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目的 探讨儿童克罗恩病的营养状况,为儿童克罗思病的营养治疗提供理论依据.方法 回顾性分析19例克罗恩病住院患儿的体格发育状况、血红蛋白、血清白蛋白、尿素、肌酐、维生素B12、叶酸及微量元素水平.用Z评分法及体质指数评价患儿体格发育状况.结果 16例患儿在发病后出现体质量下降.2例患几年龄别体质量Z评分(WAZ)>2,1例<-2,余均在正常范围内.4例患儿年龄别身高Z评分(HAZ)<-2,余均在正常范围.男性BMI平均值:14.8±2.94(10.25~22.04);女性平均值:15.7±2.8(12.5~19.9).男、女两组WAZ、HAZ及BMI平均值比较差异无统计学意义(P>0.05).17例(89.5%)患儿存在贫血,6例(31.6%)低蛋白血症.9例(47.4%)患儿肌酐<44μmol/L.6例低钙血症,2例低血磷,1例血磷增高.9例患儿进行了锌、铜、铁、镁的测定,其中7例(77.8%)患儿血锌浓度低于正常.血铜、血铁浓度增高者各1例,8例患儿进行了叶酸、维生素B12测定,均在正常范围.结论 克罗恩病儿童存在蛋白质营养不良及微量元素水平的异常.我国克罗恩病儿童的营养状况尚需前瞻性、多中心、大样本的研究明确. 相似文献
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患儿 ,女 ,13岁。因发热、中上腹痛、纳差、消瘦 3个月 ,恶心、呕吐 3d入院。既往体健。查体 :T 38℃ ,营养差 ,皮肤巩膜无黄染 ,浅表淋巴结无肿大。心肺阴性。舟状腹 ,中上腹压痛 ,肝未扪及 ,脾肋下 2cm ,移动性浊音阳性。血WBC 6 2× 10 9/L ,分类正常 ,RBC 3 84× 10 12 /L ,Hb 114g/L ,PLT 110× 10 9/L。肝功能轻度异常 ,肾功能正常。心电图及胸部X线检查正常。B超示肝脏正常 ,脾脏厚 4 5cm ,腹腔积液 4cm ,胃肠壁增厚回声紊乱。胃镜见食道下段及贲门黏膜水肿、糜烂 ,幽门水肿关闭不全 ,胆汁返流。腹水黄… 相似文献
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儿童克罗恩病误诊阑尾炎1例分析 总被引:1,自引:0,他引:1
李连东 《中华现代儿科学杂志》2008,5(1):14-14
克罗恩病临床少见,易被误诊,笔者临床上接诊1例,现将资料报告如下。 相似文献
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英夫利西作为一种针对肿瘤坏死因子的单克隆抗体,在儿童克罗恩病(CD)的治疗中已开始应用.许多大的随机对照研究已经显示其对儿童CD的诱导缓解和维持治疗具有良好的疗效,尤其是生长发育的恢复及降低肠切除术的概率,提高患儿的生活质量.英夫利西的治疗方案包括诱导缓解和维持治疗,前者在第0、2、6周以5 mg·kg-1的剂量静脉滴注,后者在缓解后每8周以相同剂量维持治疗.在治疗过程中要注意调整剂量和用药间隔,以避免失效.严重感染、输液反应、药物性红斑狼疮等不良反应也是重点关注的问题,目前英夫利西是否有致癌的可能性并不清楚,需要长期的随访观察. 相似文献
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儿童克罗恩病(CD)的治疗目标为临床缓解和黏膜愈合。定期监测疾病活动度评分、炎性标记物水平、影像学及内镜下表现、生长发育及营养状况、生物制剂药物浓度及抗药抗体水平、结核病发生情况有助于评估患儿的治疗反应,指导调整治疗策略。多项指标联合应用的评估效果优于单一指标,优先选择创伤小、放射辐射少的项目。 相似文献
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儿童克罗恩病10 例临床分析 总被引:1,自引:1,他引:0
目的 探讨儿童克罗恩病(CD) 的临床特点,并对其治疗进行初步探讨。方法 回顾性分析2005 年1 月至2013 年12 月间10 例确诊为CD 患儿的临床资料,包括其临床表现、内镜表现及内镜下黏膜活检病理特点、腹部B 超、实验室检查结果及治疗情况等。结果 患儿临床表现以腹痛、腹泻、便血为主,多伴有不同程度的生长发育障碍及营养障碍,肠外表现以发热为主。肠镜检查常见表现为非连续性阶段性黏膜充血、糜烂、黏膜呈鹅卵石样增生病变、黏膜溃疡等。腹部B 超检查示肠壁的不均匀阶段性增厚。病理表现主要为固有膜内较多淋巴细胞、嗜酸性粒细胞、浆细胞浸润,黏膜腺体部分萎缩。疾病缓解期CRP 明显低于急性发作期及疾病复发期(PP结论 儿童CD 的临床表现及实验室检查均缺乏特异性。ESR 及CRP 可作为疾病进展评估的指标。5-ASA 在儿童CD 的诱导和维持缓解中有一定的疗效。治疗转归与疾病初期PCDAI 评分的高低有一定的相关性。 相似文献
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目的探讨胶囊内镜在儿童小肠克罗恩病中的诊断价值及安全性。方法回顾性分析2003年1月至2010年4月经胶囊内镜检查的25例克罗恩病患儿临床资料,分析其临床表现、胶囊内镜检查完成情况、镜下特点及诊断情况。结果 25例克罗恩病患儿共行26次胶囊内镜检查,均顺利吞下胶囊内镜,其中21例在工作时间内到达回盲瓣,过瓣率80.8%(21/26);21例经胶囊内镜诊断克罗恩病,主要表现为阿弗他溃疡,环状或裂隙样溃疡。所有病例均无胶囊内镜梗阻发生。结论胶囊内镜在诊断儿童克罗恩病中安全,较其他影像学检查诊断率高,尤其是对累及小肠的克罗恩病,胶囊内镜下表现特异。 相似文献
