嗜酸性粒細(xì)胞性胃腸炎42例臨床分析
發(fā)布時(shí)間：2018-07-27 15:42
【摘要】：目的:通過(guò)回顧性分析大連醫(yī)科大學(xué)附屬第二醫(yī)院近10年間收治的EGE(Eosinophilic gastroenteritis,嗜酸性粒細(xì)胞性胃腸炎)住院患者的臨床特點(diǎn)及治療效果,進(jìn)一步認(rèn)識(shí)EGE,為臨床更有效的診治EGE提供理論依據(jù)。方法:應(yīng)用大連醫(yī)科大學(xué)附屬第二醫(yī)院病案檢索系統(tǒng),檢索2006年1月至2016年11月在本院診斷為EGE的住院患者,共有42例,收集患者的病史資料:一般情況、臨床表現(xiàn)、理化檢查、內(nèi)鏡及病理活檢檢查、發(fā)病至確診時(shí)間、治療情況、復(fù)發(fā)情況。應(yīng)用SPSS22.0統(tǒng)計(jì)軟件,對(duì)外周血嗜酸粒細(xì)胞水平在EGE亞型差異應(yīng)用K-W H非參數(shù)秩和檢驗(yàn),對(duì)胃腸鏡中各部位陽(yáng)性率比較應(yīng)用R×C列聯(lián)表卡方檢驗(yàn),對(duì)治療方式及療效差異進(jìn)行多組獨(dú)立樣本秩和檢驗(yàn)。結(jié)果:1、42例EGE患者中,男女性別比為1:1.8,平均年齡為46.21±15.74歲,年齡分布,40-50歲年齡段高發(fā)。有過(guò)敏史者24例,占57%,既往確診過(guò)敏性疾病者10例,占總數(shù)23.8%。42例患者中黏膜型共37例,占88%,肌層型2例,占5%,漿膜型3例,占7%,所有患者中黏膜型最為多見(jiàn)。2、臨床癥狀以腹痛最多見(jiàn),為38例,占90.4%;其次為腹瀉15例,占35.7%。3、所有患者中36例AECs(absolute eosinophilic counts,嗜酸性細(xì)胞絕對(duì)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。在不同亞型中:黏膜型AECs平均值為(1.51±0.8)×109/L,肌層型為(3.6±0.3)×109/L,漿膜型為(4.35±0.14)×109/L。漿膜型患者AECs水平高于黏膜型患者,H黏膜型-漿膜型=-22,P=0.0080.05/3,差異具有統(tǒng)計(jì)學(xué)意義。4、胃腸鏡不同部位活檢陽(yáng)性率比較:胃鏡:十二指腸陽(yáng)性率胃竇部陽(yáng)性率胃體部陽(yáng)性率,χ2胃=8.93,P=0.0115080.05,差異具有統(tǒng)計(jì)學(xué)意義。腸鏡:回腸末端陽(yáng)性率回盲部陽(yáng)性率直腸陽(yáng)性率降結(jié)腸陽(yáng)性率,χ2腸=17.62,P=0.0005270.05。5、3種治療方式及療效存在差異,H=9.208,P=0.010.05。單純激素治療和聯(lián)合激素治療均優(yōu)于單純對(duì)癥治療,差異具有統(tǒng)計(jì)學(xué)意義(H單純對(duì)癥-單純激素=-2.70,P=0.0070.05/3=0.0167;H單純對(duì)癥-聯(lián)合激素=-2.59,P=0.010.05/3=0.0167)。單純激素治療與聯(lián)合激素治療療效無(wú)差異(H單純激素-聯(lián)合激素=-0.413,P=0.6790.05/3=0.0167)。6、肌層型患者較其他亞型更易復(fù)發(fā),單純對(duì)癥治療的患者較其他治療組易復(fù)發(fā)。結(jié)論:1、EGE女性較男性更易患病,存在食物、藥物過(guò)敏史及過(guò)敏疾病史的患者為易患人群。EGE的患者中黏膜型最為常見(jiàn)。2、腹痛為EGE患者中最常見(jiàn)的癥狀,性質(zhì)主要為絞痛,部位以上腹最多見(jiàn)。3、血液中AECs水平增高為EGE診斷線索,漿膜型AECs水平高于黏膜型。4、胃腸鏡檢查及活檢可確診EGE,但不同部位的活檢陽(yáng)性率存在差異,其中以十二指腸及回腸末端最高。5、單純激素治療及聯(lián)合激素治療效均優(yōu)于單純對(duì)癥治療。
[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 鹵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 鹵1.13) 脳 10 9 / L (mean: 1.81 鹵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 鹵0.8) 脳 10 9 / L, that of muscular layer was (3.6 鹵0.3) 脳 10 9 / L, and that of serosal type was (4.35 鹵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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R57
本文編號(hào)：2148303
[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 鹵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 鹵1.13) 脳 10 9 / L (mean: 1.81 鹵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 鹵0.8) 脳 10 9 / L, that of muscular layer was (3.6 鹵0.3) 脳 10 9 / L, and that of serosal type was (4.35 鹵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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R57
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