儿童炎症性肠病肠外表现发生率及危险因素

Incidence and risk factors of extraintestinal manifestations in children with inflammatory bowel disease

目的探讨儿童炎症性肠病(IBD)肠外表现的特点、发生率及危险因素,为该病患儿的及时评估和正确治疗提供依据。方法对2012年1月至2017年12月于上海交通大学医学院附属瑞金医院儿科住院的161例IBD患儿的临床资料进行回顾性分析。根据诊断不同分为克罗恩病(CD)组和溃疡性结肠炎(UC)组,其中CD组132例(82.0%),UC组29例(18.0%),分析各种肠外表现在CD组和UC组患儿中的发生率。采用Logistic回归,分析诊断、性别、确诊时年龄、CD确诊时病变部位、CD确诊时疾病活动度及合并肛周病变是否是肠外表现发生的危险因素。结果88例(54.7%)患儿出现了肠外表现,免疫相关肠外表现和生长迟缓的发生率分别为41.0%(66/161)和24.2%(39/161)。免疫相关肠外表现中口腔溃疡最常见(37/161,23.0%),其次是关节病变(20/161,12.4%)和皮肤病变(19/161,11.8%)。43例(26.7%)患儿在IBD确诊前即出现了肠外表现,出现肠外表现的患儿中65.9%(58/88)只出现1种肠外表现。经Logistic回归分析,诊断为CD(OR=5.536,95%CI:1.825~16.788)和合并肛周病变(OR=1.969,95%CI:1.035~3.746)是发生免疫相关肠外表现的危险因素。诊断为CD(OR=11.319,95%CI:1.487~86.179)、确诊年龄<6岁(OR=8.556,95%CI:3.109~23.545)、CD确诊时中重度活动(OR=3.447,95%CI:1.196~9.934)和合并肛周病变(OR=3.361,95%CI:1.720~7.793)是发生生长迟缓的危险因素。结论肠外表现在我国IBD儿童中发生率高,CD比UC更易发生。诊断为CD、合并肛周病变、确诊时年龄<6岁、疾病活动度高是肠外表现发生的危险因素。

Objective To investigate the incidence and risk factors of extraintestinal manifestations (EIMs) in children with inflammatory bowel disease (IBD). Methods The clinical data of 161 children with IBD was collected from the electronic medical records in the Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine from January 2012 to December 2017. These patients were divided into Crohn′s disease (CD) group and ulcerative colitis (UC) group, accounting for 82.0%(132 cases) and 18.0%(29 cases), respectively. The incidence of EIMs in each group was analyzed. The potential risk factors of EIMs including the IBD phenotype, gender, age, location of the CD lesion, disease activity of CD, and the presence of perianal lesion were analyzed with logistic regression model. Results Eighty-eight patients (54.7%) had EIMs. The main EIMs were immune-mediated EIMs and growth retardation, accounting for 41.0%(66/161) and 24.2%(39/161), respectively. Aphthous ulcer (39/161, 23.0%) was the most common symptom among immune-mediated EIMs, followed by arthropathy (20/161, 12.4%) and skin lesions (19/161, 11.8%). Forty-three patients (26.7%) had EIMs before being diagnosed as IBD. Fifty-eight (65.9%) patients had only one EIM during the whole course of IBD. By logistic regression analysis, CD (OR=5.536, 95%CI:1.825-16.788) and perianal disease (OR=1.969, 95%CI:1.035-3.746) were the risk factors of immune-mediated EIMs. Meanwhile, CD (OR=11.319, 95%CI: 1.487-86.179), younger than six-year-old at diagnosis (OR=8.556, 95%CI: 3.109-23.545), moderate to severe activity of CD (OR=3.447, 95%CI: 1.196-9.934) and perianal disease (OR=3.361, 95%CI: 1.720-7.793) increased the risk of growth retardation. Conclusions The children with IBD have a high incidence of EIMs, which were more common in CD than in UC. The risk factors of developing EIMs include CD, perianal diseases, younger than six-year-old at diagnosis and moderate to severe activity of CD.