嗜酸细胞性胃肠炎患者17例的临床特点和预后分析

目的：分析嗜酸细胞性胃肠炎(eosinophilic gastroenteritis, EG)患者的临床特点,为该病的早期诊断和治疗提供依据。方法：回顾性分析2009年7月至2017年1月上海长征医院收治的17例EG患者的临床资料。结果：EG患者男性发病率高于女性,52.9%患者既往有过敏史。临床表现主要为腹痛(70.6%),其次为腹胀(41.2%)。实验室检查中所有患者外周血嗜酸性粒细胞计数均升高,内镜下病变主要位于胃窦、胃体及十二指肠降段,可见黏膜充血糜烂,病理活检和/或腹水检查见嗜酸性粒细胞浸润。腹部CT可见胃壁或局部小肠管壁水肿增厚,肠系膜增厚。糖皮质激素是EG主要治疗方案,可有效缓解症状,但停药后较易复发,复发率53.8%,复发后再次用糖皮质激素仍然有效。结论：EG临床表现缺乏特异性,内镜下多点活检是该病诊断的关键,糖皮质激素可有效缓解症状,降低外周血嗜酸性粒细胞水平。

A retrospective analysis of clinical characteristics and prognosis of 17 patients with eosinophilic gastroenteritis

Objective To analyze the clinical characteristics of eosinophilic gastroenteritis (EG) so as to provide evidence for early diagnosis and treatment of EG. Methods The clinical data of 17 patients with EG, who were admitted to Changzheng Hospital of Second Military Medical University from Jul. 2009 to Jan. 2017, were retrospectively analyzed. Results Male patients had a higher prevalence of EG and occurrence ratio of male and female was 2.4:1. Nine (52.9%) of the 17 patients had a history of allergy. The most common symptoms were abdominal pain (13/17, 76.5%), followed by abdominal distension (7/17, 41.2%). Peripheral eosinophil count elevated in the 17 patients. Endoscopic examination showed that the lesions were mainly located in the gastric antrum, gastric body and descendant duodenum, and the most common finding were mucosal erythema. Biopsy of 13 cases and/or ascites examination of 5 cases showed eosinophil infiltration in the lesions. Abdominal CT scanning of 8 cases showed stomach or partial small bowel wall thickening with edema and thickened mesenterium. Glucocorticoid therapy was the main treatment for EG, and it could effectively relieve the symptoms. Seven of 13 cases who were followed up had relapse, with the recurrence rate being 53.8% (7/13), and were improved after administration of glucocorticoid again. Conclusion The clinical manifestation of EG is non-specific, and the endoscopic multi-point biopsy is the key to diagnose EG. Glucocorticoid can effectively relieve symptoms of EG and reduce peripheral eosinophils count.