21例嗜酸性粒细胞性胃肠炎临床特征分析

发布时间：2018-05-09 05:36

本文选题：嗜酸性粒细胞性胃肠炎 + 临床表现　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的:归纳、总结和回顾性分析嗜酸性粒细胞性胃肠炎（EosinophilicGastroenteritis,EG）患者的临床特征，提高对本病的认识，为本病提供早期诊断及治疗线索，减少误诊及漏诊。方法:收集大连医科大学附属第一医院在2003年3月至2013年8月收治的21例确诊为EG患者的临床资料，对其病史、临床表现、实验室及影像学检查、内镜及病理检查、治疗等进行整理分析。结果: 1.一般资料：21例EG患者中，男性9例，女性12例，男女比例1：1.33，发病年龄13-77岁，平均44.33±1.66岁，病程2天-9年。根据Klein’s分型标准，将21例EG患者分为3组，Ⅰ组：粘膜型，Ⅱ组：浆膜型，Ⅲ组：混合型（同时累及粘膜层及浆膜层）。Ⅰ组16例，男女比例1:1，发病年龄20-77岁，平均48.25±1.45岁，病程2天-7年；Ⅱ组4例，男女比例1:3，发病年龄19-51岁，平均36.5±1.7岁，病程半个月-5年；Ⅲ组1例，女性，发病年龄13岁，，病程9年。 2.发病诱因及过敏史：21例EG患者中，发病前有明确食物诱因2例，9例（9/21，42.86%）有过敏反应史，包括食物或药物过敏史、哮喘、过敏性鼻炎及皮肤过敏史。有过敏反应史者均来自Ⅰ组与Ⅲ组，Ⅱ组EG患者既往均无过敏反应史。 3.临床表现：21例EG患者均出现不同程度消化道症状，腹痛90.48%，主要位于上腹部，其次为脐周；Ⅱ组及Ⅲ组的EG患者均出现腹痛、腹胀，其他症状依次为食欲下降（57.14%）、恶心呕吐（38.95%）、腹泻（38.95%）、腹胀（28.57%）、体重下降（23.81%）及发热（9.52%）。以腹痛起病15例（15/21，71.43%），以腹泻起病4例（4/21，19.05%），以呕吐起病1例（1/21，4.76%），以腹胀起病1例（1/21，4.76%）。 4.外周血及骨髓检查：21例EG患者中，外周血嗜酸性粒细胞计数升高19例（19/2190.48%），所有患者外周血嗜酸性粒细胞比例均升高，Ⅰ组外周血嗜酸性粒细胞计数与Ⅱ组相比无显著差异（P＞0.05）。11例行骨髓穿刺检查，均提示嗜酸性粒细胞增多，髓象嗜酸性粒细胞比例12.5-41%，以成熟阶段增多为主。 5.血清学检查：21例EG患者中，球蛋白降低14例；11例化验血清CA125，升高5例，均为Ⅱ组及Ⅲ组的EG患者；14例化验血沉正常，8例化验C反应蛋白正常；5例化验血IgE，升高4例；免疫学检查示抗核抗体、抗ENA抗体谱及RF均正常。 6.腹水检查：Ⅰ组16例EG患者均无腹水，Ⅱ组与Ⅲ组的EG患者均出现腹水，腹水细胞学检查嗜酸性粒细胞比例60-95%。 7.内镜及病理组织学检查：21例EG患者中，19例行胃镜检查，胃炎18例，主要表现为充血、水肿、增生及糜烂；胃窦溃疡1例；合并十二指肠病变6例（十二指肠球溃疡1例，十二指肠球炎或降部炎症5例），主要表现为充血、出血点、增生、溃疡；合并食道炎4例，主要表现为食道下段充血；15例行胃镜下粘膜活检，见大量嗜酸性粒细胞浸润11例（胃8例，十二指肠3例）；19例EG患者中行HP检查15例，阳性9例，阴性6例。21例EG患者中，12例行肠镜检查，结肠炎8例，主要表现为结肠粘膜充血、水肿、糜烂及息肉；直肠炎3例，主要表现为直肠充血、水肿及增生；未见异常1例；11例行肠镜下粘膜活检，见大量嗜酸性粒细胞浸润6例（结肠5例，直肠1例）。 8.影像学检查：21例EG患者中，19例EG患者行腹部CT或MRI检查提示腹水5例、胃窦壁增厚2例及小肠壁增厚2例；2例行腹部立位平片提示小肠内见少量积气及小液平；行肺CT提示右侧少量胸腔积液2例。 9.治疗：21例EG患者中，初始非激素治疗12例，激素治疗9例。非激素治疗12例中，后加用激素治疗3例，临床症状无改善1例；非激素治疗组EG患者治疗前后(时间间隔平均6.5±3.06天)外周血嗜酸性粒细胞计数分别为（4.47±3.74）×109/L、（3.31±4.52）×109/L，治疗后外周血嗜酸性粒细胞计数与治疗前相比无明显下降，差异无统计学意义（P＞0.05）。9例激素治疗组EG患者5-7天临床症状明显缓解，治疗前后（时间间隔平均6.3±1.58天）外周血嗜酸性粒细胞计数分别为（5.36±4.96）×109/L、（0.77±0.87）×109/L，治疗后外周血嗜酸性粒细胞计数与治疗前相比下降明显，差异有统计学意义（P＜0.05）；激素减量过程中出现外周血嗜酸性粒细胞计数复升1例，停用激素本病复发再次予激素治疗后缓解1例。结论: 1.EG临床表现缺乏特异性，对于腹痛、食欲下降、恶心呕吐或腹泻的患者伴外周血嗜酸粒细胞升高应警惕本病。 2.EG分类中以粘膜型多见。 3.EG外周血嗜酸性粒细胞计数多数升高，少数嗜酸性粒细胞计数正常。 4.腹水是浆膜型EG的主要临床表现，腹水中嗜酸性粒细胞比例明显升高有助于诊断。 5.EG内镜下主要表现为粘膜充血、水肿、糜烂，无特异性。 6.糖皮质激素治疗有效，停用激素后本病有复发倾向。
