53例初诊儿童炎症性肠病临床分析

Clinical analysis of 53 children with inflammatory bowel disease

目的探讨儿童炎症性肠病(IBD)初诊临床特点,提高对儿童IBD的认识。方法回顾性分析2005年1月至2015年10月于中国医科大学附属盛京医院儿科初诊,并确诊为IBD的53例患儿的临床资料,包括临床表现、实验室检查、影像学、内窥镜和病理组织学结果,以及治疗方案。结果 IBD患儿的临床表现主要以腹痛、腹泻、便血、发热为主。其中,溃疡性结肠炎(UC)患儿较克罗恩病(CD)患儿更易出现腹泻及便血症状(P<0.05),而CD患儿腹痛症状更为明显(P<0.05),同时更易出现肠外表现,34.0%患儿出现生长发育和营养障碍,84.9%患儿存在不同程度的精神状态改变。实验室检查结果以炎症性指标(如白细胞、C-反应蛋白、血沉)升高为主,UC和CD患儿的血清白蛋白比较,差异有统计学意义(P<0.05)。UC和CD患儿,内镜及病理表现明显不同,MRE同时观察到肠壁强化和瘘管及肿块的形成。51例单纯药物治疗,2例联合手术治疗。其中,13例患儿应用了英夫利昔单抗(IFX)治疗,诱导缓解迅速,身高、体质量有所增长。结论对临床出现腹痛、腹泻、便血、发热以及营养状态不佳的患儿,要警惕IBD的发生;需结合生化、影像学、内镜、病理进行综合诊断;MRE无创、无辐射,值得推广;中重度患者,IFX可以迅速缓解病情,促进生长发育。

Objective To explore children′s inflammatory bowel disease（ IBD） new clinical characteristics,to improve the recognition of IBD for children. Methods Totally 53 cases of preliminarily diagnosed IBD received from January 2005 to October 2015 were ana-lyzed retrospectively. Clinical features such as clinical manifestations, laboratory examinations, imaging performance, endoscopic and pathologic results,as well as therapeutic options were analyzed. Results The clinical manifestations of children with IBD were mainly abdominal pain,diarrhea,stool and fever. In UC group,patients had more diarrhea and bloody stool symptoms than those in CD group （P〈0. 05）,while abdominal pain symptom was more apparent than those in CD group（P〈0. 05）. Parenteral performance was more likely to appear in CD group. Growth and nutrition disorder occurred in 34. 0% children. Different degrees of mental state changes hap-pened in 84. 9% children. For laboratory results,some inflammatory index such as WBC,CRP,ESR raised obviously. Alb had differ-ences in these two groups. Imaging performance was significantly different in UC and CD patients. Bowel wall reinforcement,fistula and formation of lumps were observed at the same time in MRE. And 51 cases were administrated simple drug treatment,2 cases combined with surgery,13 cases got IFX treatment,which could alleviate soon,and promote growth. Conclusion IBD should be highly alert when the children had abdominal pain,diarrhea,stool,fever or poor nutritional status. Then the biochemical examinations,imaging per-formance,endoscopic and pathologic results could have more valuable for further diagnosis of IBD. MRE is no trauma examination with-out radiation. It is worthy of wide application. IFX can alleviate soon and promote the growth and development for those moderate to se-vere pediatric patients.