儿童炎症性肠病病因及发病机制研究进展

<正>炎症性肠病(inflammatory bowel disease,IBD)是一种病因尚不明确的慢性非特异性肠道炎症性疾病,可累及回肠、直肠、结肠甚至全消化道,包括溃疡性结肠炎(ulcerative colitis,UC)、克罗恩病(Crohn disease,CD)和一类分类不明确的未确定型肠炎(IBD-unclassified,IBD-U)。近年来,儿童IBD发病率呈上升趋势[1-3]。儿童IBD不仅可引起腹痛、腹泻、便血及肠道外症状,甚至可引起生长发育障碍及精神状态改变。尽管IBD病因及发病机制暂未明     

�������ڶ�ͯ��֢�Գ�����Ӧ��

??Inflammatory bowel disease??IBD????including ulcerative colitis??UC?? and Crohn’s disease??CD????is a chronic relapsing inflammatory disorder of the gastrointestinal tract. Probiotics could be of benefit since involvement of the microbiota in the pathogenesis of IBD is evident. Although some promising studies are underway??the evidence for probiotics is still insufficient to recommend its use for IBD in daily clinical practice. Available data showed that the primary outcomes were correlated with probiotic strains and dosages. In general??probiotics have proven valuable in the management of ulcerative colitis. However??the probiotics seem to confer little benefit in Crohn’s disease.     

儿童炎症性肠病53例临床分析

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。     

Use of complementary and alternative medicines by children and adolescents with inflammatory bowel disease

OBJECTIVES: The use of complementary and alternative medicines (CAM) appears increasingly prevalent in children and adolescents. Individuals with chronic illness may have patterns of greater usage. This questionnaire-based study aimed to ascertain the frequency of use by a group of children with proven inflammatory bowel disease (IBD) and to consider the reasons for their use. METHODS: A questionnaire was sent by mail to the parents of patients currently attending a paediatric IBD clinic. Parents were asked to describe their child's usage of alternative and probiotic therapies and to comment on a number of aspects of such therapies. RESULTS: Forty-six (77%) of 60 mailed questionnaires were returned. The mean age of the children was 10.9 (+/- 4.1) years and they were taking an average of 1.7 (+/- 0.8) prescribed medications. Thirty-three (72%) of the children were said by their parents to be having CAM, with four having five or more such therapies (average 2.4 +/- 1.3 agents per child). The most commonly used agents were probiotics (78%) and fish oils (56%). A minority (12%) of respondents reported that their child's CAM was very effective, although many (50%) noted partial benefits. The 13 children who had never used any CAM therapies ('non-users') did not differ from the 'users' in terms of gender, age, disease or duration of disease. As expected, non-users expressed greater concerns about use of CAM and described different attitudes towards such therapies. CONCLUSION: Complementary and alternative medicines, especially probiotic therapies, frequently are administered to children and adolescents with inflammatory bowel disease. Often this appears to be due to parental frustration with managing their child's chronic illness. Practitioners caring for children and adolescents with IBD need to be aware that their patients may be using alternative therapies and adopt an open attitude in this situation.     

Anthropometry at the time of diagnosis in Danish children with inflammatory bowel disease

All patients below 15 y of age living in the eastern part of Denmark with a diagnosis of inflammatory bowel disease (IBD) during the period 1998-2000 were identified (n=94) and anthropometrical data at the time of diagnosis were evaluated.CONCLUSION: The height-for-age and the BMI-for-age, as evaluated by z-scores, of children with ulcerative colitis (UC) did not differ from those of normal Danish children, but Crohn's disease (CD) children had significantly lower height and BMI values, both when compared to normal children and children with UC. In contrast to UC, CD is frequently complicated by malnutrition and growth retardation at the time of diagnosis.     

