摘要目的 分析儿童嗜酸细胞性胃肠炎(EGE)的临床表现、诊断、治疗及预后.方法 对2008年1月至2017年1月首都医科大学附属北京儿童医院消化科收治的71例EGE患儿的临床表现、实验室及影像学检查、内镜下表现、组织病理学检查及治疗预后等情况进行回顾性分析.结果71例EGE患儿男47例(66%),女24例(34%),中位发病年龄9.2(0.2～16.5)岁.常见临床表现主要有腹痛(76%,54/71),呕吐(68%,48/71),纳差(54%,38/71),体重下降(38%,27/71),腹泻(37%,26/71)等.过敏性疾病史或家族史27例(38%).外周血嗜酸细胞(EoS)绝对值中位数为0.4(0~36.8)×109/L,升高27例(38%);血清IgE检测52例[104.3(3.4~3 000.0)×103U/L],升高30例(58%).3例腹腔积液涂片镜检见大量EoS[(41.0±8.5)个/高倍镜视野(HP)].胃镜下表现充血水肿62例(87%)、花斑44例(62%)、糜烂17例(24%)、溃疡16例(23%).组织病理结果示累及十二指肠的37例(52%),胃21例(30%),食管6例(8%),结直肠10例(14%),胃和十二指肠同时受累8例(11%).食管、胃、十二指肠和结直肠黏膜组织EoS计数平均值分别为67、33、40和38个/HP.糖皮质激素治疗34例,症状均取得缓解,平均需14.9 d,11例(32%)复发.结论 EGE临床症状及内镜表现多样,缺乏特异性,胃肠道黏膜组织病理学检查对诊断尤为重要;糖皮质激素治疗疗效较好,但较易复发.

abstractsObjective To summarize the clinical data including manifestations, diagnosis, treatment and prognosis of eosinophilic gastroenteritis (EGE) in children. Methods A retrospective analysis was performed in 71 patients with pathologically proven EGE at Beijing Children's Hospital Affiliated to Capital Medical University from January 2008 to January 2017. Their clinical manifestations, laboratory and imaging examinations, endoscopic findings, histopathological examinations, and treatment were collected and analyzed. Results Among 71 EGE cases, 47 (66%) cases were male and 24 (34%) cases were female, and the median age was 9.2 (0.2-16.5) years old. The main clinical manifestations included abdominal pain (76%, 54/71), vomiting (68%, 48/71), anorexia (54%, 38/71), weight loss (38%, 27/71), and diarrhea (37%, 26/71). There were 27 cases (38%) with a history of allergic diseases or family history. The median absolute value of eosinophil in peripheral blood of the 71 patients was 0.4 (0-36.8)×109/L, and 27 cases (38%) showed an increase in eosinophil counts. Serum IgE was measured in 52 patients (104.3 (3.4-3 000.0)×103U/L), and 30 patients (58%) showed an increase in serum IgE. A large number of eosinophils ((41.0 ± 8.5)/HP) were found in 3 patients'ascites. The endoscopic examination of upper gastrointestinal tract revealed hyperemic edema in 62 cases (87%), plaque in 44 cases (62%), erosion in 17 cases (24%) and ulceration in 16 cases (23%). Histopathologically, in 8 cases (11%) the disease involved both stomach and duodeneum, in 21 cases (30%) involved stomach only, and in 37 cases (52%) involved duodeneum only. In addition, in 6 cases (8%) the disease involved esophagus and in 10 cases (14%) involved colorectum. Microscopically, eosinophil counts averaged 67/HP, 33/HP, 40/HP and 38/HP in esophageal, gastric, duodenal and colorectal mucosa respectively. A total of 34 cases were treated with glucocorticoid, and all these patients had alleviation of symptoms, which occurred within 14.9 days on average, but EGE recurred in 11 cases (32 %). Conclusions The clinical symptoms and endoscopic findings of EGE are diverse and nonspecific. Histopathological examination of gastrointestinal mucosa is particularly important for the diagnosis. Glucocorticoid treatment is effective, but the patients with EGE are prone to relapse.