儿童溃疡性结肠炎药物治疗研究进展

溃疡性结肠炎(ulcerative colitis,UC)是一种影响肠道的慢性非特异性炎症性疾病。药物治疗包括5-氨基水杨酸药物(5-ASA)、糖皮质激素、免疫调节剂和生物制剂,可以有效诱导和维持缓解,预防疾病并发症。5-ASA是轻中度UC患儿诱导及维持缓解的一线药物;而糖皮质激素用于中重度UC的一线治疗及轻中度UC对5-ASA无效者的二线诱导缓解治疗。免疫调节剂嘌呤类制剂适用于激素依赖、5-ASA不耐受、频繁复发及急性重度UC激素诱导治疗有效后的维持缓解治疗。钙调神经磷酸酶抑制剂和生物制剂英夫利西单抗可作为急性重度UC激素治疗无效的二线治疗。维得利珠单抗和乌司奴单抗可用于抗肿瘤坏死因子-α失败后的二线生物治疗,但尚缺乏在儿童UC中的研究数据。该文旨在对儿童UC的药物治疗进展进行综述,为临床实践提供参考。     

小儿溃疡性结肠炎10例分析

溃疡性结肠炎是一种原因不明的结肠非特异性炎症。多见于成人,小儿较少见。我院自1985年以来,内、外科共收治小儿溃疡性结肠炎10例,现总结如下。     

儿童溃疡性结肠炎的内镜检查和临床研究

目的 分析儿童溃疡性结肠炎的临床特征及其诊断。方法 对４０例儿童ＵＣ的内镜表现、组织学特点以及临床特征进行分析。结果 儿童ＵＣ占结肠镜检查总数的４％,２个月－１２岁,最小发病年龄生后７ｄ,中度＋重度占７５％（１８＋１２／４０）,临床表现慢性腹泻６８％（２７／４０）,粘液或粘液血便５３％（２１／４０）,反复便血４８％）１９／４０）,腹痛呕吐等不明显,营养不良有３０％（１２／４０）,贫血２８％（１１＝     

溃疡性结肠炎1例

患儿，男，9岁1个月，因反复口腔溃疡1年5个月、间断发热、腹泻2月余入院。1年5个月前无原因出现口腔黏膜及舌部溃疡，疼痛拒食，溃疡反复发作且溃疡面积增大、个数增多。外院口腔溃疡组织病检示慢性非特异性炎症，诊断为复发性口腔溃疡，予抗生素类予多次抗感染及对症治疗无效。入院前2个月不明原因腹泻，发热38～39℃，热型不规则，     

婴幼儿溃疡性结肠炎13例

目的 总结婴幼儿溃疡性结肠炎(UC)临床特征，以提高对此病的认识。方法 对13例婴幼儿溃疡性结肠炎的内镜表现、活检结果、临床特征等进行分析。结果 婴幼儿溃疡性结肠炎13例，占本院同期溃疡性结肠炎46％，多数起病急，主要表现为反复腹泻，大便为黏液血便、脓血便及便血，部分有发热，一般情况较差，腹痛等不明显，贫血、营养不良较突出，且并肛周病变。内镜下病变呈连续性分布，黏膜弥漫性充血、水肿，血管纹理模糊，质脆，易出血，有颗粒样改变并可见多发糜烂及浅表溃疡；少数见假息肉。结论 婴幼儿溃疡性结肠炎在儿童中占有一定比例，误诊率高，临床上不容忽视。结肠镜及黏膜活检是目前确诊UC最可靠的方法。     

婴儿溃疡性结肠炎1例

患儿 ,女 ,4个月 ,因反复粘液血便 1月入院。 1月前不明原因出现腹泻 ,为粘液脓血便 ,每日 3～ 4次 ,每次量少 ,排便时常哭闹不止 ,无发热 ,抽搐 ,惊厥。门诊以菌痢予抗感染治疗 ,症状稍改善 ,间隔数日又发作。查体 :急性病容 ,神清 ,皮肤无黄染 ,浅表淋巴结未扪及肿大 ,心肺正常 ,腹平软 ,无压痛 ,肝脾未及。实验室检查 :Ｈｂ 96ｇ/Ｌ ,大便色红 ,粘液( ) ,ＲＢＣ /Ｈｐ ,反复多次粪检 ,培养未见阿米巴包囊、滋养体或痢疾杆菌等。结肠镜检 :直肠及乙状结肠弥漫充血、水肿 ,并可见 8～ 10个纵形椭圆小溃疡 ,边缘红肿并有血痂附着。粘膜活检…     

