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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 explore the clinical features of children with inflammatory bowel disease (IBD) to improve the diagnosis and management of IBD in children. Methods The clinical data of 53 IBD patients from 1992 to 2002 were analyzed retrospectively. Results The prevalence of IBD increased gradually. There were 26 cases of Crohn’s disease (CD) in 56 IBDs and 27 cases of ulcerative colitis (UC) in 53 IBD cases. 2 7% CD and 45% UC were less than 6 years old, and 5 cases (19%) UC were less than 1 year old. There was no significant difference between male and female (P> 0.05) The CD was 50 weeks and the UC was 48 weeks. Clinical manifestations of CD fever, abdominal pain as the main performance, UC to diarrhea, blood in the stool as the main performance; CD visible oral parenteral manifestations of ulcers, arthritis, UC, perianal lesions can be seen, oral ulcers, etc., two groups of children with growth and development disorders (CD 6 5%, UC 5 9%, P 0 05). Pathological changes of CD to coexist with destruction and chronic proliferative changes characterized by lesions involving the terminal ileum and ileocecal; and UC with the main inflammation and exudation, lesions involving the rectum. The incidence of surgical complications was 15 4% for CD and 14 8% for UC. The effect of IBD in children was unsatisfactory. The short-term response rate was 59% for CD and 56% for UC. Conclusions IBD can affect children of all ages, including infants and toddlers. The lag of diagnosis and the lack of systematic management are the urgent problems to be solved.