以腹水为主要表现的嗜酸细胞性胃肠炎临床分析

目的探讨嗜酸细胞性胃肠炎（EG）的临床特征,提高对以腹水为主要表现的EG的识别。方法对我院1995年3月-2011年5月收治的15例EG患者的临床资料进行系统性回顾分析。结果 15例EG患者主要表现为腹痛（15/15,100%）、腹泻（11/15,73.3%）、腹胀（8/15,53.3%）、恶心（2/15,13.3%）等。其中3例（20.0%）主要表现为腹水,1例（6.7%）表现为不全性肠梗阻。所有患者外周血嗜酸细胞明显增高,其百分比为9.8%～63.7%,平均（27.2±13.6）%;绝对计数为（1.1～6.0）×109/L,平均（3.1±1.4）×109/L。15例胃镜检查中,13例（86.7%）显示胃窦、十二指肠有不同程度充血、水肿、糜烂,其中1例为十二指肠球部溃疡;7例肠镜检查患者中,5例（71.4%）结肠黏膜出现类似改变,并以回盲部多见。活检组织病理学检查均见大量嗜酸细胞浸润。3例腹水均为渗出液,腹水中嗜酸细胞占白细胞总数的36%～65%,平均（53±15.1）%。所有患者均经泼尼松治愈,疗程32～60 d。结论 EG临床表现呈多样性,无特异性。腹水型患者少见,不易早期诊断。治疗主要应用糖皮质激素,预后良好。

Clinical analysis of eosinophilic gastroenteritis with major manifestation of ascites

Objective To investigate the clinical features of eosinophilic gastroenteritis(EG)in order to improve the discrimination of EG with major manifestation of ascites.Methods A retrospective and systematic analysis of clinical data was made among 15 cases of EG hospitalized from March 1995 to May 2011.Results Their major manifestations were abdominal pain(15/15,100%),diarrhea(11/15,73.3%),abdominal distension(8/15,53.3%)and nausea(2/15,13.3%),etc.Among these cases,the major manifestation in 3 ones was ascites(20.0%)and in one was incomplete intestinal obstruction(6.7%).The oxyphil cell of peripheral blood in all the patients significantly increased and its percentage was 9.8%-63.7% with an average of(27.2±13.6)%.The absolute counting was(1.1-6.0)×109/L with an average of(3.1±1.4)×109/L.Among the 15 cases receiving gastroscopy,13 ones showed different degrees of hyperaemia,edema and erosion in sinus ventriculi and duodenum(86.7%),in which one showed ulcer in duodenal ampulla.Among the 7 cases receiving enteroscopy,the same appearances occurred in the colonic mucosa and mostly in the ileocecal junction of 5 ones(71.4%).Infiltration of large amount of oxyphil cells was observed in the pathological examination of all biopsy tissues.The ascites of three cases was mainly diffusate.In the ascites,the number of oxyphil cells accounted for 36%-65% of the total white blood cells with an average of(53±15.1)%.All patients were cured by prednisone,and the course of treatment was 32-60 days.Conclusion The clinical manifestations of EG are diversified and have no specificity.The type of EG with major manifestation of ascites is rarely seen and hard to make early diagnosis.Glucocorticosteroids is the main treatment drugs.The prognosis of this disease is good.