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患儿,女,8岁,因反复黑便3个月余、间歇发热1个月伴中度贫血,在当地儿童医院就诊,胃镜检查示“浅表性胃炎、十二指肠球部炎症”,支原体抗体MP-IgM( ),粪隐血OB( ),Hb 67 g/L,拟“浅表性胃炎、十二指肠球部炎症,MP感染、贫血”,予头孢曲松钠、阿奇霉素、法莫替丁等治疗,但症状未见好转。近2个月来常出现黑褐色大便,呈厚糊状,量中等,1、2次/d,且伴阵发性腹痛,多位于脐部,能自行缓解,无黏冻和脓血便,以往无黑便和腹痛史,无鼻衄和贫血史。门诊拟黑便、中度贫血待查收入院。查体:体质量21 kg,稍消瘦,面色苍白,心肺正常,腹平软,肝脾肋下未及,… 相似文献
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US is increasingly performed in Crohn disease (CD) in children as a first line imaging modality. It reduces the use of other
more invasive examinations such as endoscopy, CT or contrast enema. We describe bowel ultrasonography technique, normal bowel
appearances on US and pathological patterns in CD. We discuss the current role and limitations of bowel US in CD in children
including diagnosis, extent of disease, assessment of disease activity, follow-up and detection of complications. The diagnostic
accuracy of US is discussed according to the literature and compared to other imaging modalities. US is currently used for
screening in children with the suspicion of inflammatory bowel disease (IBD) with a good negative predictive value. In follow-up,
US has a role in monitoring medical treatment by evaluating disease activity, extent of disease and for detecting complications. 相似文献
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Association of blood pressure, obesity and serum homocysteine levels in healthy children 总被引:1,自引:0,他引:1
Papandreou D Rousso I Makedou A Arvanitidou M Mavromichalis I 《Acta paediatrica (Oslo, Norway : 1992)》2007,96(12):1819-1823
AIM: Obesity, hypertension and total serum homocysteine levels are well-known risk factors for cardiovascular disease in adults. However, there is limited data on the relation of these risk factors in children. METHODS: Five hundred twenty-four healthy school children aged 6-15 years participated in the study. BMI were used to categorize our subjects in normal overweight and obese groups based on Internationally Obesity Task Force criteria. RESULTS: The prevalence of overweight and obesity was 21.1% and 8.4% for boys and 17.6% and 7.3% for girls, respectively. Diastolic blood pressure (DBP), systolic blood pressure (SBP) and waist circumference (WC) were significantly higher in overweight and obese group compared to normal ones, whereas for homocysteine levels no difference was observed. Based on the results derived from the multiple regression analysis, BMI was positively related to energy intake (beta=0.247, p<0.001) and WC (beta=0.014, p<0.001). Both SBP and DBP were positively related to age ([beta=0.251, p<0.001] and [beta=0.301, p<0.001, respectively]), and BMI ([beta=0.096, p<0.001] and [beta=0.022, p<0.001], respectively). CONCLUSION: The current study revealed an association of blood pressure and WC with overweight and obesity in children, and even though these children may not have increased homocysteine levels, they still have enough reasons to reduce weight in order to avoid cardiovascular disease in their life later on. 相似文献
