本文選題：嗜酸粒細(xì)胞性胃腸炎　切入點(diǎn)：腹水　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：嗜酸性粒細(xì)胞性胃腸炎（Eosinophilic gastroenteritis，EG）是指胃壁和（或）腸壁的某些部分以嗜酸性粒細(xì)胞浸潤為特征的慢性疾病，伴或不伴外周血中嗜酸粒細(xì)胞數(shù)量的增加。EG臨床少見，且腹水型EG患者更少見，患者臨床表現(xiàn)復(fù)雜，無特異性，臨床癥狀與病變累及的部位、范圍及程度有關(guān)，可累及整個消化道，常見于小腸和胃，極易誤診、漏診，應(yīng)引起臨床醫(yī)師的重視。本文通過對我院收治的腹水型EG患者的臨床資料進(jìn)行分析，探討腹水型EG的臨床表現(xiàn)、實(shí)驗(yàn)室檢查及胃腸病變的臨床特點(diǎn)，從而提高對腹水型EG患者發(fā)現(xiàn)率，使患者盡早獲得診斷治療，避免誤診、漏診。 方法：回顧性分析總結(jié)我院1999年11月到2013年7月符合EG診斷標(biāo)準(zhǔn)的住院患者32例。年齡從19歲到79歲。其中男性15例，女性17例。以腹水為主要表現(xiàn)病例6例，對該6例EG病例進(jìn)行詳細(xì)的病例分析，其內(nèi)容有既往史、過敏史、臨床表現(xiàn)、外周血象嗜酸性粒細(xì)胞數(shù)量及比例、影像學(xué)檢查、內(nèi)鏡結(jié)果、以及疾病的誘因。 結(jié)果：嗜酸性粒細(xì)胞性胃腸炎患者多有誘因或過敏史，本組患者中，1例患者有過敏性鼻炎史，1例患者部分青霉素過敏，1例患者有哮喘病史，1例患者有明確食物誘因，在食用海帶后誘發(fā)；另有1例無明確過敏史及食物藥物誘因，但發(fā)病時(shí)出現(xiàn)丘疹等過敏性癥狀。 EG的臨床表現(xiàn)復(fù)雜多樣，常表現(xiàn)為腹痛，惡心，嘔吐，消化不良，腹瀉，吸收不良，胃腸道出血，蛋白質(zhì)丟失，體重減輕，腹水等。分析本組6例患者的臨床表現(xiàn)，腹水合并腹痛（100%），有腹瀉癥狀（74%）、腹脹、惡心嘔吐、反酸、燒心、噯氣等胃腸道癥狀，以及全身癥狀，如發(fā)熱等。 實(shí)驗(yàn)室檢查包括白細(xì)胞計(jì)數(shù)（9.06-19.96）×109/L，外周血嗜酸性粒細(xì)胞絕對值及比例升高，絕對數(shù)（2.30-13.57）×109/L，嗜酸粒細(xì)胞比例25.4%-68%，本組患者臨床數(shù)據(jù)見表4。EG患者可伴或不伴外周血嗜酸性粒細(xì)胞升高，應(yīng)檢測血常規(guī)變化，否則可能無法發(fā)現(xiàn)外周嗜酸性粒細(xì)胞增多，導(dǎo)致誤診、漏診。 6例患者均行骨髓檢查，結(jié)果顯示骨髓有核細(xì)胞增生明顯活躍，嗜酸性粒細(xì)胞比值增高，細(xì)胞形態(tài)正常；紅系增生異�；钴S，各階段百分比正常；淋巴細(xì)胞計(jì)數(shù)正常，單核細(xì)胞正常。5例患者合并白蛋白減少，1例血沉異常。6例患者均行風(fēng)濕因子、免疫球蛋白及補(bǔ)體檢查，IgM下降者2例。CRP、腫瘤標(biāo)志物（CEA、AFP、CA125、CA19-9）、血尿淀粉酶及脂肪酶，大小便常規(guī)檢查均正常。 6例患者均行腹水檢查，均為滲出液，5例外觀呈淡黃色，1例為深黃色腹水，李凡他試驗(yàn)均陽性，蛋白36-46.6g/L，細(xì)胞數(shù)（1000-3000）×109/L，腹水涂片可見大量嗜酸粒細(xì)胞浸潤，嗜酸粒細(xì)胞分類計(jì)數(shù)占有核細(xì)胞總數(shù)的54-90%，未見腫瘤細(xì)胞。 6例患者行內(nèi)鏡活檢，顯示粘膜疏松水腫，黏膜層可見大量嗜酸粒細(xì)胞浸潤。4例患者行腸鏡檢查，結(jié)果提示黏膜充血、水腫、腸病增生及狹窄，病理提示嗜酸粒細(xì)胞浸潤。 本組4例存在誤診，誤診率為67%，原因多由于腹水型臨床病例少見，臨床表現(xiàn)缺乏特異性，臨床醫(yī)師缺乏認(rèn)識，當(dāng)患者出現(xiàn)腹水時(shí)，沒能及時(shí)行細(xì)胞分類計(jì)數(shù)檢查，因此EG患者合并伴腹水時(shí)，腹水離心沉淀涂片染色，同時(shí)進(jìn)行細(xì)胞分類計(jì)數(shù)對診斷具有重要意義。 6例患者激素治療后效果較好，于5到7天內(nèi)消化道癥狀緩解，7到15天腹水可完全消失，復(fù)查外周血嗜酸粒細(xì)胞基本正常，白細(xì)胞數(shù)（8.3±1.7）×109/L，嗜酸粒細(xì)胞絕對值（0.35±0.12）×109/L，嗜酸粒細(xì)胞占白細(xì)胞總數(shù)（3.6±1.2）%，與治療前相比差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論：腹水型EG的患者臨床罕見，患者癥狀不典型，無特異性，診斷困難，易誤診、漏診，結(jié)合胃腸道組織病理學(xué)檢查及腹水檢查可確診，治療主要依靠激素，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.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R57

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本文編號：1621072