临床儿科杂志 ›› 2015, Vol. 33 ›› Issue (6): 583-.doi: 10.3969 j.issn.1000-3606.2015.06.021

• 罕见病 疑难病 • 上一篇    下一篇

儿童嗜酸细胞性胃肠炎2 例分析并文献复习

朱碧溱,白海涛,吴谨准,许锦平   

  1. 厦门大学附属第一医院儿科( 福建厦门 361000)
  • 收稿日期:2015-06-15 出版日期:2015-06-15 发布日期:2015-06-15

Clinical analysis of eosinophilic gastroenteritis in two children and review of literature

ZHU Bizhen, BAI Haitao, WU Jinzhun, XU Jinping   

  1. Department of Pediatrics, The First Affiliated Hospital of Xiamen University, Xiamen 361000, Fujian, China
  • Received:2015-06-15 Online:2015-06-15 Published:2015-06-15

摘要: 目的 探讨儿童嗜酸细胞性胃肠炎的临床病理特点、治疗及预后。方法 回顾性分析2例儿童嗜酸细胞性胃肠炎的临床表现、实验室检查、内镜病理结果、治疗经过及预后,并结合文献复习进行分析。结果 2例患儿发病年龄分别为13岁、14岁,例1为男性患儿,以急性胰腺炎起病,例2为女性患儿,有食物过敏史,以不明原因腹水起病;2例患儿外周血嗜酸性粒细胞比例均显著升高(45.9%~64.8%),血清IgE均明显升高(246~393 IU/ml);2例患儿的骨髓细胞学检查均提示嗜酸性粒细胞比例增加;例1行胃镜、例2行胃镜和肠镜,内镜检查均提示胃肠道黏膜慢性炎症,例1病理活检提示十二指肠黏膜嗜酸性粒细胞浸润,例2病理活检提示胃肠道多处黏膜嗜酸性粒细胞浸润。2例患儿经食物回避、激素抗炎及抗过敏等综合治疗1周左右病情均明显缓解,复查血常规嗜酸性粒细胞均降至正常,例1随访24个月,例2随访2个月,病情均未见反复。结论 儿童嗜酸细胞性胃肠炎临床表现及内镜所见缺乏特异性,不明原因的胃肠道症状伴外周血、骨髓嗜酸性粒细胞比例升高时应考虑到该病可能,腹水及内镜黏膜活检见嗜酸性粒细胞浸润,排除其他可能的疾病则可明确诊断。

Abstract: Objective To explore the clinical-pathological characteristics, treatment and prognosis of eosinophilic gastroenteritis in children. Methods The data of clinical manifestation, laboratory examination, endoscopy, biopsy, management and prognosis from 2 pediatric patients with eosinophilic gastroenteritis were retrospectively analyzed. Related articles were reviewed. Results The age of two patients was 13 and 14 years old. Case 1 was male and had an onset with acute pancreatitis. Case 2 was female with a history of food allergy and had an onset with unexplained ascites. Both patients presented with significantly increased peripheral eosinophil count (45.9%-64.8%) and serum IgE (246-393 IU/ml). Bone marrow cytology showed increased proportion of eosinophils in both patients. Gastroscopy was performed in case 1 while gastroscopy and colonoscopy endoscopy were performed in Case 2 and the results indicated eosinophilic infiltration in duodenum. Duodenal mucosa biopsy showed eosinophilic infiltration in case 1 while gastrointestinal pathology biopsy showed multiple mucosal eosinophil infiltration in case 2. After the therapy of food avoidance, steroid and anti-allergic drugs, both patients had complete remission 1 week later. Meanwhile the peripheral eosinophil count was decreased to normal. Case 1 was followed up for 24 months, and case 2 was followed up for 2 months. Both patients showed no evidence of relapse. Conclusions The clinical manifestation and endoscopic examination of eosinophilic gastroenteritis in children are protean and lack of specificity. Unexplained gastrointestinal symptoms accompanied with eosinophilia may suggest the possibility of eosinophilic gastroenteritis. Eosinophilic infiltration in ascites and gastrointestinal mucosa strongly indicate the diagnosis of eosinophilic gastroenteritis. After exclusion of other possible diseases, the definite diagnosis can be made.