10例嗜酸细胞性胃肠炎临床分析  

Clinical study of enosinophilic gastroenteritis analysis of 10 cases

作　　者：杨华元[1] 雷健康[2] 杜时雨[1] 贺晖英[1] 姚萍[1] 闫圣涛[1] 樊艳华[1] 

机构地区：[1]北京中日友好医院消化内科,100029 [2]陕西省汉中市人民医院

出　　处：《北京医学》2005年第12期708-710,共3页Beijing Medical Journal

摘　　要：目的分析嗜酸细胞性胃肠炎(EG)的临床特点、诊断要点和治疗预后,并探讨其误诊原因。方法对10例EG患者的病史、临床表现、实验室检查、内镜表现和治疗随诊情况进行分析。结果黏膜型EG患者常以腹痛、腹胀、恶心、呕吐为主要表现,可有腹泻。肌层型以肠梗阻为主要表现,可有腹痛、便闭。浆膜型以腹痛、腹胀、腹水为主要症状,可伴恶心、呕吐、低热等。外周血和骨髓中嗜酸细胞计数明显增高(0.425±0.215,0.306±0.025),以成熟型为主,其变化随症状的有无而增减。血沉、C反应蛋白等指标正常,IgG可下降。腹水为渗出液,可见嗜酸细胞。内镜表现多为黏膜片状糜烂和水肿,以胃窦、十二指肠和回盲部明显,活检可证实大量嗜酸细胞浸润。激素治疗可在1周内迅速缓解症状,并使嗜酸细胞恢复正常。病情可有反复,但预后良好。结论EG临床和内镜表现无特异性,外周血嗜酸细胞、腹水嗜酸细胞,尤其是胃肠黏膜组织中嗜酸细胞增多是诊断的关键。Objective To investigate clinical presentation, diagnosis and prognosis of eosinophilic gastroenteritis （EG）, and analyze causes of misdiagnosis. Methods 10 patients diagnosed as EG were studied. Their history, clinical manifestations, laboratory tests and endoscopies and follow-up data were analyzed. Results The patients with mucosal type usually had abdominal pain, bloating, nausea and vomiting and sometimes with possible diarrhea. Bowl obstruction occurred generally in patients diagnosed as muscular type with or without abdominal pain. Abdominal pain, bloating and ascites occured predominantly in those with serosal type, probably accompanied by nausea, vomiting and low fever. Peripheral eosinophilic counting and bone marrow examination were markedly increased（0.425±0.215,0.306±0.025）, most of which were mature cells. The changes of cell varied with the severity of the symptoms. Levels of ESR and CRP remained in normal range but IgG level was decreased in some cases. Ascites were exudative with eosinocytes. Endoscopy showed erosion and edema in antrum, duodenum and cecum. Eosinophilia infiltration in mucosa was confirmed by biopsy. Glucocorticoid therapy could relieve symptoms and eosinophilia. Symptoms probably recur by good prognosis. Conclusions Clinical and endoscopic presentations are not specific, therefore the presence of enosiphilia in peripheral blood and ascites, especially in gastrointestinal mucosa strongly indicate the diagnosis.

关 键 词：嗜酸细胞性胃肠炎 嗜酸细胞 临床表现 

分 类 号：R57[医药卫生—消化系统]