以大量腹水为首发表现的儿童嗜酸细胞性胃肠炎诊治分析

Diagnosis and treatment of pediatric eosinophilic gastroenteritis with massive ascites as the initial symptom

目的分析以大量腹水为首发临床表现的儿童嗜酸细胞性胃肠炎(Eosinophilic Gastroenteritis,EG)诊治特点。方法对安徽医科大学第一附属医院2014年1月至2020年4月的3例EG病儿临床特点、实验室检查、胃镜、病理以及诊治经过进行回顾性分析。结果 3例病儿均为年长儿,为EG浆膜型病变,临床表现主要为腹胀、腹水;外周血及骨髓细胞学检查显示嗜酸性粒细胞(EoS)显著增多,治疗前3例病儿外周血EoS计数分别是(9.84,9.84,8.48)×109/L;胃镜检查显示胃窦及十二指肠黏膜充血水肿明显、可见充血出血斑;病理检查在胃窦黏膜固有层可见大量EoS浸润。予以饮食回避、抗过敏、激素治疗,1周内病儿症状明显缓解。结论浆膜型EG病儿主要以大量腹水为首发临床表现,外周血EoS显著升高,确诊依靠内镜下病理检查,饮食疗法结合激素治疗有显著疗效。

Objective To analyze the diagnosis and treatment characteristics of eosinophilic gastroenteritis(EG)in children with massive ascites as the initial clinical manifestation.Methods We retrospectively analyzed the clinical characteristics,laboratory examinations,gastroscopy,pathology,diagnosis and treatment of 3 hospitalized children with EG in The First Affiliated Hospital of Anhui Medical University from January 2014 to April 2020.Results All the 3 children were older ones with EG serous type mainly presented with abdominal distension and ascites.Peripheral blood and bone marrow cytological tests showed a significant increase in eosinophils(EoS).The peripheral blood EoS counts of the 3 children before treatment were(9.84,9.84,8.48)×109/L.Gastroscopic examination revealed obvious congestion,edema and bleeding spots of gastric antrum and duodenal mucosa.Pathological examination showed great amount of EoS infiltration in the lamina propria of gastric antrum mucosa.Their symptoms were significantly relieved after avoiding suspicious food,anti-allergy and corticosteroids treatment.Conclusions The children with EG serous type had massive ascites as the initial clinical manifestation and EoS in their peripheral blood was significantly increased.The diagnosis of EG depended on endoscopic pathological examination.Diet therapy in combination with corticosteroids was very effective for EG children.