嗜酸性粒细胞性胃肠炎42例临床分析

发布时间：2018-07-27 15:42

【摘要】：目的:通过回顾性分析大连医科大学附属第二医院近10年间收治的EGE(Eosinophilic gastroenteritis,嗜酸性粒细胞性胃肠炎)住院患者的临床特点及治疗效果,进一步认识EGE,为临床更有效的诊治EGE提供理论依据。方法:应用大连医科大学附属第二医院病案检索系统,检索2006年1月至2016年11月在本院诊断为EGE的住院患者,共有42例,收集患者的病史资料:一般情况、临床表现、理化检查、内镜及病理活检检查、发病至确诊时间、治疗情况、复发情况。应用SPSS22.0统计软件,对外周血嗜酸粒细胞水平在EGE亚型差异应用K-W H非参数秩和检验,对胃肠镜中各部位阳性率比较应用R×C列联表卡方检验,对治疗方式及疗效差异进行多组独立样本秩和检验。结果:1、42例EGE患者中,男女性别比为1:1.8,平均年龄为46.21±15.74岁,年龄分布,40-50岁年龄段高发。有过敏史者24例,占57%,既往确诊过敏性疾病者10例,占总数23.8%。42例患者中黏膜型共37例,占88%,肌层型2例,占5%,浆膜型3例,占7%,所有患者中黏膜型最为多见。2、临床症状以腹痛最多见,为38例,占90.4%;其次为腹泻15例,占35.7%。3、所有患者中36例AECs(absolute eosinophilic counts,嗜酸性细胞绝对值)增高,占85.7%,AECs增高水平:(0.18-4.5)×109/L,平均值(1.81±1.13)×109/L。在不同亚型中:黏膜型AECs平均值为(1.51±0.8)×109/L,肌层型为(3.6±0.3)×109/L,浆膜型为(4.35±0.14)×109/L。浆膜型患者AECs水平高于黏膜型患者,H黏膜型-浆膜型=-22,P=0.0080.05/3,差异具有统计学意义。4、胃肠镜不同部位活检阳性率比较:胃镜:十二指肠阳性率胃窦部阳性率胃体部阳性率,χ2胃=8.93,P=0.0115080.05,差异具有统计学意义。肠镜:回肠末端阳性率回盲部阳性率直肠阳性率降结肠阳性率,χ2肠=17.62,P=0.0005270.05。5、3种治疗方式及疗效存在差异,H=9.208,P=0.010.05。单纯激素治疗和联合激素治疗均优于单纯对症治疗,差异具有统计学意义(H单纯对症-单纯激素=-2.70,P=0.0070.05/3=0.0167;H单纯对症-联合激素=-2.59,P=0.010.05/3=0.0167)。单纯激素治疗与联合激素治疗疗效无差异(H单纯激素-联合激素=-0.413,P=0.6790.05/3=0.0167)。6、肌层型患者较其他亚型更易复发,单纯对症治疗的患者较其他治疗组易复发。结论:1、EGE女性较男性更易患病,存在食物、药物过敏史及过敏疾病史的患者为易患人群。EGE的患者中黏膜型最为常见。2、腹痛为EGE患者中最常见的症状,性质主要为绞痛,部位以上腹最多见。3、血液中AECs水平增高为EGE诊断线索,浆膜型AECs水平高于黏膜型。4、胃肠镜检查及活检可确诊EGE,但不同部位的活检阳性率存在差异,其中以十二指肠及回肠末端最高。5、单纯激素治疗及联合激素治疗效均优于单纯对症治疗。
[Abstract]:Objective: to retrospectively analyze the clinical characteristics and therapeutic effects of EGE (Eosinophilic gastroenteritis, eosinophilic gastroenteritis in the second affiliated Hospital of Dalian Medical University in recent 10 years. Further understanding of EGEprovides a theoretical basis for more effective clinical diagnosis and treatment of EGE. Methods: a total of 42 inpatients diagnosed as EGE from January 2006 to November 2016 were searched by the Medical record Retrieval system of the second affiliated Hospital of Dalian Medical University. Physical and chemical examination, endoscopy and pathological biopsy, time from onset to diagnosis, treatment and recurrence. Using SPSS22.0 software, K-W H nonparametric rank sum test was used to test the difference of eosinophil level in EGE subtypes, and R 脳 C linked table chi-square test was used to compare the positive rate of different parts of gastroenteroscopy. Multiple independent sample rank sum tests were performed on the difference of treatment methods and efficacy. Results in 42 patients with EGE, the ratio of male to female was 1: 1.8, the average age was 46.21 卤15.74 years, and the age distribution was 40-50 years old. There were 24 cases with history of allergy, 10 cases with anaphylaxis, 37 cases with mucosal type (88%), 2 cases with myometrium type, 5 cases with serosal type, 3 cases with serosal type, 24 cases with anaphylaxis history, 10 cases with chronic allergic disease, 37 cases