嗜酸细胞性胃肠炎的临床表现及病理学形态特征分析

嗜酸细胞性胃肠炎的临床表现及病理学形态特征分析 简介 嗜酸细胞性胃肠炎 EG 是一种少见胃肠道疾病 KLEIN等人按嗜酸细胞浸润程度及部位提出该病分型 OYAIZU等提出过敏机制 TALLEY等人总结分析拟出嗜酸细胞性胃肠炎的诊断标准 现被广泛采用 嗜酸细胞性胃肠炎36例临床分析 研究一 研究目的 探讨嗜酸细胞性胃肠炎的临床特征及诊断方法 研究方法 收集北京大学第三医院消化内科1995 2008年收治的嗜酸细胞性胃肠炎患者36例 对其一般情况 临床症状 实验室检查 消化道造影 内镜及病理表现和治疗随访等情况进行系统性回顾分析 总结 研究结果 嗜酸细胞性胃肠炎多呈急性或亚急性病程 多有过敏性疾病病史或饮食的诱发因素 症状以腹痛 腹泻 恶心呕吐为主 无肠外症状 多数患者外周血嗜酸细胞计数升高 研究结果 内镜下主要为炎性改变 活检部位以小肠特别是十二指肠检出率较高 病理示胃肠道组织以大量嗜酸细胞为主的炎性细胞浸润 其中统计小肠嗜酸细胞 38 HP 治疗首选皮质激素 抗过敏 饮食调整有效 结论 临床怀疑嗜酸细胞性胃肠炎时应在内镜或造影检查时行多部位活检 即使内镜和造影观察正常 也应进行黏膜活检 十二指肠是活检的关键部位 空肠活检亦能提高其诊断率 蔡召强 王爱英 吕愈敏 嗜酸细胞性胃肠炎36例临床分析 J 中国内镜杂志 2010 02 135 139 Eosinophilicgastroenteritis clinicalmanifestationsandmorphologicalcharacteristics aretrospectivestudyof42patients StudyTwo Introduction Eosinophilassociatedgastrointestinaldisorders EGIDs includingeosinophilicesophagitis EE andeosinophilicgastroenteritis EGE areaspectrumofinflammatorydiseaseswhicharerecognizedwithincreasingfrequency characterizedbyeosinophilicinfiltrationofthegastrointestinal GI tractwithvaryingGIsymptoms Introduction Therearevariousclinicalmanifestationsassociatedwiththisdiseasewhichrangefromconditionsrequiringsurgerytoremittingdiscomfortoverlongperiods Endoscopicandradiographicfindingsmayvaryfromnormaltoslightlyabnormalandcasesmayshowdiffuseabnormalities Introduction Insomecases histologicalspecimensaredifficulttoobtain andasaresulttherearemanyinstancesofmisdiagnosisormisseddiagnosisofEGEinclinicalpractice OBJECTIVE Toevaluatetheclinicalmanifestations endoscopic andradiologicalcharacteristics histologicalfeatures andtreatmentofeosinophilicgastroenteritisinadultpatients METHODS Theclinicalrecordsof34patientsdiagnosedaseosinophilicgastroenteritisandeightpatientswhohadabdominalsymptomsandunexplainedperipheraleosinophiliabutnoevidenceoftissueeosinophilicinfiltrationwerereviewedandanalyzed RESULTS Thirteenpatientshadahistoryofasthmaorallergicrhinitis while10hadanallergichistory Peripheraleosinophiliaoccurredin83 3 ofpatients IgEwaselevatedinhalf and 2 macroglobulinwaselevatedin92 8 ofpatients Thesmallintestine 82 4 wasthemostcommonsiteinvolved RESULTS Erythemawasthepredominatefeatureseenonendoscopy Radiographicstudygenerallyrevealedthickeningofthesmallintestinalwall Eosinophiliagenerallyinvolvedthelaminapropriaofmucosa butanylayerofthegutcouldbeaffected eveninsiteswhichhadnormalendoscopicorradiographicappearance RESULTS Inall 15 4 6 39 ofpatientshadHelicobacterpyloriinfection Symptomremissionwithin1weekwasfoundin80 20 25 ofpatientstreatedwithsteroidsandin58 8 10 17 ofpatientstreatedwithsymptomatictreatment Inall 85 7 18 21 ofpatientshadtheireosinophilcountsreturntonormalwithin2weeksinthesteroidtreatmentgroup butnone 0 13 intheothergroup CONCLUSION Eosinophilicgastroenteritismaybemorecommonthanpreviouslyrecognized Multiplebiopsiesobtainedfromthebothnormalandabnormalappearingareasinthesecondpartoftheduodenumarehighlyrecommended Steroidsareeffectiveinrelievingsymptomsandimprovingeosinophilia ZhangL DuanL DingS LuJ JinZ CuiR McNuttM WangA Eosinophilicgastroen