嗜酸细胞性胃肠炎27例临床病例分析

Analysis of 27 cases of eosinophilic gastroenteritis

摘要:

目的 探讨嗜酸细胞性胃肠炎（EGE）的临床病例特点，提高对EGE的认识水平和诊治能力。方法 回顾性分析2015年5月－2019年5月于武汉大学人民医院确诊的27例EGE患者的临床表现、实验室检查、超声检查、影像学检查、骨髓穿刺、消化道内镜检查、病理学检查和预后情况等资料，并对其进行随访。结果 27例EGE患者发病年龄（40.78±21.53）岁，其中≥18岁的21例（77.8%），男性多于女性（2∶1），有过敏史或变态反应性疾病4例（14.8%）。临床表现为腹痛24例（88.9%），腹泻14例（51.9%）；病程2 d～8年，中位病程6个月。外周血嗜酸性粒细胞（EOS）增高17例（63.0%），EOS百分比增高17例（63.0%）；13例行外周血免疫球蛋白E（IgE）检验，其中8例（61.5%）升高。14例行腹部超声检查，6例（42.9%）提示腹腔大量积液，腹水均为渗出液，其中4例（66.7%）腹水病理提示EOS增多。25例行CT检查，提示消化道管壁增厚11例（44.0%），腹腔积液11例（44.0%），腹腔淋巴结增大9例（36.0%）。2例行CT小肠造影（CTE）检查，提示病变均位于空肠。25例行内镜及组织活检病理检查，内镜下外观无明显特异性，病变位于胃部11例（44.0%），结直肠7例（28.0%），黏膜充血或红斑共9例（36.0%），糜烂共8例（32.0%）。6例行骨髓穿刺及病理检查，骨髓病理提示4例（66.7%）有EOS浸润。4例有过敏史的患者均行食物剔除治疗。经激素或保守治疗后，病情稳定或好转15例（55.6%），复发6例（22.2%）。非参数检验结果提示：性别、年龄、过敏和临床分型与治疗前后EOS数值变化无关（P > 0.05）；激素治疗与治疗前后EOS数值变化有关（P < 0.05）。结论 EGE患者常以腹痛、腹泻等胃肠道症状就诊，常伴有EOS增高，内镜和影像学检查无明显特异性，但内镜、影像学、腹水、骨髓穿刺及相关病理活检对EGE确诊具有重要作用；糖皮质激素治疗较非糖皮质激素治疗的患者EOS下降更快。

Abstract:

Objective Through investigating the clinical characteristics of eosinophilic gastroenteritis (EGE) to improve understanding of diagnosis and treatment of EGE.Methods A retrospective analysis was conducted on the patients of EGE from May 2015 to May 2019, including the clinical manifestations, laboratory examination, ultrasound, imaging examination, bone marrow puncture, digestive tract endoscopy, the biopsies, the prognosis, the treatment and the follow-up of 27 patients.Results The onset age of 27 patients of EGE was (40.78 ± 21.53) years old, 21 cases (77.8%) were above 18 years old, men were more than women (2∶1), and 4 cases (14.8%) had allergic history or other allergic diseases. The clinical manifestations were abdominal pain in 24 cases (88.9%) and diarrhea in 14 cases (51.9%); the course was 2 d to 8 years, the median course was 6 months. 17 cases (63.0%) of eosinophils (EOS) in peripheral blood were increased, and the percentage of eosinophils (EOS%) was increased in 17 cases (63.0%); 13 cases of peripheral IgE tests were performed and 8 cases (61.5%) were increased. Abdominal ultrasound was performed in 14 cases, 6 cases (42.9%) suggested massive fluid accumulation in abdominal cavity, all of which were exudate, among which 4 cases (66.7%) in pathological ascitic fluid showed the increase of EOS. 25 cases were examined by CT, suggesting thickening of digestive tract wall in 11 cases (44.0%), abdominal effusion in 11 cases (44.0%). There were 9 cases (36.0%) of abdominal lymph node enlargement. 2 cases of CT enterography (CTE) showed that the lesions were located in the jejunum. 25 cases were examined by endoscopy and tissue biopsy, the endoscopic appearance was often not specific, and the lesions were located in the stomach in 11 cases (44.0%), colorectal in 7 cases (28.0%), mucous congestion or erythema in 9 cases (36.0%) and erosion in 8 cases (32.0%). Bone marrow puncture and pathology were performed in 6 cases, 4 cases (66.7%) showed EOS infiltration in bone marrow pathology. All 4 patients with allergic history were treated with food removal. After hormone or conservative treatment, the condition was stable or improved in 15 cases (55.6%) and recurrent in 6 cases (22.2%). The nonparametric test showed that there was no significant difference in EOS change before and after treatment in different sex, age, allergy, clinical classification groups (P > 0.05), while there was significant difference in EOS change between hormone therapy and non-hormone therapy (P < 0.05).Conclusion Gastrointestinal symptoms such as abdominal pain, diarrhea and other gastrointestinal symptoms are often seen in patients with EGE, and EOS are often increased. Endoscopy, imaging features, ascitic fluid, bone marrow and relative pathological biopsies play an important role in the diagnosis of EGE. Glucocorticoid therapy decreased EOS faster than non-glucocorticoid therapy.