炎症性肠病24例

Pediatric Inflammatory Bowel Disease in 24 Children

目的总结儿童炎症性肠病(IBD)的临床特点和诊疗经验,提高儿童IBD的诊疗水平。方法参照2001年中华医学会消化病学会制定的标准,2000年12月-2010年12月重庆医科大学附属儿童医院共确诊IBD患儿24例,通过调阅病例、随访获取资料,并对24例IBD患儿的临床、实验室检查、影像学、内窥镜、组织病理学检查,按照Sutherland指数和Harvey和Bradshow标准疾病活动性评分结果进行回顾性分析。结果 IBD 24例中溃疡性结肠炎(UC)组16例,克罗恩病(CD)组8例;男童略多于女童;IBD主要肠道表现有腹痛、腹泻、便血,主要肠外表现有发热、贫血、关节痛/炎、消瘦、生长发育迟缓;UC组与CD组临床表现差异无统计学意义,仅便血症状UC组占优势。病变侵犯部位:UC病变主要侵犯左半结肠(P=0.027);CD病变可侵犯全消化道任何部位,以回盲部及其周围肠管(P=0.002)和上消化道(P=0.028)受累最为多见。经过积极治疗IBD患儿疾病活动度显著下降,其中英夫利昔单抗对常规治疗无效的UC患儿可迅速控制临床症状。结论儿童IBD的诊断需要对临床、实验室检查、影像学、内窥镜检查及组织病理学检查综合分析,尤其结肠镜和组织病理学检查。儿童IBD积极治疗仍可获得显著疗效。

Objective To find the clinical characters of pediatric inflammatory bowel disease （IBD） and to summarize the experiences of diagnosis and treatment, by evaluating the diversity of clinical manifestations, laboratory test, radiological, endoscopic and histological examina- tion. Methods Twenty - four patients, who were diagnosed as pediatric IBD during Dec. 2000 to Dec. 2010 from Children＇ s Hospital of Chongqing Medical University according to diagnostic criteria established by Chinese Medical Gastroenteric Organization in 2001, were en- rolled and retrospective analysis was made for the diversity of clinical manifestations, the findings from laboratory tests, radiological, endoscopic and histological examinations and their disease activity scores acquired according to Stuherland index and Harvey and Bradshow index. All pa- tients were followed- up. Results There were 16 cases with ulcerative colitis（ UC ） group and 8 cases with Crohn＇s disease（CD） group a- mong these 24 patients, and among them male patients were more than female ones. The most common intestinal manifestations were abdominal pain, diarrhea, hematochezia ; main extraintestinal manifestations were fever, anemia, arthralgia/arthritis, weight loss, and growth retardation. Significant differences on clinical manifestations between UC group and CD group were not found, only hematochezia was more common seen in UC group. The lesion of UC was mainly seen in the left part of the colon（ P = 0. 027 ） , while terminal ileum or jejunoileum （P = 0. 002 ） was more commonly seen in the upper gastrointestinal tract （P = 0.028 ） in the CD group. Significant improvement of disease activity could be a- chieved if regular treatment was given to the patients. Infliximab was effective for the treatment of patients with UC who didn＇t have adequate clinical response despite treatment with conventional therapy. Conclusions In the diagnosis of pediatric IBD, comprehensive assessment on clinical manifestations,laboratory tests, radiological, endoscopic and histological examinations are essential, especially the last two examina- tions, and significant therapeutic effect can be achieved through regular treatment.