儿童嗜酸粒细胞性胃肠道疾病临床特点及诊断  

Clinical characteristics and diagnosis of eosinophilic gastrointestinal disease in pediatric patients

作　　者：刘秀萍 梁志海[1] Liu Xiuping;Liang Zhihai(Department of Gastroenterology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院消化内科,南宁530021

出　　处：《中华临床医师杂志(电子版)》2024年第11期1012-1018,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：广西自然科学基金项目(2023GXNSFAA026165)

摘　　要：目的探讨儿童嗜酸粒细胞性胃肠道疾病(EGID)的临床特点和诊断。方法对2019年1月至2023年12月在广西医科大学第一附属医院住院确诊的156例该病患儿的临床特点、内镜和病理表现及诊断要点等进行回顾性分析。结果腹痛主要在8~14岁组,血便主要在≤7岁组,差异有统计学意义(P<0.001)。其他临床症状,不同年龄组无统计学差异(P>0.05)。≤7岁组白蛋白下降及外周血嗜酸性粒细胞(EOS)浸润增加较8~14岁组明显,差异有统计学意义(P<0.05)。胃肠道黏膜病理活检,下消化道EOS计数较上消化道增加,差异有统计学意义(P<0.001)。选择内镜阳性部位活检对该病的诊断敏感度低(15.9%),特异度69.4%。以正常同龄儿童为参照,≤7岁患儿较8~14岁患儿对身高和体重影响更大,差异有统计学意义(P<0.05)。病程≤1年和病程>1年比较,病程长对体重影响较大(P<0.05),对身高影响有限(P>0.05)。结论儿童EGID临床表现无特异性,腹痛最常见,幼童血便较大龄儿童多见。实验室检查作用有限,内镜黏膜无特异性改变。内镜下多部位活检及规范的病理高倍镜EOS计数是诊断的关键。Objective To explore the clinical characteristics and diagnostic approaches for pediatric eosinophilic gastrointestinal disease(EGID).Methods A retrospective analysis was conducted on the clinical features,endoscopic and pathological findings,and diagnostic criteria of 156 pediatric patients with EGID who were admitted to the First Affiliated Hospital of Guangxi Medical University from January 2019 to December 2023.Results Abdominal pain was mainly observed in the 8-14 years age group,while blood in stool was mainly observed in the≤7 years age group,with statistically significant differences(P<0.001).There were no statistically significant differences in other clinical symptoms among different age groups(P>0.05).In the group of children aged≤7 years,the decrease in albumin and the increase in peripheral blood eosinophil(EOS)infiltration were more obvious than that in the group of children aged 8 to 14 years,with a statistically significant difference(P<0.05).Gastrointestinal mucosal pathological biopsy showed that the number of EOS in the lower gastrointestinal tract was significantly higher than that in the upper gastrointestinal tract(P<0.001).The sensitivity of the positive endoscopic site biopsy for the diagnosis was relatively low at 15.9%,while the specificity stood at 69.4%.Compared with healthy children of the same age,children aged≤7 years exhibited a significantly more pronounced impact on height and weight than children aged 8-14 years(P<0.05).When comparing patients with a disease duration of≤1 year to those with a duration of>1 year,it was observed that a longer disease duration exerted a greater impact on weight(P<0.05)but had limited influence on height(P>0.05).Conclusion The clinical manifestations of EGID in pediatric patients are not specific,with abdominal pain being the most prevalent symptom.In young children,blood in stool is more common than in older children.Laboratory tests are of limited value,and endoscopic mucosal changes are not specific.Endoscopic biopsies from multiple sites

关 键 词：嗜酸粒细胞性胃肠道疾病 儿童 临床表现 诊断 嗜酸性粒细胞计数 

分 类 号：R725.7[医药卫生—儿科]