【作者】 李婧；

【导师】 詹学；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2019， 硕士

【摘要】 目的:探讨儿童嗜酸性粒细胞性胃肠炎(eosinophilic gastroenteritis,EG)的临床表现、内镜、病理组织学表现及诊治情况,提高临床医生对该病的认识。对象与方法:回顾性分析2009年01月至2019年01月重庆医科大学附属儿童医院确诊EG患儿的临床资料。结果:1.一般资料:共收集到EG患儿23例,男性多于女性,男女比例为1.9:1,根据Klein’s分型方法分型,黏膜型共20例(87.0%),肌型+黏膜型共1例(4.3%),浆膜型+黏膜型共2例(8.7%)。2.临床表现:腹痛14例(60.9%)、呕吐11例(47.8%)、便血6例(26.1%)、腹泻4例(17.4%)、浮肿4例(17.4%)、腹水2例(8.7%)及呕血1例(4.3%)。3.实验室检查:11/23例外周血EOS百分比增高,12/23例轻度、中度贫血,3/22例CRP升高,11/18例隐血试验阳性,5/7例特异性IgE水平升高,3/4例过敏原斑贴试验阳性。5/6例骨髓细胞学示EOS增多,1/6例缺铁性贫血骨髓象。2例完善腹水检查,腹水涂片均可见大量EOS(94-97%)。4.内镜检查:内镜下见胃肠道充血(22例)、水肿(22例)、红斑(20例)、糜烂(13例)、隆起样改变(7例)、溃疡(5例)、梗阻(2例)、胃肠道壁僵硬(2例)。胃镜下病变部位集中在胃窦、胃体、胃底。5.组织学检查:EOS浸润胃窦8例、十二指肠11例、胃体2例、食管1例、结肠5例、直肠2例,密度分布在20-100个/HP。6.治疗:7/23例予糖皮质激素治疗,8/23例予孟鲁司特钠治疗,4/23例糖皮质激素联合孟鲁司特钠治疗,均获得临床症状缓解,共2例复发。结论:本组EG患儿以男性居多,存在多种非特异性胃肠道症状,黏膜型患儿多以腹痛为首发症状,肌型的患儿以呕吐为首发症状,浆膜型的患儿均以腹水为首发症状。在接诊过程中,必须全面追溯患儿临床症状和体征变化才能有助于早期发现和诊断EG。临床表现与EOS浸润组织深度关系密切。有消化道症状伴外周血、骨髓细胞学EOS升高者应高度警惕EG,大量EOS浸润胃肠道组织是诊断的关键,为避免漏诊建议取多处活检。采用糖皮质激素、孟鲁司特钠或二者联合治疗均有效,但EG患儿可能复发,糖皮质激素及免疫抑制剂对复发患儿仍有效。更多还原

【Abstract】 Objective: To determine the clinical features,laboratory tests,endoscopic manifestations,histopathological changes and treatment of children with eosinophilic gastroenteritis,so as to improve clinicians’ understanding of this disease.Subjects and Methods: The clinical data of children with EG from January 2009 to January 2019 in Children’s Hospital of Chongqing Medical University were retrospectively collected.Results:1.The general information: A total of 23 children with EG were collected,and there were more males than females,the ratio of males to females was 1.9:1.According to Klein’s type,there were 18 cases(87.0%)of mucosa type,1 case(4.3%)of mixed type(also involving the muscle and mucosa),and 2 cases(8.7%)of mixed type(also involving the serosa and mucosa).2.Clinical manifestations: There were 14 cases of abdominal pain(60.9%),11 cases of vomiting(47.8%),6 cases of bloody stool(26.1%),4cases of diarrhea(17.4%),4 cases of edema(17.4%),2 cases of ascites(8.7%),and 1 case of hematemesis(4.3%).3.Laboratory examination: There were 11/23 cases of peripheral blood eosinophil count increased,12/23 cases of mild and moderate anemia,3/22 cases of increased CRP level,11/18 cases of positive occult blood test,5/7 cases of increased specific IgE level,and 2/4 cases of positive atopy patch testing.Bone marrow cytology showed increased EOS in 5/6 patients and iron deficiency anemia in 1/6 patient.Ascites tests were performed in 2patients,and large amounts of EOS(94-97%)were observed in ascites smears.4.Endoscopic examination: Endoscopic examination showed hyperemia(22 cases),edema(22 cases),erythema(20 cases),erosion(13cases),hyperplasia(7 cases),ulcer(5 cases),obstruction(2 cases),and gastrointestinal wall stiffness(2 cases).The lesions were mainly found in the gastric antrum,gastric body,and gastric fundus during gastroscopy.5.Histological examination: EOS infiltrated the gastric antrum in 8cases,duodenum in 11 cases,gastric body in 2 cases,esophagus in 1 case,colon in 5 cases,and rectum in 2 cases,with a density of 20-100/HP.6.Treatment: 7/23 cases were treated with steroids,8/23 cases were treated with monteluster sodium,4/23 cases were treated with both steroids and monteluster sodium,all of their clinical symptoms were significantly relieved,and a total of 2 cases relapsed.Conclusion: The majority of EG children in this group were male,with a variety of non-specific gastrointestinal symptoms.Most of the children with mucosal type had abdominal pain as the first symptom,those with muscle type had vomiting as the first symptom,and those with serosa type had ascites as the first symptom.In the process of diagnosis,it is necessary to comprehensively trace the changes of clinical symptoms and signs of children in order to facilitate the early detection and diagnosis of EG.The clinical manifestations are closely related to the depth of eosinophilic infiltration.Eosinophilic gastroenteritis should be highly suspected in patients with gastrointestinal symptoms accompanied by increased eosinophils in peripheral blood and bone marrow cytology.Large amount of eosinophils infiltration gastrointestinal is the key to diagnosis,and multiple biopsies is recommended to avoid missed diagnosis.Steroids,montelukast sodium,or a combination of the two are effective in treatment.However,the children with EG can relapse,and steroids and immunosuppressant are still effective for children with recurrence.更多还原