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目的总结儿童炎症性肠病(IBD)的临床特点和诊疗经验,提高儿童IBD的诊疗水平。方法参照2001年中华医学会消化病学会制定的标准,2000年12月-2010年12月重庆医科大学附属儿童医院共确诊IBD患儿24例,通过调阅病例、随访获取资料,并对24例IBD患儿的临床、实验室检查、影像学、内窥镜、组织病理学检查,按照Sutherland指数和Harvey和Bradshow标准疾病活动性评分结果进行回顾性分析。结果 IBD 24例中溃疡性结肠炎(UC)组16例,克罗恩病(CD)组8例;男童略多于女童;IBD主要肠道表现有腹痛、腹泻、便血,主要肠外表现有发热、贫血、关节痛/炎、消瘦、生长发育迟缓;UC组与CD组临床表现差异无统计学意义,仅便血症状UC组占优势。病变侵犯部位:UC病变主要侵犯左半结肠(P=0.027);CD病变可侵犯全消化道任何部位,以回盲部及其周围肠管(P=0.002)和上消化道(P=0.028)受累最为多见。经过积极治疗IBD患儿疾病活动度显著下降,其中英夫利昔单抗对常规治疗无效的UC患儿可迅速控制临床症状。结论儿童IBD的诊断需要对临床、实验室检查、影像学、内窥镜检查及组织病理学检查综合分析,尤其结肠镜和组织病理学检查。儿童IBD积极治疗仍可获得显著疗效。
Objective To summarize the clinical features and diagnosis and treatment experience of childhood inflammatory bowel disease (IBD) and to improve the diagnosis and treatment of IBD in children. Methods According to the criteria established by Chinese Society of Gastroenterology in 2001, 24 children with IBD were diagnosed in Children’s Hospital of Chongqing Medical University from December 2000 to December 2010. The patients were followed up for data and 24 cases The clinical, laboratory, radiological, endoscopic, and histopathological findings of IBD children were retrospectively analyzed using the Sutherland index and the Harvey and Bradshow criteria for disease activity score. Results In the 24 cases of IBD, there were 16 cases of ulcerative colitis (UC) and 8 cases of Crohn’s disease (CD). The boys had slightly more than girls. The main intestinal manifestations of IBD were abdominal pain, diarrhea, blood in the stool, and major parenteral manifestations There are fever, anemia, joint pain / inflammation, weight loss, growth retardation; clinical manifestations of UC group and CD were no significant difference, only the dominant blood group UC symptoms. Lesions invaded the site: UC lesions mainly invaded the left colon (P = 0.027); CD lesions invaded all parts of the digestive tract and affected the ileocecal and its surrounding intestine (P = 0.002) and the upper digestive tract (P = 0.028) The most common. Active treatment of IBD children with disease activity decreased significantly, of which Infliximab routine treatment ineffective UC patients can quickly control the clinical symptoms. Conclusions The diagnosis of childhood IBD requires a comprehensive analysis of clinical, laboratory, radiological, endoscopic, and histopathological examinations, especially colonoscopy and histopathology. Positive treatment of children with IBD can still get a significant effect.