以上消化道溃疡为表现的儿童非食管嗜酸性粒细胞胃肠炎临床分析  

Clinical analysis of non-esophageal eosinophilic gastrointestinal disorder in children manifested by upper gastrointestinal ulcer

作　　者：葛海霞[1] 金忠芹[1] 陆惠钢[1] 周婷婷 吴婷婷 张闽[2] GE Haixia;JIN Zhongqin;LU Huigang;ZHOU Tingting;WU Tingting;ZHANG Min(Digestive Department,Children's Hospital of Soochow University,Suzhou 215000,Jiangsu,China;Pathology Department,Children's Hospital of Soochow University,Suzhou 215000,Jiangsu,China)

机构地区：[1]苏州大学附属儿童医院消化科,江苏苏州215000 [2]苏州大学附属儿童医院病理科,江苏苏州215000

出　　处：《右江医学》2025年第3期245-250,共6页Chinese Youjiang Medical Journal

摘　　要：目的总结以上消化道溃疡为表现的儿童非食管嗜酸性粒细胞胃肠炎(Non-EoE-EGID)的临床特征。方法回顾性分析2013年7月1日至2023年6月30日10年间苏州大学附属儿童医院17例以上消化道溃疡为表现的Non-EoE-EGID住院患儿的症状、体征、实验室及影像学资料、胃肠镜检查结果、病理检查结果、治疗及随访资料。结果以上消化道溃疡为表现的Non-EoE-EGID最常见的症状是腹痛,其次是恶心呕吐及贫血。其外周血嗜酸性粒细胞(EOS)计数增高占82.4%,总IgE升高占64.7%,溃疡的部位以十二指肠球部最多见,其次是胃窦部。17例患儿中有1例外周血嗜酸性粒细胞正常的患儿误诊为阑尾炎,另1例十二指肠球部巨大溃疡者合并消化道大出血。17例患儿糖皮质激素治疗1周后,消化道症状消失,外周血嗜酸性粒细胞计数降至正常,但停药后容易复发及产生糖皮质激素依赖,其中1例患儿需口服硫唑嘌呤维持治疗。结论以上消化道溃疡为表现的儿童Non-EoE-EGID溃疡最容易发生的部位是十二指肠球部,部分病例外周血嗜酸性粒细胞计数可正常,容易漏诊或误诊,对难治性消化性溃疡需考虑Non-EoE-EGID的可能,多点多部位深点活检及组织学检查有助于诊断。Objective To summarize the clinical characteristics of non-esophageal eosinophilic gastrointestinal disorder(Non-EoE-EGID)in children manifested by upper gastrointestinal ulcer.Methods Retrospective analysis was conducted on the symptoms,signs,laboratory and imaging data,gastroscopy results,pathological examination results,treatment and follow-up data of 17 hospitalized children with Non-EoE-EGID manifested by more than 10 years of upper gastrointestinal ulcer from July 1,2013 to June 30,2023 at Children's Hospital of Soochow University.Results The most common symptom of children with Non-EoE-EGID manifested by upper gastrointestinal ulcer was abdominal pain,followed by nausea,vomiting and anemia.Peripheral blood eosinophil(EOS)count elevated in 82.4%of cases,and total IgE level increased in 64.7%of cases.The most common location of the ulcers was duodenal bulb,followed by pyloric antrum of the stomach.Among the 17 children,one child with normal peripheral blood eosinophils was misdiagnosed as appendicitis,and another child with a huge duodenal ulcer complicated with gastrointestinal bleeding.After one week of glucocorticoid treatment,digestive tract symptoms disappeared in 17 children,and blood EOS count decreased to normal,but relapse and glucocorticoid dependence were common after discontinuation of the medication.One child needed oral azathioprine maintenance treatment.Conclusion The most common location of Non-EoE-EGID manifested by upper gastrointestinal ulcer is duodenal bulb.In some cases,peripheral blood eosinophil count could be normal,and it is easy to lead to underdiagnosis or misdiagnosis.For refractory peptic ulcer,the possibility of Non-EoE-EGID should be considered.Multiple biopsies from different points,locations and deep tissue sampling,along with histological examination,are helpful for diagnosis.

关 键 词：非食管嗜酸性粒细胞胃肠炎 嗜酸性粒细胞 上消化道溃疡 儿童 

分 类 号：R725.7[医药卫生—儿科]