儿童下消化道出血的病因及临床特点分析

Etiology and clinical characteristics of lower gastrointestinal bleeding in children

目的探讨儿童下消化道出血(LGIB)的病因及临床特点。方法对2012年5月至2020年12月在广西医科大学第一附属医院确诊的203例LGIB住院患儿的临床表现、病因诊断、检查方式进行回顾性分析。结果病变部位主要在结直肠,出血方式最常见为鲜血便,伴随症状中腹痛的发生率最高。黏液血便在不同年龄组中差异有统计学意义(P<0.05),主要见于<3岁。腹痛、肛周疼痛、面色苍白在不同年龄组中差异有统计学意义(P<0.05),腹痛多见于3~16岁,肛周疼痛多见于3~6岁,面色苍白多见于7~16岁。贫血率为38.4%(78/203),不同年龄组的贫血程度差异无统计学意义(P>0.05),不同病变部位的贫血程度差异有统计学意义(P<0.05),小肠出血主要表现为中度贫血。常见的病因依次为肛管疾病44例,肠道息肉40例,炎症性肠病34例,食物过敏相关性肠炎24例。不同年龄组的前10位病因差异有统计学意义(P<0.05),<3岁为食物过敏相关性肠炎、肠道息肉,3~6岁为肛管疾病、肠道息肉,7~16岁为炎症性肠病、肛管疾病。结肠镜检查有179例,阳性率为72.1%。结论儿童LGIB好发于结直肠,常表现为解鲜血便,多伴随腹痛,常见的病因为肛裂、肠道息肉、炎症性肠病,结肠镜是最常用的检查方法。

Objective To investigate the etiology and clinical features of lower gastrointestinal bleeding(LGIB)in children.Methods The clinical manifestations,etiological diagnosis and examination methods of 203 hospitalized children with LGIB diagnosed in the First Affiliated Hospital of Guangxi Medical University from May 2012 to December 2020 were analyzed retrospectively.Results The lesion was mainly located in in colorectum,the most common way of bleeding was bloody stool,and the incidence of abdominal pain was the highest among the concomitant symptoms.There was significant difference in mucous blood stool among different age groups(P<0.05),mainly in<3 years old.There were significant differences in abdominal pain,perianal pain and pallor among different age groups(P<0.05).Abdominal pain,perianal pain and paleness were more common in 3-16 years old,3-6 years old and 7-16years old.The anemia rate was 38.4%(78/203).There was no significant difference in the degree of anemia among different age groups(P>0.05).There was significant difference in the degree of anemia in different lesions(P<0.05).Small intestinal bleeding was mainly manifested as moderate anemia.The common causes were anal diseases(n=44),intestinal polyps(n=40),inflammatory bowel disease(n=34)and food allergy-associated enteritis(n=24).There were significant differences in the top 10 causes among different age groups(P<0.05).Food allergy-related enteritis and intestinal polyps were found in<3 years old,anal diseases and intestinal polyps in 3-6 years old,inflammatory bowel disease and anal diseases in 7-16 years old.Colonoscopy was performed in 179cases,with a positive rate of 72.1%.Conclusion LGIB in children often occurs in colorectum and is often characterized by bloody stool and abdominal pain.the common diseases are anal fissure,intestinal polyps and inflammatory bowel disease.Colonoscopy is the most commonly used inspection.