17例儿童嗜酸细胞性胃肠炎临床诊治分析

目的 分析儿童嗜酸细胞性胃肠炎（EG）的临床特点和诊治方法.方法 回顾性分析我院收治的17例EG患儿的过敏史、临床症状、实验室检查、内镜下特点及治疗情况.结果 本组17例患儿中,腹痛12例（70.6％）、腹泻9例（52.9％）、血便5例（29.4％）、恶心呕吐4例（23.5％）、体重下降1例（5.9％）、过敏史4例（23.5％）.辅助检查：血常规白细胞升高8例（47.1％）,嗜酸性粒细胞（EOS）百分比升高12例（70.6％）.8例（47.1％）特异性过敏源抗体检测结果阳性.8例大便隐血阳性.1例腹部B超及CT提示腹水.2例腹平片示不完全性肠梗阻.内镜下表现主要有以下三种镜下表现：（1）粘膜红斑糜烂;（2）粘膜溃疡;（3）粘膜结节样增生,组织病理学表现为粘膜下层大量EOS浸润,最多52个/HP.对有特异性过敏源者回避过敏源,治疗首选糖皮质激素,症状严重者加用顺尔宁、酮替芬,住院天数为5～ 18天,均痊愈出院.结论 儿童EG的临床表现各异,以腹痛腹泻为主.内镜下表现无特异性.组织学EOS大量浸润和外周血EOS升高是重要诊断依据.治疗首选糖皮质激素,症状严重者加用抗组胺药及白三烯受体拮抗剂,疗效显著.

Diagnosis and treatment of 17 children with eosinophilic gastroenteritis

Objective To analyze the clinical characteristics and treatment methods of child eosinophilic gastroenteritis（EG）. Methods The allergy history, clinical symptoms, laboratory test results, endoscopic features, and treatment of 17 EG children were retrospectively analyzed. Results Among the 17 cases, 12 （70.6%） got abdominal pain, 9 （52.9%） diarrhea, 5 （29.4%） hematochezia, 4 （23.5%） nausea and vomiting, 1 （5.9%） weight loss, and 4 （23.5%） allergies. Blood routine test showed that WBC were increased in 8 cases （47.1%） and the percentage of eosinophile granulocyte （EOS） were increased in 12 cases （70.6%）. There were also 8 cases positive in antibody test against specific allergens, 8 cases positive in occult blood in stool, 1 case with ascites by ventral type-B ultrasonic and CT examination and 2 cases with incomplete intestinal obstruction. There were mainly three endoscopic appearances, including mucosal erythema erosion, mucosal ulcer, and mucosa nodular hyperplasia with massive EOS infiltration in the submficosa 52 per HP. For patients positive in specific allergens, suspected allergens were avoided, while glucocorticoids were the preferred treatment. For paitents with severe symptom, Singulair and Ketotifen were adopted in glucocorticoids treatment. After 5-18 days＇ hospitalization, all the children recovered and dismissed. Conclusions Children with EG showed different clinical symptoms, mainly abdominal pain and diarrhea, and no specific endoscopic indications. EOS infiltration and increased EOS in peripheral blood were important for diagnosing EG. The preferred treatment for children was glucocorticoids, with addition of Singnlair and Ketotifen for the severe cases.