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目的分析嗜酸细胞性胃肠炎(EG)的临床特点、诊断要点和治疗预后,并探讨其误诊原因。方法对10例EG患者的病史、临床表现、实验室检查、内镜表现和治疗随诊情况进行分析。结果黏膜型EG患者常以腹痛、腹胀、恶心、呕吐为主要表现,可有腹泻。肌层型以肠梗阻为主要表现,可有腹痛、便闭。浆膜型以腹痛、腹胀、腹水为主要症状,可伴恶心、呕吐、低热等。外周血和骨髓中嗜酸细胞计数明显增高(0.425±0.215,0.306±0.025),以成熟型为主,其变化随症状的有无而增减。血沉、C反应蛋白等指标正常,IgG可下降。腹水为渗出液,可见嗜酸细胞。内镜表现多为黏膜片状糜烂和水肿,以胃窦、十二指肠和回盲部明显,活检可证实大量嗜酸细胞浸润。激素治疗可在1周内迅速缓解症状,并使嗜酸细胞恢复正常。病情可有反复,但预后良好。结论EG临床和内镜表现无特异性,外周血嗜酸细胞、腹水嗜酸细胞,尤其是胃肠黏膜组织中嗜酸细胞增多是诊断的关键。
Objective To analyze the clinical features, diagnosis points and prognosis of eosinophilic gastroenteritis (EG) and to explore the causes of misdiagnosis. Methods The clinical data, clinical manifestations, laboratory findings, endoscopic findings and follow-up of 10 patients with EG were analyzed. Results mucosal EG often abdominal pain, bloating, nausea, vomiting as the main performance, may have diarrhea. Myometrial obstruction as the main performance, may have abdominal pain, they closed. Serosal type to abdominal pain, bloating, ascites as the main symptoms, may be associated with nausea, vomiting, fever and so on. Peripheral blood and bone marrow eosinophil count was significantly higher (0.425 ± 0.215,0.306 ± 0.025), mainly in mature type, the change with the presence or absence of symptoms increases. ESR, C-reactive protein and other indicators of normal, IgG can be decreased. Ascites as exudate, visible eosinophils. Endoscopic performance of mucosal lamellar erosion and edema, to the antrum, duodenum and ileocecal obvious biopsy can confirm a large number of eosinophil infiltration. Hormone therapy can quickly relieve symptoms in 1 week, and make eosinophil return to normal. The condition can be repeated, but the prognosis is good. Conclusions EG has no specific clinical and endoscopic findings. Eosinophilia in peripheral blood, ascites in ascites, especially in gastrointestinal mucosa is the key to diagnosis.