[Abstract]:Objective: To sum up, summarize and review the clinical features of EosinophilicGastroenteritis (EG), to improve the understanding of this disease, to provide early diagnosis and treatment clues for this disease, and to reduce misdiagnosis and missed diagnosis.
Methods: the clinical data of 21 EG patients admitted to the First Affiliated Hospital of Dalian Medical University from March 2003 to August 2013 were collected and analyzed. The medical history, clinical manifestation, laboratory and imaging examination, endoscopy and pathology examination, and treatment were collected and analyzed.
Result:
1. general data: of 21 EG patients, 9 men, 12 women, male and female, 1:1.33, age 13-77, average 44.33 + 1.66 years, and 2 days -9 years. According to Klein 's classification standard, 21 patients were divided into 3 groups, group I: mucosa type, group II: serosa type, group III: mixed type (involving mucous layer and serous layer at the same time involving mucous layer and serous layer). Group I, male, male Female ratio 1:1, the age of 20-77 years old, the average age of 48.25 + 1.45 years, the course of 2 days, 2 days, 4 cases, 4 cases, male and female ratio of 1:3, the age of 19-51 years, the average 36.5 + 1.7 years, the course of half a month -5, 1 cases in group III, women, the age 13 years, the course 9 years.
2. the cause of the disease and the history of allergy: among 21 EG patients, there were 2 cases of food inducement before onset, 9 (9/21,42.86%) history of anaphylaxis, including the history of food or drug allergy, asthma, allergic rhinitis, and skin allergy history. All patients with allergic reaction were from group I and group III, and group II of EG had no history of anaphylaxis.
3. clinical manifestations: 21 cases of EG patients have different degree of digestive tract symptoms, abdominal pain 90.48%, mainly located in the upper abdomen, followed by the umbilical week, and group II and group III of EG patients have abdominal pain, abdominal distension, other symptoms are descending appetite (57.14%), nausea and vomiting (38.95%), diarrhea (38.95%), abdominal distention (28.57%), weight decline (23.81%) and fever (9.52%). There were 15 cases of abdominal pain onset (15/21,71.43%), 4 cases of diarrhea onset (4/21,19.05%), 1 cases of vomiting onset (1/21,4.76%), and 1 cases of abdominal distention (1/21,4.76%).
