儿童慢性腹泻合并肠道蛋白丢失的临床研究

Clinical research of chronic diarrhea with intestinal protein loss in children

目的探讨儿童慢性腹泻合并肠道蛋白丢失的临床特点及病理特征。方法选取成都市第五人民医院儿科2010年10月-2012年12月诊治的慢性腹泻合并肠道蛋白丢失患儿31例为观察组,选取同期健康体检儿童31例为对照组,均行临床指征检测(总蛋白、白蛋白、前白蛋白、大便总量、当日血清α1-抗胰蛋白酶浓度、混匀后大便α1-抗胰蛋白酶浓度、24 h大便α1-抗胰蛋白酶清除率),分析观察组患儿的肠镜特点和病理特征。结果观察组患儿的总蛋白、白蛋白、前白蛋白、当日血清α1-抗胰蛋白酶浓度均明显低于对照组,观察组患儿的大便总α1-抗胰量、混匀后大便α1-抗胰蛋白酶浓度、24 h大便α1-抗胰蛋白酶清除率均明显高于对照组,差异均有统计学意义(P<0.05)。克罗恩病、溃疡性结肠炎、嗜酸性胃肠病、过敏性胃肠病、肠结核均是儿童慢性腹泻合并肠道蛋白丢失的常见病症,均具有典型的病理特征。结论慢性腹泻合并肠道蛋白丢失患儿多伴有总蛋白、白蛋白、前白蛋白、大便总量、α1-抗胰蛋白酶等指标的异常改变,肠镜检查和病理检查是儿童慢性腹泻合并肠道蛋白丢失的有效检测手段。

Objective To investigate clinical characteristics and pathological features of chronic diarrhea with intestinal protein loss in children.Methods Thirty-one patients with chronic diarrhea with intestinal protein loss were selected in the Fifth People＇ s Hospital of Chengdu City from Oct.2010 to Dec.2012 as observation group.Thirty-one healthy children were selected in hospital at same period as control group.Children underwent clinical indications detection （total protein,albumin,pre-albumin,stool quantity,serum α1-antitrypsin concentratio,stool α1-antitrypsin concentratio after mixing,24 h stool α1-antitrypsin clearance）.Colonoscopy features and pathological features were analyzed in observation group.Results Total protein,albumin,pre-albumin,serum α1-antitrypsin concentration in observation group were significantly lower than those in control group.Stool quantity,stool α1-antitrypsin concentratio after mixing,24 h stool α1-antitrypsin clearance in observation group were significantly higher than those in control group.Difference was statistically significant （P ＜0.05）.Crohn＇ s disease,ulcerative colitis,eosinophilic gastrointestinal disease,allergic gastroenteropathy,intestinal tuberculosis were common diseases in children with chronic diarrhea and intestinal protein loss,which had typical pathological features.Conclusion Children with chronic diarrhea and intestinal protein loss often has abnormality indexes in total protein,albumin,pre-albumin,stool quantity,serum α1-antitrypsin concentratio,stool α1-antitrypsi nconcentratio after mixing,24 h stool α1-antitrypsin clearance.Colonoscopy examination and pathology examination are effective means of detection in children with chronic diarrhea and intestinal protein loss.