嗜酸细胞性胃肠道疾病的临床表现及内镜特点（附84例报告）

Clinical and endoscopic features of eosinophilic gastrointestinal disease (84 cases)

摘要:

目的 分析嗜酸细胞性胃肠道疾病（EGID）的临床表现、内镜下特征及组织病理学特点，以提高对EGID的认识，降低漏诊率和误诊率。方法 回顾性分析84例确诊为EGID的住院患者的一般资料、临床表现、实验室检查、内镜及病理检查、治疗预后及随访等资料。结果 32例（38.1%）有食物药物过敏史或过敏性疾病史，21例（25.0%）发病前有明确诱因。67例（79.8%）入院主诉腹痛。63例（75.0%）外周血嗜酸性粒细胞（EOS）计数增高，71例（84.5%）EOS百分比（EOS%）增高，14例（16.7%）血清学过敏原总免疫球蛋白E（IgE）抗体筛查阳性。68例行腹部超声检查，腹腔积液5例（7.4%），盆腔积液2例（2.9%）。64例行腹部CT检查，胃肠壁增厚13例（20.3%）。10例行小肠CT检查，发现肠壁增厚和狭窄等6例（60.0%）。内镜表现为充血发红、糜烂及溃疡等非特异性表现，病理为大量EOS浸润的慢性黏膜炎，以十二指肠和回肠末端处活检阳性率最高（P < 0.05）。48例激素治疗及36例对症治疗后，均达到临床缓解（P < 0.05），5例患者复发，激素治疗仍然有效。结论 腹痛是EGID患者多见的临床表现，常伴EOS计数增高，影像学检查及内镜表现缺乏特异性，组织活检发现明显EOS浸润，这在诊断中至关重要，糖皮质激素或单纯抗过敏及抑酸治疗，预后良好。

Abstract:

Objective Analyze the clinical manifestations, endoscopic and histopathological features of eosinophilic gastrointestinal disease (EGID) to improve the understanding of the EGID and reduce the rate of missed diagnosis and misdiagnosis.Methods A retrospective analysis was conducted on the patients of general information, clinical manifestations, laboratory tests, endoscopic and pathological examinations, treatment prognosis and follow-up of 84 patients.Results With the history of food and drug allergies or allergic diseases in 38.1% cases (32/84), had a clear predisposition before the onset of illness in 25.0% (21/84). The main clinical symptom was abdominal pain in 79.8% (67/84). Peripheral blood eosinophil (EOS) count increased significantly in 63 cases (63/84, 75.0%) and EOS percentage (EOS%) increased significantly in 71 cases (71/84, 84.5%). 14 cases (16.7%) tested positive for serum allergen total immunoglobulin E (IgE) antibodies. Among the 68 cases of abdominal ultrasoud examination, there were 5 cases (5/68, 7.4%) of ascites and 2 cases (2/68, 2.9%) of pelvis effusion. 64 cases were examined by CT, suggesting thickening of digestive tract wall in 13 cases (13/64, 20.3%), 10 cases were examined by small intestine CT, suggesting thickening and narrowing of digestive tract wall in 6 cases (6/10, 60.0%). Endoscopic manifestations were nonspecific manifestations such as hyperemic redness, erosion and ulceration. The pathological examination showed mucosal inflammation with a large number of EOS infiltration, with the highest positive rate of biopsy at the duodenum and terminal ileum (P < 0.05). Glucocorticoid therapy in 48 cases and symptomatic supportive care in 36 cases, they all achieved clinical remission (P < 0.05). Glucocorticoid therapy remained effective in 5 cases with relapse.Conclusion Abdominal pain is a common clinical manifestation in patients with EGID, often with an elevated EOS count. The imaging and endoscopic findings of EGID lack specificity. Tissue biopsy with a large number of EOS infiltration is critical in the diagnosis. Simple antiallergy with acid-suppressing or application of glucocorticoid therapy has a good prognosis.