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儿童克罗恩病诊断和治疗的10年临床经验总结 总被引:2,自引:0,他引:2
目的分析儿童克罗恩病(Crohn’s disease,CD)临床特点、总结10年来的诊治经验,促进对儿童CD的认识,提高诊断治疗水平。方法对1996至2005年诊断为CD的9例患儿的临床资料及诊治结果进行分析。结果本组9例,男8例,女1例,年龄6—13岁。平均病程10个月。病变单独累及小肠者3例,小肠和大肠同时受累者6例。腹痛和腹泻是最常见的胃肠道症状。主要的肠道外表现为体重下降、低蛋白血症、轻度贫血、发热和低钙血症。结肠镜下主要的病变有溃疡、节段性病变、鹅卵石样改变、多发性息肉和肛周病变。1例行胶囊内镜检查见典型纵形裂隙样溃疡和鹅卵石样改变。内镜活检组织病理检查以非特异性黏膜慢性炎症为主,2例见非干酪样肉芽肿(22.2%)。2例手术标本均未检出非干酪样肉芽肿。7例患儿予5氨基水杨酸(5-ASA)口服,部分加用抗生素和营养治疗,2例加用肾上腺皮质激素。现3例患儿维持长期缓解。结论儿童CD诊断需特别强调排除感染性腹泻。CD患儿常见的体重下降和营养障碍可为诊断提供重要线索。合适的剂型和较大剂量的5-ASA[30—50mg/(kg·d)]对诱导和维持缓解有较好疗效。 相似文献
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The interventional radiologist plays an important role in the treatment of complicated Crohn disease in children. Interventional
radiology includes percutaneous drainage of abscesses and insertion of suitable intravenous lines. A multidisciplinary approach
is mandatory for the management of these patients. 相似文献
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目的 探讨不同严重程度手足口病患儿外周血细胞因子的变化特点.方法 2011年3月至12月住院的62例手足口病患儿为研究对象,其中男37例,女25例;年龄最小4个月,最大4岁11个月,平均年龄(1.56±0.89)岁.按照病情分组:普通组20例,重症组20例,危重症组22例.对照组为22例健康儿童.检测各组血清促炎细胞因子[肿瘤坏死因子(tumor necrosis factor,TNF)-α、白细胞介素(interleukin,IL)-1β、IL-6]和抗炎细胞因子(IL-10、IL-13、IL-4)的水平.结果 与对照组比较,手足口病各组患儿外周血中促炎及抗炎细胞因子均升高.重症组及危重症组促炎细胞因子TNF-α水平分别为(201.45±133.42)ng/L、(220.37±117.54) ng/L,均比普通组(118.12±112.05) ng/L明显升高(P<0.05),IL-1β及IL-6水平在危重症组分别为(651.77±538.45) ng/L、(88.02 ±50.76) ng/L,均较重症组[(551.75 ±252.75) ng/L、(59.25 ±28.80) ng/L]及普通组[(270.18 ±249.79) ng/L、(55.76±28.68) ng/L]明显升高(P<0.05).抗炎细胞因子IL-10水平在普通组升高最明显,为(137.53±72.07) ng/L,而重症及危重症组仅轻度升高,分别为(57.07±55.02) ng/L及(73.37±56.01) ng/L(P<0.05).IL-13水平重症组为(507.53±210.86) ng/L,危重症组为(489.67±168.99) ng/L,均比普通组(387.16±157.43) ng/L明显升高(P<0.05),IL-4水平在手足口病各组中差异无统计学意义(P>0.05).结论 手足[口病患儿存在促炎因子与抗炎因子同时参与的炎症反应,其中促炎细胞因子TNF-α、IL-1β及IL-6升高与病情的严重程度相一致,而抗炎细胞因子IL-10、IL-13随病情的加重反而降低,因此促炎因子的升高、抗炎因子的下降是疾病恶化的重要标志. 相似文献
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MRI is an important imaging tool in evaluation of adult and pediatric patients with Crohn disease. Pelvic MRI, in particular,
has become the method of choice to evaluate for perianal fistulas and associated complications of Crohn disease. MRI can define