The incidence of childhood inflammatory bowel disease in Wales

A prospective study was undertaken throughout Wales over the period from 1 January 1995 to 30 March 1997, to determine the incidence of childhood inflammatory bowel disease (IBD). Thirty-eight (24 male) new cases of IBD were reported. Twenty (16 male) of the reported cases had Crohn's disease, 11 (5 male) had ulcerative colitis (UC) and 7 (3 male) indeterminate colitis. Crohn's disease occurred four times more often in boys than girls, whereas there was no sex difference in the incidence for UC and indeterminate colitis. The median age at presentation was 12 (range 1.5–16) years and there was no difference in the age of presentation or the duration of symptoms prior to diagnosis in any of the types of IBD. Conclusion The overall incidence (95% confidence intervals) for IBD in Wales was 2.6 (1.87–3.48) cases per 100,000 per year. The incidence for Crohn's disease was 1.36 (0.86–2.04) cases per 100,000 per year, for UC 0.75 (0.39–1.28) cases per 100,000 per year and for indeterminate colitis 0.48 (0.2–0.92) cases per 100,000 per year. Received: 14 June 1999 / Accepted in revised form: 23 September 1999     

Incidence and prevalence of inflammatory bowel disease in children in South-Western Sweden

Hildebrand H, Brydolf M, Holmquist L, Krantz I, Kristiansson B. Incidence and prevalence of inflammatory bowel disease in children in South-Western Sweden Acta PEdiatr 1994;83:640–5. Stockholm. ISSN 0803–5253
The incidence and prevalence of inflammatory bowel disease were estimated in all children less than 16 years of age living in the city of Göteborg and in three counties in South-Western Sweden, from 1983 to 1987. One hundred and thirty-two patients were classified according to set criteria into one of four diagnostic categories: ulcerative colitis, Crohn's disease, probable Crohn's disease and indeterminate colitis. The crude incidence of inflammatory bowel disease was 5.3 per 100 000 children per year and the prevalence 21.5 per 100000 children. This study lends support to the hypothesis that Crohn's disease has increased among Swedish children. Crohn's disease now appears to be at least as common as ulcerative colitis. Thirty-five of 55 patients first classified as indeterminate colitis or probable Crohn's disease later fulfilled the criteria of ulcerative colitis or Crohn's disease during a mean follow-up period of 4.6 years. This study emphasizes the importance, in epidemiological studies of inflammatory bowel disease, of inciuding those cases where a definite diagnosis of ulcerative colitis or Crohn's disease cannot be established initially and of re-evaluating the initial diagnosis regularly.     

Carditis complicating inflammatory bowel disease in children

A 10-year-old child with ulcerative colitis is described who during the quiescent phase of his disease suffered from pericarditis with pleuropericardial effusion. The literature on cardiac involvement in inflammatory bowel disease is reviewed with emphasis on the paediatric age group.     

Current diagnosis, management and morbidity in paediatric inflammatory bowel disease

In the 1970s several reports highlighted the long delay in diagnosis often experienced by children with Crohn's disease. In recent years this disorder has attracted much publicity, and many believe that the incidence has increased substantially. The aim of this investigation was to determine whether heightened awareness had shortened the interval to diagnosis, improved clinical management and reduced morbidity. A retrospective study was therefore carried out on 112 children with inflammatory bowel disease (64 Crohn's disease, 41 ulcerative colitis, 7 indeterminate colitis) referred to a paediatric gastroenterology department in the UK between 1994 and 1998. In Crohn's disease the median interval to diagnosis was 47 wk (maximum 7 y). In those without diarrhoea this was longer (66 vs 28 wk; p = 0.005). In ulcerative colitis the median interval was 20 wk (maximum 3 y). Even in severe colitis the median interval was 5.5 wk (range 3-9 wk) and 4 required urgent colectomy soon after referral. Many with unrecognized Crohn's disease had undergone inappropriate treatments, such as growth hormone or psychiatric therapy. Nineteen (17%) had undergone endoscopic investigations in adult units prior to referral. Malnutrition was equally common in Crohn's disease and ulcerative colitis (11%). Short stature was present in 19% with Crohn's disease, and 5% with ulcerative colitis, and was severe in 8% with Crohn's disease. There was a significant correlation between symptom duration and the degree of growth impairment present (r(s) = -0.4; p = 0.004). Conclusion: This study suggests that late diagnosis and inappropriate investigation and management are still significant problems.     

��ͯ��֢�Գ�����ʹ���ٴ��ص������Ʋ���

??The incidence and prevalence of inflammatory bowel disease ??IBD?? in children are increasing worldwide. Abdominal pain is one of important symptoms of IBD?? and has certain clinical characteristics. The pathogenesis of abdominal pain in IBD is extremely complex?? there are a number of factors and mechanisms involved in the pathogenesis of IBD. Clinically?? the management of abdominal pain in IBD should be individualized.