婴儿溃疡性结肠炎1例

<正> 患儿,男,8月,于生后23 d无明显诱因出现腹泻,8～10次/d,黄绿色稀糊状便,无脓血,无呕吐、发热等伴随症状,纳差,精神较好,自服思密达、乐托尔等无效,于3个月时腹泻加重,出现粘液便及脓血便,约10余次/d,反复查大便常规:粘液脓血便,wBC(++～++++),多次查大便培养无致病菌生长。先后予静脉点滴磷霉素、头孢哌酮钠、头孢曲松等抗生素治疗无效,腹泻时轻时重,脓血便与黄绿色稀便交替出现,营养发育较差,轻度贫血貌,心肺     

儿童炎症性肠病45例临床分析

目的 了解小儿炎症性肠病(IBD)的临床、X线、内窥镜及病理组织学特点，以提高对IBD诊断水平。方法 对45例IBD患儿按照1993年全国慢性非感染性肠道疾病学术研讨会制定的溃疡性结肠炎(UC)的诊断标准及WHO对克隆病(CD)推荐的6个诊断要点及采用Harvey和Bradshow标准进行临床、X线、内窥镜和病理组织学分析。结果 UC38例，克隆病(CD)7例。IBD以男童发病为多，腹痛、发热、消瘦、贫血在两组间无明显差异，而UC组多出现腹泻、便血；腹部包块及肠外表现在CD组更常见；上消化道病变分布仅在CD出现，UC以全结肠受累为主。结论 小儿IBD诊断需对临床、X线、内窥镜及病理组织学资料进行综合评价，特别是目前仍应以结肠镜及病理组织学检查为确诊依据。     

儿童过敏性结肠炎33例诊治分析

目的探讨儿童过敏性结肠炎(AC)的诊治特点。方法分析33例AC儿童的临床表现、结肠镜及病理学特点、相关的实验室检查及治疗情况。结果①AC以2岁以下儿童多见,共24例(占72.7%)。临床主要表现为腹泻28例(84.8%),便血25例(75.8%),其他还有腹痛、体重下降、腹胀、呕吐等。②内镜下表现为灶性红斑、粘膜变脆7例(21.2%),多发性小结节12例(36.4%),血管减少、多发浅表糜烂10例(30.3%),明显溃疡、表面渗出4例(12.1%),主要累及直肠24例(72.7%),乙状结肠28例(84.8%)。组织病理学主要表现为粘膜各层EOS浸润,以固有层轻中度浸润为主(94%)。③病史及辅助检查包括有:血红蛋白下降23例,外周血EOS增高8/20例。血清白蛋白下降5/33例,IgA下降6/10例,IgE增高6/18例。过敏原阳性9/18例,其中牛奶阳性3例,鱼虾、蟹阳性3例,鸡蛋阳性2例,豚草阳性1例。11例病儿有过敏性体质史。10例症状发作与进食食物明显有关(牛奶6例,鸡蛋2例,豆制品1例,动物肝脏1例),5例患儿母亲有明显进食牛奶及海鲜食物史。④患儿经住院治疗均缓解出院,平均住院时间(10.2±4.7)d。结论儿童AC临床表现及内镜特点各异;详细的病史、辅助检查、内镜检查结合多点粘膜活检有助于AC的诊断;停食可疑食物是治疗AC的关键。     

婴儿溃疡性结肠炎合并结肠穿孔 1例报告

临床资料 患儿,男,10个月。因腹泻7个月,间断发热5个月于2002年9月18日入院,9月24日死亡。入院前7个月(即生后3个月)患儿出现腹泻,大便带有粘液和脓血,每天十余次,每次排便时均伴有哭闹。入院前5个月开始间断发热,体温波动在38℃～39℃之间,并发现肛周有脓液溢出。于院外间断使用多种抗生素治疗,效果均不佳。发病来无呕吐、无关节肿胀,无呼吸道疾病史,近4个月体重不增。患儿新生儿期体健,3个月抬头,5个月认母,8个月会坐;母乳喂养,否认食物、药物过敏史;预防接种按期进行;     

