71例嗜酸细胞性胃肠炎的临床特征和预后分析

Clinical characteristics and prognosis of eosinophilic gastroenteritis in 71 cases

目的:探讨嗜酸细胞性胃肠炎(eosinophilic gastroenteritis,EGE)的临床特征和预后。方法:收集2003年10月至2019年5月上海交通大学医学院附属瑞金医院明确诊断为EGE的患者71例,通过电话随访预后,分析EGE患者的临床表现、实验室检查、影像学特点、内镜和病理特征、治疗及预后情况。结果:71例EGE患者中,男性46例(64.8%),平均年龄(25.18±21.44)岁。39.4%(28/71)有过敏性疾病史,其中食物过敏占48.1%。临床表现以腹痛最为常见(74.6%)。外周血嗜酸性粒细胞(eosinophils,EOS)直接计数升高的比例显著高于间接计数升高的比例(92.3%比73.2%,P=0.043)。43例行胃镜活组织检查(活检),45例行肠镜活检,胃镜、肠镜活检病理阳性率分别为20.9%、31.1%。胃肠镜活检病理阳性率与活检部位数目显著相关(胃:P=0.012,肠道:P=0.014),与活检组织总数无显著相关性(胃:P=0.381,肠道:P=0.553)。随访成功80.3%(57/71),63.2%有复发,外周血EOS直接计数升高的比例和血清C反应蛋白(C-reactive protein,CRP)升高的比例在复发患者中显著升高(P<0.05),复发患者肠道组织EOS计数显著增高(P<0.05)。使用肠道菌群调节剂的EGE患者复发率更低[优势比(odds ratio,OR)=0.254,95%置信区间(confidence interval,CI):0.068~0.946,P=0.041]。结论:EGE是一种慢性消化系统疾病,与食物过敏有关,好发于中青年,临床表现以腹痛为主。EOS直接计数更有利于准确评估EGE患者外周EOS水平。内镜下多部位活检有利于提升EGE病理诊断的阳性率。外周EOS计数、血清CRP水平及肠道EOS计数增加提示更高的复发风险;菌群调节剂的使用可能使复发率降低。

Objectives To investigate the clinical features and prognosis of eosinophilic gastroenteritis(EGE).Methods Seventy-one cases diagnosed with EGE in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from October in 2003 to May in 2019 were recruited.The prognosis was followed up by telephone.The information including clinical manifestations,laboratory tests results,radiological features,endoscopic and pathological results,as well as prognosis were collected,and the statistical analysis was carried out using SPSS software.Results Seventy-one EGE patients[mean age(25.18±21.44)years,64.8%males]were recruited in our study.28/71(39.4%)cases had allergic history,in which 48.1%ones had food allergy.Abdominal pain(74.6%)was the most common symptom in the patients.The proportion of elevated peripheral blood eosinophils(EOS)direct count was significantly higher than that of EOS indirect count(P=0.043).43/51 cases received gastroscopy biopsy and 45/53 cases received colonoscopy biopsy.As tissue EOS infiltration≥20/HPF(high power field)was defined as pathologically positive,the positive rate of biopsy was significantly correlated with the number of biopsied sites(gastric:P=0.012,intestinal:P=0.014),but was not related to the total number of biopsy tissues(gastric:P=0.381,intestinal:P=0.553).57/71 cases were followed-up successfully by telephone,in which 63.2%ones had recurrence.The patients with a higher rate of elevated peripheral EOS direct count and serum CRP(C-reactive protein),as well as a higher level of intestinal tissue EOS infiltration,showed significantly higher recurrence rate(P<0.05).The EGE patients using microflora regulator agents had significantly reduced recurrence rate[odds ratio(OR)=0.254,95%confidence interval(CI):0.068-0.946,P=0.041].Conclusions EGE,as the disease commonly seen in young and middle-aged patients,is a chronic digestive disease related to food allergy,and its’common clinical manifestation is abdominal pain.Testing peripheral EOS direct count could be more beneficial for the accurate assessment of peripheral EOS level.Multi-sites gastrointestinal endoscopy biopsy is helpful to increase the pathologically positive rate of EGE diagnosis.Increase of peripheral EOS count,serum CRP and intestinal EOS infiltration can be used to predict a higher risk of recurrence.Microflora regulator agents might help reduce the recurrence rate of EGE.