嗜酸性粒细胞性胃肠炎32例临床诊治分析

目的 分析嗜酸性粒细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床特点、内镜下表现、病理特点及诊治要点,以提高对该病的认识.方法 回顾性分析湖北医药学院附属太和医院消化内科2001年1月～2011年5月收治的32例EG患者临床资料,对病史、临床表现、实验室结果、内镜结果及治疗情况汇总分析.结果 32例患者黏膜型25例,浆膜型6例,黏膜-肌层混合型1例；患者多以腹痛为首发症状(84.38％)；外周血和骨髓嗜酸粒细胞(ensinophils,EOS)计数明显增高(14.2％ ～49.5％ vs 12.5％ ～42.5％)；镜下表现为黏膜充血水肿、糜烂、红斑,病变多分布在胃窦部、十二指肠和结肠；活检和腹水检测有大量EOS浸润；糖皮质激素治疗后患者症状缓解,复发用药亦有效.结论 EG多以腹痛起病,胃窦部、十二指肠、结肠为常见病变部位,内镜活检和腹水中见EOS浸润有助于明确诊断,糖皮质激素疗效好.

Diagnosis and Treatment Analysis of 32 Patients with Eosinophilic Gastroenteritis

Objective To investigate the clinical,endoscopic,pathological characteristics,diagnosis,and therapy of eosinophilic gastroenteritis(EG),to improve the awareness of the disease.Methods To retrospective ananlysis of the clinical data of 32 patents with EG in department of gestroenterology of Taihe hospital of Hubei university of medicine from January 2001 to May 2011.The clinical information incude the history,clinical manifestations,laboratory findings,endoscopic findings and treatment.Results There were in 25 cases of mucosal type,6 cases of serous,mucosal and muscle mixed in 1 case.Abdominal pain is the first clinical manifestations in most patients(84.38%),peripheral blood and bone marrow eosinophils count was significantly higher(14.2%~49.5% vs 12.5%~42.5%).Mucosal congestion,edema,erosion and erythema are common endoscopic findings,lesions are located in the gastric antrum,duodenum and colon.Detection of a large number of eosinophils(EOS) infiltration in biopsies and ascites;glucocorticoid treatmet can relieve symptoms,to those relapse ones it is also effective.Conclusion Abdominal pain is the first clinical manifestations in most patients.Gastric antrum,duodenum and colon are the common lesions.Biopsy under endoscopy or cytological examination of ascties is helpful to the diagnosis,patients are well respond to therapy with steroid.EOS infiltration in endoscopic biopsy and ascites can help confirm the diagnosis,glucocorticoid treatment leads to pefect result.