Turner Syndrome Associated with Ulcerative Colitis

We report the case of a 7-yr-old girl with Turner syndrome, ulcerative colitis (UC) and coarctation of the aorta. The diagnosis of Turner syndrome was made in early infancy (karyotype analysis 45, X). Growth hormone treatment was started at 3 yr and 2 mo of age. From the age of 4 yr and 5 mo, the patient suffered from persistent diarrhea with traces of blood and intermittent abdominal discomfort. As these symptoms gradually deteriorated, she was referred to our clinic at the age of 7 yr for further evaluation. Barium enema showed aphtha and loss of the fine network pattern in the descending colon and rectum. An endoscopic examination showed ulceration, edema, friability, and erythema beginning in the rectum and extending up to the splenic flexure of the descending colon. The histology of the descending colon area showed severe stromal infiltration of inflammatory cells. These endoscopic findings and the histological findings were consistent with UC. Thus, based on these findings, the patient was diagnosed as having UC. Mesalazine therapy was initiated at this time. The patient is currently being treated with mesalazine (1,000 mg/day) and abdominal symptoms and bloody diarrhea have disappeared. GH therapy was not interrupted during the therapy for UC. Retrospectively, growth hormone improved growth velocity (9 cm/year) during the first year of treatment, however from the age of 4 yr, growth velocity decreased (4–5 cm/yr) in spite of the GH treatment. Conclusion: Patients with Turner syndrome and gastrointestinal symptoms should be investigated for inflammatory bowel diseases. Growth velocity is useful for evaluating the presence of inflammatory bowel diseases and other systemic diseases.     

Turner Syndrome with Ulcerative Colitis

Turner syndrome is a chromosomal disease frequently associated with autoimmune disorders including diabetes mellitus, thyroid disease and inflammatory bowel disease (IBD). Although the etiology of IBD has not been fully elucidated, genetic analysis has recently revealed several susceptibility genes. Recently, cases with Turner syndrome associated with IBD have been reported. We report here a 13-yr-old girl with Turner syndrome associated with ulcerative colitis. The patient was undergoing growth hormone treatment and presented with abdominal discomfort and bloody diarrhea. Her karyotype pattern was 46,X,i(Xq). Barium enema revealed punctate collections of barium suggesting microulcerations in the descending and sigmoid colon with loss of haustra. Flexible sigmoidoscopy showed that the mucosa was erythematous and friable upon touch and that the wall had frank hemorrhage and inflammatory polyp formation from the anal verge through the splenic flexure. Histologically, mucosal and submucosal inflammation was prominent, suggesting cryptitis and crypt abscess formation. Based on these findings, she was diagnosed as having ulcerative colitis, and 5-aminosalicylic acid, prednisolone and dietary therapy were initiated. Our observations in this patient suggest that X chromosome abnormality may influence the development of IBD and that screening for gastrointestinal disease in patients with Turner syndrome may help lengthen life expectancy in these patients.     

姜黄素联合美沙拉嗪治疗溃疡性结肠炎小鼠的疗效

目的 探讨姜黄素联合美沙拉嗪治疗溃疡性结肠炎小鼠的疗效及作用机制.方法 50只小鼠分成5组:正常组、模型组、姜黄素联合美沙拉嗪治疗组、姜黄素治疗组和美沙拉嗪治疗组,采用传统的葡聚糖酸钠法制备小鼠溃疡性结肠炎模型.自造模成功次日,姜黄素联合美沙拉嗪治疗组予姜黄素灌肠及美沙拉嗪灌胃治疗;姜黄素治疗组仅予姜黄素灌肠治疗;美沙拉嗪治疗组予美沙拉嗪灌胃治疗;正常组及模型组均予9 g·L-1盐水灌胃.以上均为每日1次,共10 d.给药10 d后,观察其结肠病理组织学变化,并采用流式细胞术检测其结肠上皮细胞凋亡率,采用ELISA法测定小鼠血清IL-2、IL-10水平.结果 姜黄素联合美沙拉嗪治疗组结肠指数、结肠损伤评分、病理组织学评分及细胞凋亡率较模型组均明显下降(Pa<0.01).与姜黄素治疗组和美沙拉嗪治疗组比较,姜黄素联合美沙拉嗪治疗组结肠损伤评分、病理组织学评分及细胞凋亡率有所下降,且差异均有统计学意义(Pa<0.05);与模型组比较,姜黄素联合美沙拉嗪治疗组、姜黄素治疗组和美沙拉嗪治疗组血清IL-10水平均显著下降,血清IL-2水平显著升高(Pa<0.01).与姜黄素治疗组和美沙拉嗪治疗组比较,姜黄素联合美沙拉嗪治疗组血清IL-10水平显著下降,血清IL-2水平显著升高(Pa<0.05).结论 姜黄素联合美沙拉嗪治疗小鼠溃疡性结肠炎,效果较单用美沙拉嗪好,姜黄素联合美沙拉嗪治疗小鼠溃疡性结肠炎在降低IL-10、升高IL-2水平方面较单用美沙拉嗪显著.     