4. peripheral blood and bone marrow examination: in 21 cases of EG, peripheral blood eosinophil count increased in 19 cases (19/2190.48%). The proportion of eosinophils in peripheral blood increased in all patients. There was no significant difference between the peripheral blood eosinophil count in group I and group II (P > 0.05).11 routine bone marrow aspiration, suggesting the increase of eosinophils The ratio of myeloid eosinophils to 12.5-41% is mainly in the mature stage.
5. serological examination: among 21 patients with EG, globulin decreased in 14 cases, 11 cases of serum CA125, 5 cases increased, all were in group II and group III of EG patients; 14 cases were normal, 8 cases of C reactive protein normal; 5 cases of IgE, 4 cases; immunological examination showed anti nuclear antibody, anti ENA antibody spectrum and RF normal.
6. ascites examination: in group I, there were no ascites in 16 cases of EG, and ascites in group EG and group III. The percentage of eosinophils in ascites cytology was 60-95%.
7. endoscopy and histopathological examination: among 21 EG patients, 19 cases underwent gastroscopy and 18 gastritis, mainly characterized by hyperemia, edema, hyperplasia and erosion, 1 cases of gastric antrum ulcers, 6 cases of duodenal lesions (1 cases of duodenal ulcers, duodenoobulitis or descending inflammation 5 cases), mainly characterized by hyperemia, bleeding points, hyperplasia and ulcers. 4 cases of esophagitis were characterized by hyperemia in the lower segment of the esophagus, 15 cases of gastroscopic mucosal biopsy, 11 cases of eosinophil infiltration (8 cases of stomach, 3 duodenum), 19 cases of EG patients, 15 cases, 9 positive, 6.21 cases EG, 12 routine enteroscopy, 8 cases of colitis, mainly manifested by colonic mucous congestion, edema and chyle. Rotten and polyp, 3 cases of proctitis, mainly manifested as rectal hyperemia, edema and hyperplasia, no abnormality in 1 cases, 11 cases of subintestinal mucosal biopsy, 6 cases of eosinophil infiltration (5 cases of colon and 1 cases of rectum).
8. imaging examination: of 21 EG patients, 19 cases of EG patients underwent abdominal CT or MRI examination in 5 cases of ascites, 2 cases of gastric antral wall thickening and 2 cases of small intestinal wall thickening, and 2 routine abdominal radiographs suggesting small amount of accumulation of gas and small fluid level in the small intestine, and 2 cases of pleural effusion on right side of the right side of the lung CT.
9. treatment: of 21 cases of EG, 12 cases of initial non hormone therapy, 9 cases of hormone therapy, 12 cases of non hormone therapy, 3 cases with hormone therapy, 1 cases without improvement of clinical symptoms, and peripheral blood eosinophil count (4.47 + 3.74) x 109/L (3.31 + 4.52) * 109 in peripheral blood before and after treatment in non hormone treatment group EG patients (average time interval 6.5 + 3.06 days) /L, there was no significant decrease in eosinophil count of peripheral blood after treatment. The difference was not statistically significant (P > 0.05). The clinical symptoms of EG patients in.9 patients with EG were significantly relieved, and the eosinophil count of peripheral blood was (5.36 + 4.96) x 109/L and (0.77 + 0.87) x 109/L, respectively, before and after treatment (6.3 + 1.58 days of time interval). The number of eosinophils in peripheral blood after treatment was significantly lower than that before treatment (P < 0.05), and 1 cases of peripheral blood eosinophil count occurred in the process of hormone reduction, and 1 cases were relieved after hormone treatment.
Conclusion:
The clinical manifestations of 1.EG are not specific. For patients with abdominal pain, loss of appetite, nausea and vomiting or diarrhea, the eosinophils in peripheral blood should be elevated.
In the 2.EG classification, the mucous membrane was most common.
Peripheral blood eosinophils count increased most of 3.EG, while eosinophils count was normal.
4. ascites is the main clinical manifestation of serosa EG. The increase of eosinophil percentage in ascites is helpful for diagnosis.
5.EG endoscopic mainly showed mucosal congestion, edema, erosion, and no specificity.
6. glucocorticoid treatment is effective, and after withdrawal of hormone, the disease tends to relapse.

【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

【参考文献】