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中国循证儿科杂志

中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (5): 356-360.

• 论著 • 上一篇    下一篇

儿童嗜酸性粒细胞性胃肠炎22例病例系列报告

龙云，王震，梅少华，李传应，吴成   

  1. 安徽省儿童医院消化内科 合肥，230051
  • 收稿日期:2020-06-30 修回日期:2020-10-23 出版日期:2020-10-25 发布日期:2020-10-25
  • 通讯作者: 吴成

22 cases of children's eosinophilic gastroenteritis: A case series report

LONG Yun, WANG Zhen, MEI Shaohua, LI Chuanying, WU Cheng   

  1. Department of Gastroenterology of Anhui Provincial Children's Hospital, Hefei 230051, China
  • Received:2020-06-30 Revised:2020-10-23 Online:2020-10-25 Published:2020-10-25
  • Contact: WU Cheng

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摘要： 目的：总结儿童嗜酸性粒细胞性胃肠炎（EGE）的临床表现、内镜及病理组织学特点，评估饮食及激素治疗的疗效和预后。方法：回顾性分析安徽省儿童医院消化内科2016年2月至2020年2月住院确诊的EGE患儿的临床资料，包括性别、初诊年龄、病程、确诊时间、临床表现、过敏史、家族史、EGE分型、实验室检查、影像学检查、内镜检查、病理学检查、治疗和随访。结果：22例EGE患儿纳入分析，其中男15例，女7例；中位年龄7岁（3月至13岁）。①消化道常见症状为腹痛（16例，72.7%）、腹泻（13例，59.1%）和腹胀（9例，40.9%）；肠外症状以贫血（10例，45.5%）和体重下降（5例，22.7%）多见。②血清总IgE升高18例（81.8%），外周血嗜酸性粒细胞比例升高15例（68.2%），D-二聚体升高7例（31.8%）。③22例均行胃镜检查，溃疡病变12例（54.6%）,十二指肠黏膜绒毛萎缩3例（13.6%)；14例行结肠镜检查，黏膜正常4例（28.6%），末端回肠受累6例（42.9%）；活检部位以十二指肠及末端回肠检出阳性率（EOS≥20·HPF-1）较高，分别为52.6%和46.2%。④饮食疗法和激素治疗可缓解症状，激素联合饮食治疗可显著降低组织嗜酸性粒细胞的浸润，并较单纯饮食治疗后差异有统计学意义（P＝0.002）；复发率为15.8%。结论：EGE临床症状不具特异性，外周血总IgE及嗜酸性粒细胞比例升高者应考虑EGE的可能性，内镜下消化道多部位、多点活检及组织学检查有助于确诊。

Abstract: ObjectiveTo analyze the clinical manifestations, endoscopic and histopathological characteristics of eosinophilic gastroenteritis（EGE）and to evaluate the efficacy and prognosis of diet and glucocorticoid therapy. MethodsA retrospective analysis was made for clinical data of patients with EGE who were hospitalized in the Department of Gastroenterology of Anhui Provincial Children's Hospital from February 2016 to February 2020, including gender, age at first diagnosis, course of disease, time of diagnosis, clinical manifestations, history of allergy, family history, EGE classification, laboratory examination, imaging examination, endoscopy, pathology, treatment and follow-up. ResultsA total of 22 patients were included into the analysis with 15 males and 7 females， with the median age of 7 years (3 months to 13 years). The most common gastrointestinal symptoms were abdominal pain (16 cases, 72.7%), diarrhea (13 cases, 59.1%) and abdominal distention (9 cases, 40.9%). In addition, the most common extraintestinal symptoms were anemia (10 cases, 45.5%) and weight loss (5 cases, 22.7%). The serum total IgE level, the ratio of eosinophil in peripheral blood and D-dimer were elevated for 18 cases (81.8%),15 cases (68.2%) and 7 cases (31.8%) ，respectively. In gastroscopy, 12 out of 22 cases (54.6%) were ulcers and 3 cases (13.6%) showed atrophy of duodenal villi. In colonoscopy, 4 out of 14 cases (28.6%) showed normal mucosa and 6 cases (42.9%) were affected on the terminal ileum. The positive rate was high(≥20 eos·HPF-1) in duodenum (52.6%) and terminal ileum (46.2%). Diet therapy and glucocorticoid therapy could alleviate symptoms. In particular, glucocorticoid therapy combined with diet could heavily reduce the infiltration of eosinophils in histology, which presented statistically significant differences compared with that of the single diet therapy（P＝0.002）. The recurrence rate reached 15.8%. ConclusionEGE gives no specific clinical symptoms. Possibility of EGE should be taken into consideration for patients with high level of serum total IgE and high ratio of eosinophil in peripheral blood. Multi-point endoscopic biopsy and histological examination are helpful for the diagnosis.

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