BALB/c小鼠渍疡性结肠炎远段结肠Cajal间质细胞分布变化

目的：建立BALB／c小鼠急、慢性溃疡性结肠炎（UC）动物模型，观察UC小鼠远段结肠组织中Cajal间质细胞（ICC）分布的变化，探讨ICC在UC肠功能紊乱发病中的作用。方法：将30只BALB／c小鼠随机分为健康对照组、急性和慢性UC组，每组各10只。通过饮用50g／L葡聚糖硫酸钠（DSS）方法建立BALB／c小鼠急、慢性UC动物模型，对照组仅饮用蒸馏水。应用免疫荧光、激光共聚焦荧光定量等技术检测ICC在UC小鼠远段结肠组织内分布的变化。结果：1．健康对照组远段结肠组织ICC主要分布在黏膜下丛（IC—SM）和肌间丛（IC—MY），IC—MY在切面上几乎呈现连续性分布，相互连接形成网络状结构；2．急性UC组远段结肠组织内ICC的分布较健康对照和慢性UC组明显减少（Pa〈0、001），IC—MY的网络状结构完全破坏，残存ICC形态也出现异常；3．慢性UC组远段结肠组织ICC的分布较健康对照组减少（P〈0．05），但较急性UC组显著增加（P〈0．001），其形态接近正常，但IC—MY的连续性分布不明显，未能形成正常的网络状结构。结论：UC小鼠远段结肠组织内ICC分布减少，形态异常，推测与UC小鼠肠功能紊乱有一定相关性。     

不完全川崎病136例

目的探讨不完全川崎病(KD)的临床特点。方法对不完全KD 136例及典型KD 443例的临床资料进行回顾性分析。结果两组年龄、性别、临床表现及各项实验室检查方面均无明显差异,但在冠状动脉病变发生率方面,不完全KD(18.4%)明显高于典型KD(11%)。结论不完全KD冠状动脉病变发生率高。临床应重视早期诊断和早期治疗。     

A Case of Ulcerative Colitis Induced by Oral Ferrous Sulfate

We report a case of ulcerative colitis (UC) in a 15 year old female undergoing treatment for anemia with oral ferrous sulfate. We suggest that the oral ferrous sulfate initiated the typical symptoms of UC in this case. This case is the first clinical report to our knowledge supporting the 'iron-catalysed oxidant-mediated ischemic injury theory' of UC.     

儿童炎症性肠病11例

目的探讨儿童炎症性肠病(IBD)的临床特点,以提高对儿童IBD的认识。方法对1995年1月-2005年12月本院收治的11例IBD患儿的临床资料进行回顾性分析。结果11例IBD患儿中克罗恩病(CD)8例,溃疡性结肠炎(UC)3例;男9例,女2例;发病年龄1个月～12岁9个月(中位年龄6岁)。11例IBD患儿均无阳性家族史。临床表现为贫血9例(81.8%),消瘦、腹痛各8例(72.7%),发热7例(63.6%),腹泻6例(54.5%),便血5例(45.5%)。实验室检查11例(100%)患儿均有CRP增高,ESR升高10例(90.9%),白细胞升高8例(72.7%)。病理结果表现为浅表小溃疡7例(63.6%)、黏膜慢性炎症6例(54.5%),患儿均未见非干酪样肉芽。其中10例予5-氨基水杨酸或柳氮磺胺吡啶、糖皮质激素治疗后缓解。结论IBD可在婴幼儿期发病,其诊断应根据临床表现、血液学指标、消化内镜及组织病理学等资料进行综合评价。如临床高度怀疑IBD,实验室检查虽无典型病理改变,在除外感染性疾病和其他自身免疫性疾病的基础上,可行诊断性治疗。     

Serum Antibodies to Cow's Milk Proteins in Pediatric Inflammatory Bowel Disease: Crohn's Disease vs. Ulcerative Colitis

ABSTRACT. Serum antibodies to five cow's milk proteins, α-casein, bovine serum albumin (BSA), β-lac-toglobulin A and B (BLG-a, BLG-b) and α-lactalbumin (ALA) were investigated in young patients with inflammatory bowel disease, 56 with Crohn's disease (CD), 24 with ulcerative colitis (UC). IgG antibodies against BSA and BLG-a and -b were higher in Crohn's disease patients as compared to those with ulcerative colitis and controls. The IgG anti-BSA were higher in the group of CD patients with higher score of disease activity. Additionally, IgA antibodies to a-casein were higher in CD and UC compared to control. These findings may be due to increased uptake of dietary antigens or enhanced immunological response occurring in CD patients.