the extent and location of perianal fistulas and abscesses, as well as provide critical information for operative management.
In this pictorial essay, we describe useful MRI techniques for evaluation of perianal complications in pediatric patients
with Crohn disease. We review pertinent anatomy and illustrate typical examples of perianal fistulas with and without abscess.
We show one case of clinically suspected perianal fistula that was actually a pilonidal sinus. 相似文献
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Efthymia Alexopoulou Eleftheria Roma Dimitra Loggitsi Nikos Economopoulos Olympia Papakonstantinou Ioanna Panagiotou Ioanna Pahoula Nikolaos L. Kelekis 《Pediatric radiology》2009,39(8):791-797
Background Examinations using ionizing radiation are frequently used in the evaluation of disease activity in children affected by idiopathic
inflammatory bowel disease (IBD).
Objective To develop an MR imaging protocol without the need for fluoroscopic insertion of an enteral tube and to assess the disease
activity in children with IBD.
Materials and methods Included in the study were 37 children (22 girls and 15 boys; age range 7–15 years, mean 11.67 years) with IBD who underwent
MR imaging of the small bowel. Of these 37 children, 32 had Crohn disease and 5 had indeterminate colitis. A water solution
containing herbal fibres was administered orally or through a nasogastric tube. Patients were imaged on a 1.5-T MR scanner
with T1-weighted and Τ2-weighted sequences followed by a dynamic study using 3-D T1-W images after intravenous administration
of gadolinium.
Results The percentage enhancement of the bowel wall was significantly increased in patients with abnormal C-reactive protein (CRP)
values compared to patients with CRP values in the normal range (P<0.001). A relatively weak but significant correlation between percentage enhancement of the bowel wall and CRP values was
noted during all phases of enhancement.
Conclusion This MR imaging protocol is a safe and well-tolerated method for evaluating disease activity and extraintestinal manifestations
of IBD in children. 相似文献
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目的:探讨反复呼吸道感染与其部分相关影响因素的关系。方法用病例对照的研究方法,调查分析反复呼吸道感染与其部分影响因素的关系。结果儿童反复呼吸道感染和母乳喂养、微量元素缺乏(锌缺乏)、营养不良、环境因素(室内装修、被动吸烟、饲养宠物)、使用糖皮质激素存在相关性,但与母乳喂养这种相关性只在5岁以下的儿童中发现。还发现了不管出生前或出生后,二手烟与反复呼吸道感染的相关只是在男孩中发现,而在女孩中却不相关。家居装修、微量元素缺乏(锌缺乏)、营养不良、母乳喂养与反复呼吸道感染相关只是在女孩中发现,而在男孩中却不相关,提示各个影响因素对男孩和女孩的影响是不一样。结论反复呼吸道感染是受多因素影响的,而不同的影响因素对性别的影响也不同。 相似文献
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