儿童嗜酸细胞性食管炎22例分析  

Eosinophilic esophagitis in children： analysis of 22 cases

作　　者：孙明芳[1] 顾伟忠[1] 彭克荣[1] 刘明南 舒小莉[1] 江丽琴[1] 江米足[1] Sun Mingfang Gu Weizhong Peng Kerong Liu Mingnan Shu Xiaoli Jiang Liqin Jiang Mizu(Department of Gastroenterology, Children＇s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China)

机构地区：[1]浙江大学医学院附属儿童医院消化科,杭州310003

出　　处：《中华儿科杂志》2017年第7期499-503,共5页Chinese Journal of Pediatrics

基　　金：国家自然科学基金面上项目（81270459）

摘　　要：目的探讨儿童嗜酸细胞性食管炎（EoE）的临床特点、诊治方法及其进展。方法临床资料回顾性分析2011年1月至2015年12月浙江大学医学院附属儿童医院诊断治疗的22例EoE患儿的临床和内镜特点及治疗随访情况。结果（1）临床资料：22例EoE患儿，年龄5个月一13岁，临床表现以呕吐、腹痛最常见，分别占45％（10／22）、41％（9／22）。（2）胃镜食管黏膜及病理：食管黏膜粗糙11例（50％），充血、糜烂6例（27％），纵向裂隙5例（23％），环形隆起3例（14％），颗粒状隆起3例（14％），正常黏膜3例（14％）；组织病理示食管嗜酸性粒细胞浸润，且计数≥15个／高倍镜视野。（3）实验室检查：13例患儿外周血嗜酸性粒细胞比例及计数升高，占62％。（4）过敏史：7例存在过敏史，占32％。（5）治疗情况：16例患儿经奥美拉唑治疗后好转；2例患儿经奥美拉唑联合顺尔宁治疗后好转；1例饮食回避后好转，1例饮食回避联合口服泼尼松治疗后好转，2例失访；2例治疗后复查胃镜，食管黏膜组织学恢复正常。结论儿童EoE的临床表现多种多样，内镜下食管黏膜可表现为纵向裂隙、黏膜白斑或者渗出、皱纸样黏膜、环形隆起、颗粒状隆起等。多数患儿经质子泵抑制剂治疗可取得较好的效果，少数患儿需要回避饮食，甚至加用糖皮质激素治疗。Objective Eosinophilic esophagitis （EoE） is a chronic immune-mediated esophageal disease. The current domestic reports of EoE in children is rare. The aim of this study was to analyze the clinical features, the diagnosis and treatment advance of EoE in children by case analysis and literature review. Method Clinical data of 22 children with EoE from January, 2011 to December, 2015 in Children＇s Hospital, Zhejiang University School of Medicine were recorded, retrospective analysis was performed on clinical presentation, gastroendoscopy and histopathological examination features and the treatment. Result （1） Clinical data： EoE can occur at any age in children （5 months to 13 years ）. The most common clinical manifestations of EoE are vomiting and abdominal pain, 45% （10/22） and 41% （9/22） respectively. （2） Endoscopy and pathological features of esophageal mucosa ： 11 cases with coarse mucous membrane （50%） , 6 cases with congestion or erosion of esophageal membrane （27%） , 5 cases with longitudinal crack （23%）, 3 cases with ring uplift （14%）, 3 cases with granular uplift （14%）, 3 cases with normal mueosa（ 14% ）. Histopathologic manifestation is eosinophil infiltration and the eosinophil counts were all more than or equal to 15/HP. （3） Laboratory results： 13 cases had increasing eosinophi] counts and eosinophils proportion （62%）. （4）Allergy history： among 22 cases, 7 patients had allergy history （32%） . （5） Situation of treatment and remission： 16 cases had clinical remission by oral omeprazole; 2 cases had clinical remission by oral Omeprazole and Monteiukast sodium; 1 case acquired remission by elimination diet; 1 case acquired remission by elimination diet and oral prednisone. 2 cases dropped out ; Only 2 patients received gastroendoscopy re-examination after 3 months and revealed esophageal mucosal histologic complete recovery. Conclusion The clinical symptoms of EoE in children varies. Esophageal mucosal features of gastroendoscopy

关 键 词：嗜酸细胞增多性食管炎 治疗结果 儿童 临床特点 

分 类 号：R725.7[医药卫生—儿科]