摘要
目的总结以上消化道症状为主的成人嗜酸细胞性胃肠炎临床特征，以提高对该病的诊断水平。方法检索2010—2014年中国医院知识总库全文数据库．对19例以上消化道症状为主的成人嗜酸细胞性胃肠炎病例的临床表现、外周血嗜酸粒细胞计数及百分比升高情况、腹部CT及腹部超声检查异常情况、病理获得途径、临床分型、确诊及误诊情况进行汇总，并分析其与临床诊断的相关性。结果患者以上腹部疼痛为主，占94．7％，可有上消化道所有症状。嗜酸性粒细胞计数及／或百分比全部升高，达100％。腹部cT有助于发现肌层型和浆膜型病变。病理多数可由胃肠镜检查获得，肌层型病理获得较困难。临床分型以黏膜型为主，也可有肌型及浆膜型病变。本组患者临床误漏诊率较高，误漏诊率达89．5％（17／19），其中，错误诊断发生率为47．4％（9／19），延误诊断发生率为36．8％（7／19），漏诊发生率为5．3％（1／19）。误诊为慢性胃病和胰胆疾病的占比较高，部分错误诊断造成的后果较为严重。多数患者经多次就诊方确诊。结论临床应加强对以上消化道症状为主的成人嗜酸细胞性胃肠炎的认识，注重与其他上消化道疾病和上腹部疾病的鉴别，重视胃镜检查的同时勿忽略结肠镜检查，重视外周血嗜酸粒细胞异常情况，胃肠镜多次多点活检，注意结合腹部CT检查是减少误诊漏诊的关键。
Objective To summarize the clinical characteristics of adult eosinophilic gastroenteritis with the major perfor- mance of upper gastrointestinal tract symptoms, in order to improve the diagnosis level of the disease. Methods CHKD full-text database was retrieved from 2010 to 2014. The clinical information of 19 adult eosinophilic gastroenteritis pa- tients with the major performance of upper gastrointestinal tract symptoms was analyzed, including clinical manifesta- tion, the increase of peripheral blood eosinophilia count and/or percentage, the abnormality of abdominal CT and ab- dominal ultrasound examination, pathologic access, clinical classification, diagnosis and misdiagnosis. The correlation between these information and diagnosis was explored. Results The symptom about 94.7% of the cases in this group was given priority to upper abdominal pain, and all the symptoms of upper gastrointestinal tract maybe occurred in the cases. The eosinophilia count and/or percentage increased in all the patients, up to 100%. Abdominal CT was con- ducive to find muscular type and subserosal disease. Pathology of the most cases could be obtained by endoscope, but the muscular type was obtained difficultly. Clinical classification was given priority to predominant mucosal type, but muscular type and subserosal disease could be observed also. The rate of the clinical mistakenly and missed diagnosis was higher, accounts for 89.5% （17/19）. The error diagnosis rate was 47.4% （9/19）, the delay diagnosis rate was 36.8% （7/19）, and the missed diagnosis rate was 5.3% （1/19）. The rate of the patients which was misdiagnosed as chronic stomach diseases and pancreatic biliary diseases was high, the consequences of the part of the error diagnosis were more serious. Most cases did not to be diagnosed until to see a doctor for many times. Conclusion To strengthen the understanding of the adult eosinopbilic gastroenteritis with the major performance of upper gastrointestinal tract symp- toms, pay attention to identify the other diseases with it, attach great importance to the gastroscopy and not ignore colonoscopy detection, lay stress on peripheral blood eosinophilia granulocyte anomalies, take multi-point biopsy under endoscopy and take endoscopy examination in more than one time, pay attention to combine with abdominal CT exami- nation are the key to reduce the rate of misdiagnosis.
作者
王丽
WANG Li(Department of Gastronterology, Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital, Beijing 101300, China)
出处
《中国医药导报》
CAS
2016年第34期77-80,共4页
China Medical Herald
关键词
成人
嗜酸细胞性胃肠炎
上消化系统症状
诊断
Adult
Eosinophilic gastroenteritis
Upper gastrointestinal tract symptoms
Diagnosis
