39例青少年儿童炎症性肠病临床病例分析

Clinical case analysis of inflammatory bowel diseases in 39 children

目的分析青少年儿童炎症性肠病(IBD)的特点,从而发现小儿IBD最佳诊断方法以提高诊断水平。方法对39例IBD住院患儿根据2000年全国炎症性肠病学术研讨会制定的IBD诊断标准及WHO对CD推荐的诊断要点进行分析,并比较UC和CD差异。结果UC24例,CD15例,男女比为2∶1,临床表现均以腹痛、腹泻、便血为主;病变分布UC以左半结肠为主,CD以末段回肠为主;肠镜检查特点UC为黏膜血管纹理模糊、紊乱、易脆、出血及脓性分泌物附着多见(78.3%),CD病变以不具特异性的息肉样增生及肠腔狭窄为主(87.5%);IBD病理组织检查特点UC为以炎性细胞浸润为主(86.7%),CD最多见的是淋巴细胞、浆细胞及炎性细胞浸润与聚集(73.3%),故肠镜在诊断IBD中作用明显。结论现阶段临床结合肠镜检查及病理组织学检查是诊断青少年儿童IBD的最佳方法。

Objective To acquire the best diagnostic method by analyzing the features of the children's IBD.Methods According to the diagnostic criteria of IBD that was established in national seminar about inflammatory bowel diseases in 2000,diagnostic key points of CD recommended by WHO,39 children with IBD in hospital were analyzed clinically and comparing UC with CD.Results Among 39 patients with IBD,24 patients were UC,15 patients were CD,the ratio of boys and girls was 2:1.The clinical manifestation of UC and CD was usually abdominal pain,diarrhea and hemafecia.Left hemicolon lesion often presented in UC cases;end piece of ileum lesion developed usually in CD cases.The features of enteroscopy were that diminished and distorted mucosal vascular pattern,friability,hemorrhage and purulent exudates usually found in UC(78.3%)and unspecific sarcomyces and narrowing of the lumen often happened in CD(87.5%).The main histological feature of UC is inflammatory cells infiltration(86.7%),while achroacyte plasma cells and inflammatory cells infiltrating were mainly affected in CD(73.3%).Conclusion At the present stage,the combination of clinical manifestation combine with colon endoscopy and histopathologic examination is the best diagnostic way in children's IBD.