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JACI Pract:嗜酸细胞性食管炎诊治:成人优于儿童

2015-02-02 houqiuke 丁香园

嗜酸细胞性食管炎是一种以食管嗜酸性粒细胞增多(每高倍视野多于15个嗜酸性粒细胞)为主要特征的疾病,抑酸药治疗无效。多项研究已证实,嗜酸细胞性食管炎患者的临床表现具有年龄差异,但是国际胃肠病研究小组以及美国胃肠病学大学发布的指南对初始治疗以及转诊病人的建议并未有太大区别。 美国Ichan医学院过敏与临床免疫学的Rassbach教授进行了一项研究,提示嗜酸细胞性食管炎的诊断与治疗具有显著年龄

嗜酸细胞性食管炎是一种以食管嗜酸性粒细胞增多(每高倍视野多于15个嗜酸性粒细胞)为主要特征的疾病,抑酸药治疗无效。多项研究已证实,嗜酸细胞性食管炎患者的临床表现具有年龄差异,但是国际胃肠病研究小组以及美国胃肠病学大学发布的指南对初始治疗以及转诊病人的建议并未有太大区别。

美国Ichan医学院过敏与临床免疫学的Rassbach教授进行了一项研究,提示嗜酸细胞性食管炎的诊断与治疗具有显著年龄差异,文章最近发表在J Allergy Clin Immunol Pract上。

该回顾性队列研究共纳入了2009-2011年转诊中心的426名(包括儿童和成人)食管嗜酸性粒细胞增多症患者,所有患者至少存在1种或以上食管炎症状,如胃酸反流或上消化道功能紊乱等,并进行了食管组织活检。根据年龄差异,对所有食管嗜酸性粒细胞增多症患者进行诊断和治疗分析。

研究结果显示,79.6%(336/426)的患者食管组织活检每高倍视野多于15个嗜酸性粒细胞,该结果与年龄无关。然而,在因过敏症状严重而转诊、开始口服激素治疗时间以及反复组织活检等方面比较,成人显著低于儿童患者,差异有统计学意义。

随着年龄的增加,过敏体质、活检嗜酸性粒细胞计数达到峰值等差异值有所下降,但是相比仍具有统计学意义。活检前8周限制质子泵抑制剂摄入试验并没有改变因年龄差异而导致的过敏性转诊以及反复组织活检的几率。

上述研究结果表明,有症状性食管嗜酸性粒细胞增多症的诊断与治疗在不同年龄患者中存在着一定差异。成人在诊断为嗜酸细胞性食管炎的患者中因过敏症状而转诊、应用激素治疗、反复组织活检等方面均少于儿童患者。

综上所述,嗜酸细胞性食管炎的诊断与治疗具有年龄差异,然而尚需进一步研究。年龄差异所造成的在治疗方法上的长期影响尚属未知,但是不同的治疗方法可以明显改变疾病的自然进程,建议在今后嗜酸细胞性食管炎的指南制定中考虑年龄因素的影响。

原始出处:

Rassbach W1, Rubenstein JH2, Elkins M3, DeMatos V4, Greenson JK5, Greenhawt M6.Age-based Differences in the Diagnosis and Management of Esophageal Eosinophilia.J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):81-87.e1. doi: 10.1016/j.jaip.2014.06.019. Epub 2014 Oct 29.

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    2015-02-23 orthoW

    不错的文章,学习了

    0

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    2015-02-04 zhouqu_8
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