中国成年嗜酸细胞性食管炎患者的临床特征分析  

Clinical characteristics of adult patients with eosinophilic esophagitis in China

作　　者：胡佳慧 周晓蓥 喻芳 徐承富[1] 沈哲[1] 马涵[1] Hu Jiahui;Zhou Xiaoying;Yu Fang;Xu Chengfu;Shen Zhe;Ma Han(Department of Gastroenterology,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Pathology,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院消化内科,杭州310003 [2]浙江大学医学院附属第一医院病理科,杭州310003

出　　处：《中华内科杂志》2025年第3期212-219,共8页Chinese Journal of Internal Medicine

摘　　要：目的嗜酸细胞性食管炎(EoE)作为一种由过敏原/免疫介导的慢性食管疾病,其全球患病率正逐渐增加,但在中国的数据非常有限。本研究阐述了EoE患者的临床特征。方法回顾性分析浙江大学医学院附属第一医院2019年1月至2024年5月符合EoE病理诊断标准的所有成人患者的病历资料。同时按照年龄和性别以1∶1的比例匹配内镜下诊断为反流性食管炎的患者,并在两组之间进行比较。结果EoE在本院的整体检出率约0.05%,并且有逐年增加的趋势。共纳入61例EoE患者,其中42例(68.9%)为男性,患者的中位年龄为53岁。EoE患者临床表现多种多样,常见症状包括吞咽困难、反酸和上腹痛。血清学检查显示23.1%(9/39)的患者嗜酸性粒细胞绝对数升高。73.8%(45/61)的患者合并过敏性疾病。大多数患者内镜下可呈现出典型的食管黏膜改变,EREFS评分中位数为3分。临床最常使用的治疗药物是质子泵抑制剂,有13例患者使用了激素类药物。随访期间共42例(68.9%)患者获得了临床症状的改善或病理学上的缓解。中青年组与老年组在临床症状、合并过敏性疾病的比例、药物使用以及改善率方面差异均无统计学意义(均P>0.05)。此外,与反流性食管炎患者相比,EoE患者更常表现为吞咽困难(29.5%比1.6%,χ^(2)=15.96,P<0.001)、合并过敏性疾病(73.8%比13.1%,χ^(2)=45.67,P<0.001)以及血清嗜酸性粒细胞数量增多(23.1%比3.3%,χ^(2)=7.61,P<0.01)。结论本研究系统性描述了中国成人EoE患者的临床特征,其疾病严重程度较西方国家普遍较轻,预后较好。本研究未观察到年轻患者和老年患者之间的临床表现和预后的显著差异。临床上可以通过症状、合并过敏性疾病情况以及血清嗜酸性粒细胞的水平,与反流性食管炎相鉴别。对于可疑EoE的患者人群,内镜下食管活检将有助于早期诊断。Objective Eosinophilic esophagitis(EoE),an allergen/immune-mediated chronic disorder of the esophagus,is witnessing an incremental rise in its global incidence.However,data in China are very limited.This study aimed to clarify the characteristics of EoE in Chinese adults at our medical center.Methods We collected information,including clinical characteristics and endoscopic findings,relative to all cases of adult patients who met the pathological diagnostic criteria for EoE at our institution from January 2019 to May 2024.Patients diagnosed with reflux esophagitis(RE)were matched in a 1∶1 ratio based on age and sex,and comparisons were made between the two groups.Results The overall detection rate of EoE in our hospital was approximately 0.05%,with a trend increasing yearly.In total,61 patients met the diagnostic criteria for EoE,of whom 42(68.9%)were male.The median age was 53 years.The clinical manifestations of EoE patients were diverse,with common symptoms including dysphagia,acid reflux,and upper abdominal pain.Serological examination revealed that 23.1%(9/39)of patients had increased absolute eosinophil counts.Allergic diseases were observed in 73.8%(45/61)patients.Most patients exhibited typical mucosal changes in the esophagus during endoscopy,the median EREFS score was 3 points.The most commonly administered treatment included proton pump inhibitors,and 13 patients received steroid treatment.During a follow-up period,42 patients(68.9%)exhibited clinical symptom improvement or pathological remission.In comparison to Western countries,patients with EoE in China typically presented with milder disease severity and a more favorable prognosis.No significant differences were observed between younger and older adult groups regarding clinical symptoms,the proportion of comorbid allergic diseases,medications,or the rate of improvement(P for all>0.05).Additionally,patients with EoE more commonly presented with dysphagia(29.5%vs.1.6%,χ^(2)=15.96,P<0.001),comorbid allergic diseases(73.8%vs.13.1%,χ^(2)=45.67,P<0.

关 键 词：嗜酸细胞 食管炎 疾病特征 亚洲 

分 类 号：R571[医药卫生—消化系统]