六岁以下儿童嗜酸细胞性胃肠炎临床特征分析

Clinical characteristics of eosinophilic gastroenteritis in children under six years old

目的分析6岁以下儿童嗜酸细胞性胃肠炎(EG)的临床特征,提高临床医生对该病的认识。方法收集2016年1月1日至2022年12月31日于首都医科大学附属北京儿童医院消化科住院治疗的6岁以下EG患儿的临床资料、实验室检查、影像学检查、消化道内镜及病理组织学检查结果、治疗及预后资料,总结6岁以下儿童EG的临床特点。结果共纳入31例6岁以下EG患儿,≤3岁14例,>3岁17例,38.71%(12/31)有多部位受累。腹痛(20/31,64.52%)为最常见的临床表现,其次为呕吐(11/31,35.48%)、便血(7/31,22.58%)、腹泻(7/31,22.58%)。单部位受累患儿症状分析显示,嗜酸细胞性十二指肠炎和嗜酸细胞性结肠炎患儿更易出现腹痛,发生率均为83.33%(10/12)(P<0.05)。70.97%(22/31)嗜酸性粒细胞增高,更常见于>3岁患儿(88.24%比50.00%,P<0.05);29.03%(9/31)存在贫血,≤3岁患儿贫血发生率更高(50.00%比11.76%,P<0.05);22.58%(7/31)存在低白蛋白血症;73.33%(22/30)食物过敏原特异性IgE(sIgE)阳性,牛奶、鸡蛋、小麦为最常见的过敏原。消化道内镜下可表现为黏膜充血水肿(29/31,93.55%)、黏膜红斑(26/31,83.87%)、粗糙(12/31,38.71%)、溃疡(10/31,32.26%)等。患儿均采取回避饮食治疗,在此基础上10例口服奥美拉唑,16例口服孟鲁司特,17例接受糖皮质激素治疗。治疗后整体复发或糖皮质激素依赖发生率32.26%(10/31),70.00%(7/10)于治疗1年内出现。结论6岁以下儿童EG可表现为单部位或多部位受累。腹痛为最常见的临床表现。患儿可能出现外周血嗜酸性粒细胞升高、贫血、低白蛋白血症。多数患儿存在食物过敏原。近1/3患儿会出现复发或糖皮质激素依赖。

Objective To analyze the clinical characteristics of eosinophilic gastroenteritis in children under 6 years old.Methods The clinical data,laboratory examinations,imaging examinations,gastrointestinal endoscopy,histopathology,treatment,and prognosis of patients under 6 years old with eosinophilic gastroenteritis who were hospitalized in the Department of Gastroenterology,Beijing Children's Hospital from January 1,2016 to December 31,2022 were collected and analyzed.Results A total of 31 children under 6 years of age with eosinophilic gastroenteritis were enrolled in the study,including 14 cases≤3 years old and 17 cases>3 years old,and 38.71%(12/31)of them had multiple sites involved.The main clinical manifestations were abdominal pain(20/31,64.52%),vomiting(11/31,35.48%),hematochezia(7/31,22.58%),and diarrhea(7/31,22.58%).The children with eosinophilic duodenitis and eosinophilic colitis were more likely to have abdominal pain,with an incidence of 83.33%(10/12)(P<0.05).Eosinophilia increased in 70.97%(22/31)of children,which was more common in children>3 years of age(88.24%vs.50.00%,P<0.05).Anemia was seen in 29.03%(9/31)of the patients,and it was more common in children under 3 years of age(50.00%vs.11.76%,P<0.05).Hypoalbuminemia was found in 22.58%(7/31)of patients.Specific IgE(sIgE)was positive in 73.33%(22/30)of children.Milk,egg,and wheat were the most common allergens.Gastrointestinal endoscopy showed mucosal edema(29/31,93.55%),erythema(26/31,83.87%),roughness(12/31,38.71%),ulcer(10/31,32.26%),et al.All children were treated with the elimination diet.Besides,10 cases were treated with omeprazole,16 cases were treated with montelukast,and 17 cases were treated with glucocorticoid.The incidence of relapse or steroid resistance was 32.26%(10/31),and 70.00%(7/10)of them occurred within one year of treatment.Conclusion Eosinophilic gastroenteritis in children under 6 years of age may involve single or multiple sites.Abdominal pain is the most common clinical manifestation.Children may have elevated peripheral blood eosinophils,anemia,or hypoalbuminemia.Most children have food allergens.Nearly one-third of children experience relapse or steroid resistance.