜酸细胞性膀胱炎临床表现、实验室检查、影像学和病理学特点、诊治要点及预后情况。方法回顾性分析2012年1月至2015年5月中国医科大学附属盛京医院小儿肾脏风湿免疫科及小儿泌尿外科收治的4例儿童嗜酸细胞性膀胱炎的临床资料。结果4例患儿均为男性，年龄6～8岁，主要临床症状为尿频、尿痛、排尿困难、耻骨上疼痛、血尿，4例均出现外周血嗜酸性粒细胞增高，影像学主要表现为膀胱壁增厚，2例经膀胱镜、2例经开腹手术取膀胱组织行膀胱病理活检，病理显示膀胱间质嗜酸性粒细胞浸润。口服糖皮质激素和抗组胺药物治疗后，临床症状缓解，外周血嗜酸性粒细胞及膀胱影像学改变均恢复正常。4例中3例病情反复，糖皮质激素总疗程3个月至1年6个月，1例停药2年无复发，2例复发1次、l例复发2次。结论嗜酸细胞性膀胱炎确诊依靠膀胱病理诊断，患者外周血嗜酸性粒细胞增高及膀胱壁增厚对诊断有提示作用，糖皮质激素治疗本病有效，需要长期密切随访。

Objective To investigate the clinical features, diagnosis, treatment and prognosis of eosinophilic cystitis in pediatric population. Methods The records of four patients who had been diagnosed and treated for eosinophilic cystitis from January 2012 to May 2015 in Shengjing Hospital were retrospectively reviewed. Results All the four patients were boys whose age ranged from 6 to 8 years. The main symptoms of the 4 cases were frequent micturition, odynuria, dysuria, suprapubic pain and hematuria.All of the 4 cases had significant peripheral eosinophilia and increased bladder wall thickness. All of the patients were diagnosed with biopsy. Bladder interstitial eosinophil infiltration was revealed by histopathology. The clinical symptoms, peripheral eosinophilia and bladder imaging changes were relieved after steroids and antihistamines treatment. Three cases developed recurrence. Total course of oral corticosteroids ranged from 3 months to 18 months. One case remained persistent remission for 2 years, two cases had are recurrence and one case had two recurrences. Conclusion Bladder biopsy is essential to establishing the diagnosis of eosinophilic cystitis. Patients with peripheral eosinophilia and the increased bladder wall thickness should be considered with eosinophilic cystitis. Steroids is effective as medical therapy for eosinophilic cystitis and close long-term follow-up is necessary.