嗜酸性粒细胞性胃肠炎30例诊治分析

Diagnosis and treatment of eosinophilic gastroenteritis: An analysis of 30 cases

目的分析嗜酸性粒细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床特点、诊治经过,以提高对EG的诊治效果。方法回顾性分析2008年1月至2017年3月于济宁医学院附属医院首次确诊为EG的30例住院患者,总结分析其病史、临床症状及体征、实验室检查、影像学检查、病理诊断的特点,评估其治疗结果和预后。结果 30例患者中10例(33.3%)有明确诱因或过敏史者,28例(93.3%)患者具有腹痛,30例均有不同程度的嗜酸性粒细胞增高,10例(33.3%)D-二聚体升高,7例(23.3%)大便肠道菌群失调。30例EG全腹部增强发现,12例(40%)发现腹膜后多发淋巴结肿大,消化道壁略增厚;10例(33.3%)患者有腹腔、盆腔积液;1例(3%)患者有肠梗阻。所有EG患者内镜下均无特异性表现。所有EG患者糖皮质激素初次治疗有效,其中13.3%的患者复发,复发后再次使用糖皮质激素仍然有效。结论 EG的临床表现复杂多样,特异性不强。诊断时,除仔细询问病史外,要高度重视内镜下诊断及活检;治疗上,一旦确诊,及时规范使用激素。

Objective The clinical characteristics,diagnosis and treatment of eosinophilic gastroenteritis( eosinophilic gastroenteritis,EG) were analyzed in order to improve the therapeutic effect on the diagnosis and treatment of EG.Methods A retrospective analysis of 30 hospitalized patients who first diagnosed as EG were selected in the Affiliated Hospital of Jining Medical University from January 2008 to March 2017,and summarized the characteristics of their history,clinical symptoms and body disease,laboratory examination,imaging examination and pathological diagnosis,and evaluated the treatment outcome and prognosis. Results Among 30 patients,10 cases( 33. 3%) had clear inducements or allergies; 28 cases( 93. 3%) had abdominal pain; 30 cases had increased eosinophils in different degrees; 10 cases( 33.3%) had D-two aggregates; and 7 cases( 23. 3%) had bowel dysentery. 30 cases of EG total abdominal enhancement found that 12 cases( 40%) found multiple retroperitoneal lymph nodes,slightly thickened the digestive tract wall; 10 cases( 33. 3%) had abdominal cavity and pelvic effusion; 1 cases( 3%) had intestinal obstruction. All EG patients had no specific findings under endoscopy. The first treatment of glucocorticoids in all EG patients was effective,of which 13. 3%of the patients relapsed and reused corticosteroids were still effective after recurrence. Conclusion The clinical manifestations of EG are complex and varied,and the specificity is not strong. In the diagnosis,in addition to the careful inquiry of the medical history,we should pay high attention to the diagnosis and biopsy of the endoscopy. In the treatment,once the diagnosis is confirmed,the hormone is used in time.