儿童炎症性肠病与艰难梭菌感染的临床特征比较

Comparison of clinical features between pediatric patients with inflammatory bowel disease and Clostridium difficile infection

目的:比较儿童炎症性肠病(IBD)和艰难梭菌感染(CDI)的临床特征。方法:采用横断面研究方法,回顾性收集2017年8月至2022年8月西安交通大学附属儿童医院收治的初诊IBD患儿及CDI患儿的临床资料,对年龄、性别、临床症状及实验室检查指标等进行分析比较。结果:IBD组共纳入患儿44例,其中男性24例,女性20例;年龄9.04(5.34,12.50)岁;CD 30例,UC 12例,未分类IBD 2例。CDI组共纳入患儿45例,其中男性28例,女性17例;年龄4.00(2.38,6.00)岁。两组间性别差异无统计学意义(χ^(2)=0.54,P=0.4625);CDI组年龄小于IBD组,差异具有统计学意义(U=568.50,P=0.0004)。IBD和CDI患儿腹泻、便血、腹痛及发热发生率均较高。IBD组患儿腹痛比例明显高于CDI组(61.36%比40.00%,χ^(2)=4.06,P=0.0439);CDI组患儿腹泻和便血比例均明显高于IBD组(腹泻:71.11%比47.73%,χ^(2)=6.48,P=0.0109;便血:75.56%比50.00%,χ^(2)=6.23,P=0.0126)。IBD组症状持续时间明显长于CDI组(U=437.50,P<0.01)。与CDI组相比,IBD患儿白细胞计数、中性粒细胞比例、血小板计数、C-反应蛋白(CRP)、红细胞沉降率(ESR)水平更高,而血红蛋白及白蛋白水平更低,差异均具有统计学意义(均P<0.05)。结论:IBD和CDI患儿临床症状相似,但IBD更常见症状为腹痛,CDI患儿腹泻、便血更常见,IBD患儿症状持续时间更长,CRP、ESR水平更高,可用于鉴别初诊IBD和CDI。

Objective To compare the clinical features between inflammatory bowel disease(IBD)and Clostridium difficile infection(CDI)in children.Methods A cross⁃sectional study was conducted.Clinical data of patients initially diagnosed IBD and CDI in the Affiliated Children′s Hospital of Xi′an Jiaotong University from August 2017 to August 2022 were collected retrospectively.The age,gender,symptom,laboratory test indexes of children in the two groups were analyzed and compared.Results A total of 44 children[24 males,20 females;median age,9.04(5.34,12.50)years]were included in IBD group and there were 30 patients with Crohn′s disease(CD),12 with ulcerative colitis(UC)and 2 with IBD unclassified(IBDU).A total of 45 children[28 males,17 females;median age,4.00(2.38,6.00)years]were included in CDI group.There was no significant difference in gender between the two groups(χ^(2)=0.54,P=0.4625).The age of the CDI group was younger than that of the IBD group,and the difference was statistically significant(U=568.50,P=0.0004).The incidences of diarrhea,hematochezia,abdominal pain and fever were high both in patients with IBD and CDI.The more common symptom in IBD group was abdominal pain,and its ratio was significantly higher than that of CDI group(61.36%vs.40.00%,χ^(2)=4.06,P=0.0439).The common clinical manifestations in CDI group were diarrhea and hematochezia,with a significantly higher proportion compared to the IBD group(diarrhea:71.11%vs.47.73%,χ^(2)=6.48,P=0.0109;hematochezia:75.56%vs.50.00%,χ^(2)=6.23,P=0.0126).The duration of symptoms in the IBD group was significantly longer than that in the CDI group(U=437.50,P<0.01).Compared with the CDI group,IBD patients had higher level of white blood cell count,neutrophil ratio,platelet count,C⁃reactive protein(CRP),and erythrocyte sedimentation rate(ESR),while lower level of hemoglobin and albumin,and all the differences were statistically significant(all P<0.05).Conclusions IBD and CDI have similar symptoms,however abdominal pain is more common in the patients with IBD,diarrhea and hematochezia are more common in patients with CDI.The duration of symptoms in IBD patients is longer,and the level of CRP and ESR is higher.These clinical features can be used to differentiate the patients with initially diagnosed IBD from CDI.