胃镜检查诊断消化道疾病儿童临床特征与营养状况分析

Analysis on clinical characteristics and nutriture in children with digestive diseases diagnosed by gastroscope inspection

目的分析胃镜检查诊断为消化道疾病的6～18岁儿童的临床表现、胃镜结果与营养状况关系。方法以2010年8月至2011年1月在重庆医科大学附属儿童医院内镜中心行胃镜检查的儿童为研究对象,进行问卷调查,测量体格生长指标(身高和体重),分析临床表现和胃镜检查结果,参照WHO2007年制定的"儿童生长标准"评价胃镜检查诊断为消化道疾病儿童的营养状况。结果研究期间431例儿童行胃镜检查,排除资料不完整者25例,406例(94.2%)进入分析,其中6～12岁313例,～18岁93例。①244例以慢性反复性腹痛为主诉,病程多在1年以上;急性腹痛就诊59例,以进食后早饱、食欲不振就诊40例;以进食后恶心、呕吐就诊15例。②389/406例(95.8%)胃镜检查结果异常,其中73.3%(285例)为慢性胃炎,十二指肠、食管和急性胃黏膜病变检出率分别为78例(20.1%)、11例(2.8%)和8例(2.1%)。③389例胃镜检查结果异常儿童BMI呈偏态分布;胃部病变、十二指肠病变、食管病变儿童BMI<P5分别占23.7%(71/300例)、16.7%(13/78例)和9.1%(1/11例);在BMI<P5的67例慢性胃炎患儿中,HP相关性慢性胃炎占38.8%(26/67例)。④胃镜检查结果异常的243/389例慢性腹痛儿童中,40例(16.5%)BMI<P5;58/389例急性腹痛儿童中,1例(1.7%)BMI<P5;39/389例以"消瘦"为主诉就诊的儿童中,38例(97.4%)BMI<P5。结论上消化道疾病儿童体型消瘦的比例较高。慢性腹痛、无明原因的体重减轻或消瘦等症状的学龄儿童和青少年需除外慢性上消化道疾病。

Objective To analyze the clinical characteristics and nutriture in gastroscope inspection in 406 children and adolescents diagnosed as digestive diseases. Methods Medical histories and the results of gastroscope inspection were collected in the endoscopy center, Children′s Hospital of Chongqing Medical University from August 2010 to January 2011. The questionnaire investigation was performed. The heights and weights of the children and adolescents were measured by the nurses. The symptoms and results of gastroscope inspection and the nutrition condition of the children diagnosed as digestive diseases were evaluated according to child growth standard made by WHO in 2007. Results A total of 431 children were taken gastroscope inspection, among them 25 children were without complete medical histories. Finally 406 children （94.2%） were enrolled including 313 children aged 6 to 12 years and 93 children aged 13-18 years. ①Chronic recurrent abdominal pain was as the chief complaint in 244 cases with duration over 1 year, 59 cases presented as acute abdominal pain, 40 cases as early satiety after eating and loss of appetite, 15 cases as vomiting after eating and nausea at onset. ② The results of gastroscope inspection were abnormal in 389/406 patients （95.8%）, of them 73.3% showed chronic gastritis, 20.1% of duodenum, 2.8% of esophagus and 2.1% of acute gastric mucosal lesions were found. ③BMI of 389 cases with abnormal gastroscopy showed a skewed distribution. Gastric lesions, duodenal lesions and esophageal lesions in children with BMI P 5 accounted for 23.7%（71/300）, 16.7%（13/78） and 9.1%（1/11）, respectively. HP related chronic gastritis in 67 children with chronic gastritis of BMI P 5 accounted for 38.9% （26/67）. ④ Among 243/389 patients with abnormal endoscopic findings in children with chronic abdominal pain, BMI of 40 patients （16.5%） was less than P5. Among 58/389 patients with acute abdominal pain, BMI of 1 case （1.7%） was less than P 5 . Among 39/389 patients with leanness as the chief complaint, BMI of 38 cases （97.4%） was less than P5. Conclusions The original diseases, especially in gastrointestinal diseases need to be ruled out for the school-aged children and and adolescents with clinical symptoms such as chronic abdominal pain or weight loss with unknown causes.