with mucosal type (88%), 2 cases with muscular layer type (5 cases) and 3 cases with serosal type. The clinical symptoms were abdominal pain (38 cases, 90.4%), followed by diarrhea (15 cases, 35.70.3.The absolute value of eosinophilic cells in 36 cases of all patients) was increased, accounting for 85.7% AECs: (0.18-4.5) 脳 109% L, mean (1.81 卤1.13) 脳 10 9 / L (mean: 1.81 卤1.13) 脳 109% 路L ~ (-1) 路min ~ (-1) 路L ~ (-1) ~ (-1) 脳 10 ~ (9) 路L ~ (-1) 路L ~ (-1) ~ (-1) 脳 10 ~ (9) 路L ~ (-1) 路L ~ (-1). In different subtypes, the mean AECs of mucosal type was (1.51 卤0.8) 脳 10 9 / L, that of muscular layer was (3.6 卤0.3) 脳 10 9 / L, and that of serosal type was (4.35 卤0.14) 脳 10 9 / L. The level of AECs in serous type patients was higher than that in mucosal type patients with H mucosal type and serosal type (0.0080.05 / 3), the difference was statistically significant. 4. Comparison of positive rate of biopsy in different parts of gastroenteroscopy: gastroscopy: duodenal positive rate gastric antral positive rate gastric body positive rate: gastroscope: duodenal positive rate gastric antral positive rate gastric body positive rate The rate of 蠂 2 was 8.93% (P < 0.05) and the difference was statistically significant (P < 0.05). Colonoscopy: ileal terminal positive rate ileocecal positive rate rectal positive rate descending colonic positive rate, 蠂 2 intestinal mucosa 17.62PU 0.0005270.05.5The three treatment methods and curative effect are different. Simple hormone therapy and combined hormone therapy were better than simple symptomatic therapy, and the difference was statistically significant (H simple to symptom-simple hormone -2.70% P0. 0070.05 / 3 0.0167% H simple-combined hormone-2.59% -0.010.05 / 3 / 0.0167). There was no difference between single hormone therapy and combined hormone therapy (H simple hormone combined with hormone 0.46790.05 / 30.0167) .6.The myometrium type patients were more likely to recur than other subtypes, and the patients with simple symptomatic therapy were more prone to relapse than other treatment groups. Conclusion among the patients with the history of food, drug allergy and allergic diseases, the mucosal type is the most common in the patients with age. The abdominal pain is the most common symptom in the patients with EGE, and the most common symptom is colic. The higher AECs level in blood was the diagnostic clue for EGE, and the AECs level in serous type was higher than that in mucosal type .EGE could be diagnosed by gastroenteroscopy and biopsy, but the positive rate of biopsy was different in different parts. Among them, duodenum and ileum were the highest. The curative effect of single hormone therapy and combined hormone therapy was better than that of simple symptomatic therapy.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R57

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