本文選題：嗜酸性粒細胞性胃腸炎 + 臨床表現(xiàn)��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的:歸納、總結(jié)和回顧性分析嗜酸性粒細胞性胃腸炎（EosinophilicGastroenteritis,EG）患者的臨床特征，提高對本病的認識，為本病提供早期診斷及治療線索，減少誤診及漏診。 方法:收集大連醫(yī)科大學附屬第一醫(yī)院在2003年3月至2013年8月收治的21例確診為EG患者的臨床資料，對其病史、臨床表現(xiàn)、實驗室及影像學檢查、內(nèi)鏡及病理檢查、治療等進行整理分析。 結(jié)果: 1.一般資料：21例EG患者中，男性9例，女性12例，男女比例1：1.33，發(fā)病年齡13-77歲，平均44.33±1.66歲，病程2天-9年。根據(jù)Klein’s分型標準，將21例EG患者分為3組，Ⅰ組：粘膜型，Ⅱ組：漿膜型，Ⅲ組：混合型（同時累及粘膜層及漿膜層）。Ⅰ組16例，男女比例1:1，發(fā)病年齡20-77歲，平均48.25±1.45歲，病程2天-7年；Ⅱ組4例，男女比例1:3，發(fā)病年齡19-51歲，平均36.5±1.7歲，病程半個月-5年；Ⅲ組1例，女性，發(fā)病年齡13歲，，病程9年。 2.發(fā)病誘因及過敏史：21例EG患者中，發(fā)病前有明確食物誘因2例，9例（9/21，42.86%）有過敏反應史，包括食物或藥物過敏史、哮喘、過敏性鼻炎及皮膚過敏史。有過敏反應史者均來自Ⅰ組與Ⅲ組，Ⅱ組EG患者既往均無過敏反應史。 3.臨床表現(xiàn)：21例EG患者均出現(xiàn)不同程度消化道癥狀，腹痛90.48%，主要位于上腹部，其次為臍周；Ⅱ組及Ⅲ組的EG患者均出現(xiàn)腹痛、腹脹，其他癥狀依次為食欲下降（57.14%）、惡心嘔吐（38.95%）、腹瀉（38.95%）、腹脹（28.57%）、體重下降（23.81%）及發(fā)熱（9.52%）。以腹痛起病15例（15/21，71.43%），以腹瀉起病4例（4/21，19.05%），以嘔吐起病1例（1/21，4.76%），以腹脹起病1例（1/21，4.76%）。 4.外周血及骨髓檢查：21例EG患者中，外周血嗜酸性粒細胞計數(shù)升高19例（19/2190.48%），所有患者外周血嗜酸性粒細胞比例均升高，Ⅰ組外周血嗜酸性粒細胞計數(shù)與Ⅱ組相比無顯著差異（P＞0.05）。11例行骨髓穿刺檢查，均提示嗜酸性粒細胞增多，髓象嗜酸性粒細胞比例12.5-41%，以成熟階段增多為主。 5.血清學檢查：21例EG患者中，球蛋白降低14例；11例化驗血清CA125，升高5例，均為Ⅱ組及Ⅲ組的EG患者；14例化驗血沉正常，8例化驗C反應蛋白正常；5例化驗血IgE，升高4例；免疫學檢查示抗核抗體、抗ENA抗體譜及RF均正常。 6.腹水檢查：Ⅰ組16例EG患者均無腹水，Ⅱ組與Ⅲ組的EG患者均出現(xiàn)腹水，腹水細胞學檢查嗜酸性粒細胞比例60-95%。 7.內(nèi)鏡及病理組織學檢查：21例EG患者中，19例行胃鏡檢查，胃炎18例，主要表現(xiàn)為充血、水腫、增生及糜爛；胃竇潰瘍1例；合并十二指腸病變6例（十二指腸球潰瘍1例，十二指腸球炎或降部炎癥5例），主要表現(xiàn)為充血、出血點、增生、潰瘍；合并食道炎4例，主要表現(xiàn)為食道下段充血；15例行胃鏡下粘膜活檢，見大量嗜酸性粒細胞浸潤11例（胃8例，十二指腸3例）；19例EG患者中行HP檢查15例，陽性9例，陰性6例。21例EG患者中，12例行腸鏡檢查，結(jié)腸炎8例，主要表現(xiàn)為結(jié)腸粘膜充血、水腫、糜爛及息肉；直腸炎3例，主要表現(xiàn)為直腸充血、水腫及增生；未見異常1例；11例行腸鏡下粘膜活檢，見大量嗜酸性粒細胞浸潤6例（結(jié)腸5例，直腸1例）。 8.影像學檢查：21例EG患者中，19例EG患者行腹部CT或MRI檢查提示腹水5例、胃竇壁增厚2例及小腸壁增厚2例；2例行腹部立位平片提示小腸內(nèi)見少量積氣及小液平；行肺CT提示右側(cè)少量胸腔積液2例。 9.治療：21例EG患者中，初始非激素治療12例，激素治療9例。非激素治療12例中，后加用激素治療3例，臨床癥狀無改善1例；非激素治療組EG患者治療前后(時間間隔平均6.5±3.06天)外周血嗜酸性粒細胞計數(shù)分別為（4.47±3.74）×109/L、（3.31±4.52）×109/L，治療后外周血嗜酸性粒細胞計數(shù)與治療前相比無明顯下降，差異無統(tǒng)計學意義（P＞0.05）。9例激素治療組EG患者5-7天臨床癥狀明顯緩解，治療前后（時間間隔平均6.3±1.58天）外周血嗜酸性粒細胞計數(shù)分別為（5.36±4.96）×109/L、（0.77±0.87）×109/L，治療后外周血嗜酸性粒細胞計數(shù)與治療前相比下降明顯，差異有統(tǒng)計學意義（P＜0.05）；激素減量過程中出現(xiàn)外周血嗜酸性粒細胞計數(shù)復升1例，停用激素本病復發(fā)再次予激素治療后緩解1例。 結(jié)論: 1.EG臨床表現(xiàn)缺乏特異性，對于腹痛、食欲下降、惡心嘔吐或腹瀉的患者伴外周血嗜酸粒細胞升高應警惕本病。 2.EG分類中以粘膜型多見。 3.EG外周血嗜酸性粒細胞計數(shù)多數(shù)升高，少數(shù)嗜酸性粒細胞計數(shù)正常。 4.腹水是漿膜型EG的主要臨床表現(xiàn)，腹水中嗜酸性粒細胞比例明顯升高有助于診斷。 5.EG內(nèi)鏡下主要表現(xiàn)為粘膜充血、水腫、糜爛，無特異性。 6.糖皮質(zhì)激素治療有效，停用激素后本病有復發(fā)傾向。
[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.

