嗜酸细胞性胃肠炎患者26例临床分析

Eosinophilic gastroenteritis:clinical manifestations and treatment in 26 cases

目的探讨嗜酸细胞性胃肠炎(EG)的临床特点、内镜下表现及其治疗效果。方法回顾分性分析2005年9月—2016年11月中日友好医院消化内科住院治疗的26例EG患者的临床表现、实验室检查、影像学特点、内镜下改变和治疗效果。其中男9例,女17例,年龄2~79(42.7±16.1)岁。结果(1)26例患者中,最常见的症状为腹痛19例(73.08%),其次为恶心、呕吐7例(26.92%),腹泻5例(19.23%);(2)所有患者外周血嗜酸性粒细胞百分比均升高,并且累及浆膜层的患者其嗜酸性粒细胞百分比高于累及黏膜层的患者(51.11%±10.95%vs.19.15%±13.41%,t=5.60,P<0.05);(3)内镜下表现缺乏特异性,小肠为最常见的受累部位,在黏膜表现正常的部位活检也可见嗜酸性粒细胞浸润;(4)激素可缓解症状,并降低外周血嗜酸性粒细胞水平。结论腹痛伴嗜酸性粒细胞增多可提示该病,内镜检查需多部位活检,尤其是在十二指肠降段及末段回肠。

Objective To determine the clinical features, endoscopic findings and treatment of Eosinophilic gastroenteritis （EG） in adult patients. Methods Retrospective investigated 26 patients with EG from 2005 through 2016. The clinical records, laboratory tests, radiological characteristics, endoscopic features and treatment were reviewed and analyzed. Results （1） Most patients had abdominal pain （73. 08% ）, followed by nausea/vomiting （26. 92% ） and diarrhea （19.23%）. （2） All patients had peripheral eosinophilia, which was more prominent in patients with predominantly serosal involvement compared to patients with predominantly mueosal involvement[ （51.11 ±10.95 ） % vs. （ 19.15± 13.41 ） %, t = 5.60, P 〈0.05 ]. （3） The small bowel（73.08% ） was the most commonly involved site. Eosinophilic infiltration was found in biopsies from sites of relatively normal endoscopic appearance. （4） The symptoms and eosinophilia would be relieved with steroid therapy. Conclusion The EG should be considered in the presence of abdominal pain and peripheral eosinophilia. Multiple biopsies obtained from both normal and abnormal appearing areas in the small bowel, especially in the second part of the duodenum and the terminal ileum, tare highly recommended.