嗜酸细胞性胃肠炎与高嗜酸性粒细胞综合征

Eosinophilic gastroenteritis and hypereosinophilic syndrome

目的 探讨嗜酸细胞性胃肠炎 (EG)和高嗜酸性粒细胞综合征 (HES)临床特征的异同。方法 回顾性对照研究 9例EG和 19例HES ,分析其临床表现及治疗经过。结果 EG组腹泻、腹痛、体重下降和消化道受累的发生率高于HES组 (P <0 .0 5 )。HES组循环嗜酸性粒细胞 (EOS)和白细胞计数、IgE水平均高于EG组 (P值均 <0 .0 5 )。 9例EG和 3例HES行内镜黏膜活检发现有EOS浸润 ,HES的大肠黏膜活检阳性率明显高于EG(P <0 .0 1)。EG患者经对症或激素治疗均缓解。激素和化疗药物治疗HES有效 (12 / 15 )。结论 EG是以胃肠道组织中EOS异常浸润为特征的胃肠道疾病。循环中EOS、白细胞计数和IgE的高水平以及大肠的EOS浸润提示HES的诊断。

Objective To determine the clinical characteristics of eosinophilic gastroenteritis (EG) and hypereosinophilic syndrome (HES). Methods Series of 9 patients with EG and 19 patients with HES were studied retrospectively. The clinical manifestations and treatment of each case were analyzed. Results The prevalance rates of diarrhea, abdominal pain, weight-loss, and digestive tract involvement in EG group were higher than those of HES group. Peripheral eosinophil (EOS) and white blood cell counts, as well as serum IgE level of all HES cases were much higher than those of EG ( P <0.05). Mucosal EOS infiltration was found in all 9 EG and 3 HES by endoscopy and biopsies. EOS infiltration in large intestine was more common in HES group than EG (100% vs. 0%, corrected χ 2=7.3, P <0.01). All 9 EG patients achieved remission after treatment for symptoms and glucocorticoid therapy, while glucocorticoid and chemotherapeutic agents were effective for HES group (12/15). Conclusions EG is a rare disease characterized by infiltrating eosinophils in one or more layers of the gastrointestinal tract. Large intestinal EOS infiltration, as well as elevated circulatory eosinophils and, white blood cell count, and increased level of IgE suggest the diagnosis of HES.