目的 探讨儿童嗜酸性粒细胞性膀胱炎的临床表现、病理特点与治疗方法。方法 收集2016年1月至2017年3月本院收治的2例嗜酸性粒细胞性膀胱炎患儿临床资料,并结合文献复习进行分析。结果 病例1,男,6岁,间断性肉眼血尿,伴尿频、尿急、排尿困难和腹痛,尿沉渣每高倍视野下可见20～25个红细胞,户尘螨粉尘螨(D1D2)2级IU/mL。病例2,男,7岁,尿频、尿急、尿痛,无血尿、排尿困难和耻骨上疼痛,均无过敏史。2例血常规嗜酸性粒细胞明显增高,骨髓穿刺检查嗜酸性粒细胞均增多,尿培养均阴性,B超、CT、膀胱逆行造影等影像学检查发现膀胱壁不均匀增厚明显,黏膜弥漫性病变。膀胱镜检显示膀胱容量变小,未见占位性病变,膀胱底及膀胧颈部黏膜发红,病变区活组织检查病理学提示黏膜水肿,嗜酸性粒细胞大量浸润至固有肌层,及局灶性肌坏死。病例1给予抗生素,西地利嗪并辅以6周剂量递减的强的松治疗; 病例2仅给予抗生素,西地利嗪治疗。2例术后随访6个月,排尿异常症状消失,B超,CT影像学未见膀胧壁增厚及占位性病变。结论 儿童嗜酸性粒细胞性膀胱炎临床少见,易误诊为膀胱非特异性炎症及膀胱占位性病变,膀胱镜检查与病理学检查是诊断的必要步骤,治疗以抗炎、抗过敏及皮质激素非特异性药物保守治疗为主。
Objective To explore the clinical features,pathological examinations and treatments of eosinophilic cystitis. Methods Two male cases of eosinophilic cystitis were reviewed from January 2016 to March 2017. Results Case 1,6-year-old,had intermittent hematuria with urinary frequency,urgency,difficult urination and abdominal pain; Case 2,7-year-old,complained of urinary frequency,urgency,urine pain,dysuria and pubic bone pain.Neither had any history of allergy.Counts of eosinophils increased obviously.Bone marrow biopsy indicated eosinophil increased,urine culture was negative,urine microscopy examination,6-year-old boy of every 20 to 25 red blood cells at a high magnification and household dust mites(D1D2)level 2 IU/ml.Ultrasound,computed tomography(CT)and cystography showed that bladder wall became thickened obviously with diffuse mucosal lesions.Microscopic examination indicated bladder capacity decreased and there was no occupying lesion.Mucosal redness was found at bottom and neck of bladder.And biopsy pathology revealed mucosal edema,numerous eosinophils infiltrating through intrinsic muscle layer and focal necrosis.Case 1 received cetirizine hydrochloride supplemented by 6-week decreasing doses of prednisone treatment while case 2 had cetirizine hydrochloride alone.During a postoperative follow-up period of 6 months,abnormal symptoms of micturition disappeared.Neither ultrasound nor CT revealed no wall thickening or occupying lesions. Conclusion Eosinophilic cystitis is rare in children.Easily misdiagnosed as nonspecific inflammation and bladder occupying lesions,it is definitely diagnosed by cystoscopy and biopsy pathology.Anti-inflammatory,anti-allergic and cortical hormone nonspecific drugs are routinely offered.
