腹水型嗜酸粒细胞性胃肠炎6例临床诊治分析并文献复习

发布时间：2018-03-16 18:09

本文选题：嗜酸粒细胞性胃肠炎　切入点：腹水　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：嗜酸性粒细胞性胃肠炎（Eosinophilic gastroenteritis，EG）是指胃壁和（或）肠壁的某些部分以嗜酸性粒细胞浸润为特征的慢性疾病，伴或不伴外周血中嗜酸粒细胞数量的增加。EG临床少见，且腹水型EG患者更少见，患者临床表现复杂，无特异性，临床症状与病变累及的部位、范围及程度有关，可累及整个消化道，常见于小肠和胃，极易误诊、漏诊，应引起临床医师的重视。本文通过对我院收治的腹水型EG患者的临床资料进行分析，探讨腹水型EG的临床表现、实验室检查及胃肠病变的临床特点，从而提高对腹水型EG患者发现率，使患者尽早获得诊断治疗，避免误诊、漏诊。方法：回顾性分析总结我院1999年11月到2013年7月符合EG诊断标准的住院患者32例。年龄从19岁到79岁。其中男性15例，女性17例。以腹水为主要表现病例6例，对该6例EG病例进行详细的病例分析，其内容有既往史、过敏史、临床表现、外周血象嗜酸性粒细胞数量及比例、影像学检查、内镜结果、以及疾病的诱因。结果：嗜酸性粒细胞性胃肠炎患者多有诱因或过敏史，本组患者中，1例患者有过敏性鼻炎史，1例患者部分青霉素过敏，1例患者有哮喘病史，1例患者有明确食物诱因，在食用海带后诱发；另有1例无明确过敏史及食物药物诱因，但发病时出现丘疹等过敏性症状。 EG的临床表现复杂多样，常表现为腹痛，恶心，呕吐，消化不良，腹泻，吸收不良，胃肠道出血，蛋白质丢失，体重减轻，腹水等。分析本组6例患者的临床表现，腹水合并腹痛（100%），有腹泻症状（74%）、腹胀、恶心呕吐、反酸、烧心、嗳气等胃肠道症状，以及全身症状，如发热等。实验室检查包括白细胞计数（9.06-19.96）×109/L，外周血嗜酸性粒细胞绝对值及比例升高，绝对数（2.30-13.57）×109/L，嗜酸粒细胞比例25.4%-68%，本组患者临床数据见表4。EG患者可伴或不伴外周血嗜酸性粒细胞升高，应检测血常规变化，否则可能无法发现外周嗜酸性粒细胞增多，导致误诊、漏诊。 6例患者均行骨髓检查，结果显示骨髓有核细胞增生明显活跃，嗜酸性粒细胞比值增高，细胞形态正常；红系增生异常活跃，各阶段百分比正常；淋巴细胞计数正常，单核细胞正常。5例患者合并白蛋白减少，1例血沉异常。6例患者均行风湿因子、免疫球蛋白及补体检查，IgM下降者2例。CRP、肿瘤标志物（CEA、AFP、CA125、CA19-9）、血尿淀粉酶及脂肪酶，大小便常规检查均正常。 6例患者均行腹水检查，均为渗出液，5例外观呈淡黄色，1例为深黄色腹水，李凡他试验均阳性，蛋白36-46.6g/L，细胞数（1000-3000）×109/L，腹水涂片可见大量嗜酸粒细胞浸润，嗜酸粒细胞分类计数占有核细胞总数的54-90%，未见肿瘤细胞。 6例患者行内镜活检，显示粘膜疏松水肿，黏膜层可见大量嗜酸粒细胞浸润。4例患者行肠镜检查，结果提示黏膜充血、水肿、肠病增生及狭窄，病理提示嗜酸粒细胞浸润。本组4例存在误诊，误诊率为67%，原因多由于腹水型临床病例少见，临床表现缺乏特异性，临床医师缺乏认识，当患者出现腹水时，没能及时行细胞分类计数检查，因此EG患者合并伴腹水时，腹水离心沉淀涂片染色，同时进行细胞分类计数对诊断具有重要意义。 6例患者激素治疗后效果较好，于5到7天内消化道症状缓解，7到15天腹水可完全消失，复查外周血嗜酸粒细胞基本正常，白细胞数（8.3±1.7）×109/L，嗜酸粒细胞绝对值（0.35±0.12）×109/L，嗜酸粒细胞占白细胞总数（3.6±1.2）%，与治疗前相比差异有统计学意义（P0.05）。结论：腹水型EG的患者临床罕见，患者症状不典型，无特异性，诊断困难，易误诊、漏诊，结合胃肠道组织病理学检查及腹水检查可确诊，治疗主要依靠激素，效果良好。
[Abstract]:Objective: eosinophilic gastroenteritis (Eosinophilic gastroenteritis EG) refers to the stomach wall and (or) some parts of the intestinal wall with eosinophilic chronic disease characterized by eosinophil infiltration, with or without peripheral blood eosinophils in the number of eosinophil cell increased.EG and abdominal type clinical rare, more rare in patients with EG patients, with complicated clinical manifestations, nonspecific clinical symptoms and lesions involving the site, range and degree, can affect the entire digestive tract, common in stomach and small intestine, easy misdiagnosis, missed diagnosis, which should be paid attention to. In this paper, through the analysis of the clinical data of our hospital patients with ascites EG to investigate the clinical manifestations, EG ascites, clinical features and laboratory examination of gastrointestinal diseases, so as to improve the detection rate of ascites in patients with EG, patients get early diagnosis and treatment, to avoid misdiagnosis and missed diagnosis.
Methods: a retrospective analysis of our hospital from November 1999 to July 2013 were summarized with EG diagnostic criteria in 32 patients. Age from 19 to 79 years old. There were 15 males and 17 females. In 6 cases of ascites as the main case, conduct a detailed analysis of the case of the 6 EG cases, the contents of a previous history, allergy history, clinical manifestation, peripheral blood eosinophils and eosinophil number ratio, the results of imaging examination, endoscopy, and the cause of the disease.
Results: the patients with eosinophilic gastroenteritis have many causes or allergies, this group of patients, 1 patients had a history of allergic rhinitis, 1 patients of allergic to penicillin, 1 patients had a history of asthma, 1 cases of patients with clear food causes, induced in edible kelp; another 1 cases without clear allergy the history of food and drug incentives, but the onset of rash and other allergic symptoms.
