嗜酸粒细胞性胃肠炎特点及误诊研究.docVIP

嗜酸粒细胞性胃肠炎特点及误诊研究【摘要】 目的 探讨嗜酸粒细胞性胃肠炎的临床表现及诊断标准，分析误诊原因。方法 分别从临床表现、实验室检查、内镜下表现以及治疗等方面对本组6例患者进行分析，进一步提高对本病的认识。结果 本组6例均经内镜检查并取病理确诊为嗜酸粒细胞性胃肠炎。本组中6例均有明显腹痛，其中3例有腹泻，易误诊为急性胃肠炎；4例有黑便，化验便潜血阳性，易误诊为肠道肿瘤；1例以腹水为主要表现，易误诊为结核性腹膜炎。结论 嗜酸粒细胞性胃肠炎临床表现多种多样，无特异性，常易误诊或漏诊。? 【关键词】嗜酸粒细胞性胃肠炎；临床表现；误诊分析?? Clinical Characteristics and Misdiagnosis Analysis of the Enosinophilic Gastroenteritis LU Lei, ZHANG Ye, DU Rei-ling． Department of Gastroenterology, Beijing Shunyi Hospital, Beijing 101300，China ? 【Abstract】 Objective To study clinical manifestation and diagnosis, and analyze case of misdiagnosis. MethodsSix patients diagnosised as Eosinophilic gastroenteritis（EG） were studied.Clinical manifestation, laboratory tests,endoscopies and therapy were analyzed.Resultssix patients were diagnosised as EG throughout endoscopies. All had obviously abdominal pain and three of them had diarrhea, which were easily misdiagnosised as acute gastroenteritis. Four patients had henatichezia and we easily misdiagnosised them as carcinoma. One case presented with ascites, and it was probably diagnosised as tuberculous peritonitis. Conclusionclinical and endoscopic presentations of EG are not specific, therefore the presense of enosinphilia in peripheral blood and ascites especially in gastrointestinal mucosa strongly indicate the diagnosis.? 【Key words】Enosinophilic gastroenteritis; Clinical manifestation; Misdiagnosis analysis ? 嗜酸粒细胞性胃肠炎（enosinophilic gastroenteritis，EG）是以大量嗜酸细胞浸润胃肠壁为特征的一种少见病[2]。临床表现多种多样，无特异性，以消化系统症状如腹痛、腹泻、恶心、腹部不适等为常见临床表现，伴有消化道不同程度的嗜酸细胞增多或浸润以及外周血嗜酸粒细胞增高等，少数患者因急性腹痛伴胃肠道不全梗阻起病，极易误诊为一般胃炎，结核性腹膜炎或外科急腹症等。现将本科四年来收治的6例EG进行分析，以提高对本病的认识。? 1 临床资料 ? 对本院2003年8月至2007年6月收治的6例诊断明确的EG患者临床资料进行分析，本组男3例，女3例，其中1男1女为夫妻关系，发病前曾有共同食物史。年龄30～59岁，平均43岁。发病时间到确诊时间为35～52 d。EG的诊断根据以下标准[1]：①进食特殊食物后出现胃肠道症状和体征；②外周血嗜酸性粒细胞增多；③组织学证明胃肠道有嗜酸粒细胞增多或浸润；④无胃肠道以外多器官EC浸润，除外寄生虫感染等。? 2 结果 ? 2．1 临床表现 本病临床表现缺乏特异性。病变主要累及胃肠黏膜，典型症状为上腹痛、脐周痛或肠痉挛，恶心呕吐或腹泻，也可有腹胀、贫血、黑便、吸收不良和蛋白丢失性肠病等表现。肌层受累时可出现幽门梗阻或肠梗阻。浆膜层受累可出现腹水[2]。本组中6例均有