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

【參考文獻】

相關(guān)期刊論文 前7條

1 王永華,黃啟陽,竇艷,趙卡冰,楊云生;嗜酸性胃腸炎臨床分析[J];胃腸病學和肝病學雜志;2005年02期

2 聶艷孝;侯鵬;楊云生;吳志強;殷健;汪濤;郭旭;;嗜酸細胞性胃腸炎臨床分析[J];胃腸病學;2008年05期

3 Iryna S Hepburn;Subbaramiah Sridhar;Robert R Schade;;Eosinophilic ascites,an unusual presentation of eosinophilic gastroenteritis:A case report and review[J];World Journal of Gastrointestinal Pathophysiology;2010年05期

4 段麗萍,呂愈敏,胡傳松,王愛英,葉嗣懋,林三仁;嗜酸細胞性胃腸炎的臨床多樣性[J];中華消化雜志;2001年01期

5 顧偉,陳敏,焦建明;父子同患嗜酸細胞性胃腸炎[J];中華醫(yī)學遺傳學雜志;2005年01期

6 Ming-Jen Chen;Cheng-Hsin Chu;Shee-Chan Lin;Shou-Chuan Shih;Tsang-En Wang;;Eosinophilic gastroenteritis: Clinical experience with 15 patients[J];World Journal of Gastroenterology;2003年12期

7 Hugh James Freeman;;Adult eosinophilic gastroenteritis and hypereosinophilic syndromes[J];World Journal of Gastroenterology;2008年44期

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