The clinical manifestations of EG are complicated, often manifested as abdominal pain, nausea, vomiting, indigestion, diarrhea, malabsorption, gastrointestinal bleeding, protein loss, weight loss, ascites. Clinical analysis of 6 cases of patients with ascites, abdominal pain (100%), with diarrhea (74%), abdominal distension, nausea vomiting, acid reflux, heartburn, belching and other gastrointestinal symptoms and systemic symptoms, such as fever and so on.
Laboratory tests including white blood cell count (9.06-19.96) * 109/L, peripheral blood eosinophils and absolute eosinophil ratio increases, the absolute number of (2.30-13.57) * 109/L, the percentage of eosinophil in 25.4%-68%, this group of patients with clinical data table 4.EG patients with or without peripheral blood eosinophils increased. Should detect the changes of blood, or it may not be found in peripheral eosinophilia, lead to misdiagnosis and missed diagnosis.
6 patients underwent bone marrow examination showed bone marrow nucleated cell proliferation activity, eosinophil ratio increased, normal cell morphology; erythroid hyperplasia is unusually active, the percentage of normal stage; normal lymphocyte count, monocyte.5 patients with normal albumin decreased, 1 cases of.6 patients were abnormal ESR for rheumatoid factor, immunoglobulin and complement, IgM decreased in 2 cases of.CRP, tumor markers (CEA, AFP, CA125, CA19-9), amylase and lipase, urine routine examination were normal.
6 patients underwent ascites, 5 cases were exudate, the appearance of pale yellow, deep yellow ascites in 1 cases, and all he Li test were positive, 36-46.6g/L protein, cell number (1000-3000) * 109/L ascites smear showed a large amount of eosinophilic infiltration of eosinophils in nucleated cells the total number of 54-90%, no tumor cells.
6 patients underwent endoscopic biopsy, showing loose mucosa edema and a large number of eosinophil infiltration in mucosa..4 patients underwent colonoscopy. The results showed mucosal congestion, edema, bowel disease hyperplasia and stenosis, and pathology showed eosinophil infiltration.
The group of 4 patients are misdiagnosed, the misdiagnosis rate was 67%, the reason because of clinical cases of ascites is rare, the lack of specific clinical manifestations, lack of awareness of clinicians, patients with ascites, failed to timely for cell counting and classification examination, so EG patients with ascites and ascites centrifugation smear staining, and cell classification the count has important significance for the diagnosis.
Results 6 patients after hormone therapy in 5 to 7 days of gastrointestinal symptoms, 7 to 15 days of ascites can be completely disappeared, after peripheral blood eosinophils was normal, the number of white blood cell (8.3 + 1.7) * 109/L, eosinophil absolute value (0.35 + 0.12) * 109/L eosinophilic cells, accounting for the total number of white blood cells (3.6 + 1.2)%, compared with before treatment, the difference was statistically significant (P0.05).
Conclusion: the patients with ascites type EG are rare. Their symptoms are atypical, nonspecific, difficult to diagnose, easy to misdiagnose, missed diagnosis, combined with gastrointestinal histopathological examination and ascites examination, they can be diagnosed. Treatment is mainly based on hormones, and the effect is good.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R57

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