2054例儿童消化道出血的临床特点及病因分析

Clinical characteristics and etiology of 2054 children with alimentary tract hemorrhage

目的探讨儿童消化道出血的临床特点及病因,以达到优化诊疗的目的。方法对2014年1月至2018年12月昆明市儿童医院2054例消化道出血患儿的临床资料进行回顾性分析。结果2054例消化道出血患儿中,男1274例,女780例,男女之比为1.6∶1;<3.0岁647例(31.5%),3.0~5.9岁488例(23.8%),6.0~8.9岁413例(20.1%),9.0~11.9岁281例(13.7%),≥12岁225例(11.0%);上消化道出血991例,下消化道出血1063例。引起儿童上消化道出血的前三位病因为急慢性胃炎/胃溃疡、过敏性紫癜和全身严重感染;引起儿童下消化道出血的前三位病因为肠息肉、过敏性紫癜和食物蛋白过敏性结直肠炎。引起消化道出血的罕见病有黑斑息肉综合征、门静脉海绵样变性、Bartter综合征、系统性红斑狼疮、Budd-Chiari综合征、环形胰腺、Reye综合征、Klippel-Trenaunay综合征、Evans综合征、肛周血管扩张症等。结论消化道出血是儿科的常见病,随着年龄的增长,消化道出血患儿的比例下降。不同年龄阶段导致上下消化道出血的主要病因不同,除注意常见的病因外,对于罕见病导致的消化道出血应该提高警惕和认识。

Objective To explore the clinical characteristics and etiology of children with alimentary tract hemorrhage so as to optimize the diagnosis and treatment.Methods The clinical data of 2054 children with alimentary tract hemorrhage in Kunming Children′s Hospital from January 2014 to December 2018 were retrospectively analyzed.Results Among 2054 children with alimentary tract hemorrhage,males was in 1274 cases,females was in 780 cases,and the ratio of males to females was 1.6∶1;<3.0 years old was in 647 cases(31.5%),3.0 to 5.9 years old was in 488 cases(23.8%),6.0 to 8.9 years old was in 413 cases(20.1%),9.0 to 11.9 years old was in 281 cases(13.7%),and≥12 years old was in 225 cases(11.0%);upper alimentary tract hemorrhage was in 991 cases,lower alimentary tract hemorrhage was in 1063 cases.The top three causes of children with upper alimentary tract hemorrhage were acute or chronic gastritis/gastric ulcer,anaphylactoid purpura and systemic serious infection;the top three causes of children with lower alimentary tract hemorrhage were intestinal polyps,anaphylactoid purpura and food protein allergic colitis.A rare causes of alimentary tract hemorrhage had Peutz-Jeghers syndrome,cavernous transformation of portal vein,Bartter syndrome,systemic lupus erythematosus,Budd-Chiari syndrome,annular pancreas,Reye syndrome,Klippel-Trenaunay syndrome,Evans syndrome and perianal angiectasia and so on.Conclusions Alimentary tract hemorrhage is a common disease in pediatrics.With the increase of age,the proportion of children with alimentary tract hemorrhage decreased.The main causes of upper and lower alimentary tract hemorrhage are different in different age stages.In addition to paying attention to common causes,the rare causes of alimentary tract hemorrhage should be vigilant and recognized.