儿童炎症性肠病53例临床分析

Clinical analysis of inflammatory bowel disease in 53 children

目的 探讨儿童炎症性肠病 (IBD)的临床特点 ,以提高儿童IBD的诊治和管理水平。方法 对 1992～2 0 0 2年 5 3例IBD患儿的临床资料进行回顾性分析。结果 IBD的患病率逐渐增加 ,5 3例IBD中克罗恩病 (CD)2 6例 ,溃疡性结肠炎 (UC) 2 7例。 2 7%的CD和 4 5 %的UC发病在 6岁以下 ,有 5例 (19% )UC发病在 1岁以内 ;男女性别无显著性差异 (P >0 0 5 ) ;发病至确诊平均时间CD为 5 0周 ,UC为 4 8周。临床表现CD以发热、腹痛为主要表现 ,UC以腹泻、便血为主要表现 ;胃肠外表现CD可见口腔溃疡、关节炎等 ,UC可见肛周病变、口腔溃疡等 ,两组患儿生长发育障碍的发生率均较高 (CD 6 5 % ,UC 5 9% ,P >0 0 5 )。病理改变CD以破坏和慢性增殖改变并存为特点 ,病灶均累及回肠末端及回盲部 ;而UC以急性炎症和渗出为主 ,病灶均累及直肠。外科合并症的发生率CD为 15 4 % ,UC为 14 8% ;儿童IBD治疗效果不满意 ,短期缓解率CD为 5 9% ,UC为 5 6 %。结论 IBD可以累及包括婴幼儿在内的各年龄组儿童 ,诊断的滞后以及缺乏系统的管理是临床亟待解决的问题。

Objective To evaluate the diversity of clinical manifestation of IBD and to improve the clinical diagnosis and management of IBD in children.Methods Retrospective analysis of the database was performed on patients diagnosed as IBD at Beijing Children's Hospital between 1992 and 2002.Patients were divided into two groups:Crohn's disease (CD) and ulcerative colitis (UC).Results A total of 53 patients met the criteria (CD:n=26,UC:n=27).The incidence of IBD increased during 11 years.The onset of 27% of patients with CD was less than 6 years of age;45% of patients with UC less than 6 years of age and 5 patients of UC (19%) less than 1 year.No obvious difference existed between males and females.The average interval from the reported onset of first symptom to the final diagnosis was often prolonged (CD50w,UC48w,P>0.05).All patients of CD presented with fever and abdominal cramp pain;extra intestinal manifestation in CD included aphthous ulcer,arthritis,etc.100% CD had pathological focus involving terminal ileum.Most patients of UC presented with diarrhea (100%) and bleeding (93%);extra intestinal manifestations included perianal disease,aphthous ulcer,etc.100% UC had pathological focus involving rectum.The incidence of growth failure was 65% in CD and 59% in UC (P>0.05).The incidence of surgical complication was 15.4% in CD and 14.8% in UC.The effect of short therapy was not satisfactory (CD 59%,UC 56%).Conclusion IBD can affect children at any age,including infants and toddlers.Delayed diagnosis and lack of systemic management are severe problems in paediatric clinics.