小儿迁延性慢性腹泻与乳糖不耐受（附74例分析）

乳糖不耐受为小儿迁延性慢性腹泻的一个重要原因,近年来渐引起国内外的重视,我院91年4～10月对108例迁延性慢性腹泻患儿进行了粪便乳糖定性测定,现报告如下。     

儿童迁延性及慢性腹泻病因研究进展

儿童迁延性、慢性腹泻的病程为2周至2个月或超过2个月,是一组多病因导致的临床综合征。本文对其常见病因进行了综述,常见病因包括感染、非特异性炎症性肠病、食物过敏、乳糖不耐受以及抗生素相关性腹泻、神经调节异常、免疫缺陷病、营养不良、乳糜泻、锌缺乏等。     

加强小儿慢性腹泻病的防治研究

腹泻病是一组多病因引起的以腹泻症状为主的临床综合征,尽管医学有了很大的发展,对于腹泻病的认识不断深入,腹泻防治水平有了很大提高,但全球每年死于腹泻的儿童仍有200万之多。我国的腹泻病防治方案和儿科教科书上将腹泻按病程的长短分为急性腹泻、迁延性腹泻、慢性腹泻。急性腹泻病程≤2周,迁延性腹泻病程超过2周,但不超过2个月,慢性腹泻指病程迁延超过2个月,甚至数年者。国外的教科书和文献大多将腹泻持续超过2周者一起论述,称为慢性腹泻（chronic diarrhea）或持续性腹泻（persistent diarrhea,PD）,相当于我们以前所称的迁、慢性腹泻。     

小儿迁延性、慢性腹泻病25例治疗分析

目的总结小儿迁延性、慢性腹泻病的治疗方法及效果。方法收集2003～2005年25例在我院住院符合迁延性、慢性腹泻病患儿治疗情况及效果，进行总结。结果25例患儿治疗2～4周，17例痊愈，5例好转，有效率达88％，3例无明显效果。结论经综合治疗，小儿迁延性、慢性腹泻病可达到令人满意的治疗效果。     

慢性腹泻患儿乳糖不耐受的研究：附50例分析

本文报道对50例慢性腹泻患儿作小肠粘膜活检、粘膜乳糖酶活性分析和粪便还原糖测定。结果:粪糖阳性率70%,乳糖酶缺乏68%,其中两者皆存者28例(占56%)。78%患儿有不同程度的肠粘膜损害,其损害的程度可能决定乳糖不耐受的发生率。表明继发乳糖不耐受是腹泻的一常见并发症,可能是腹泻持续的一个重要因素。乳糖酶活性测定为一较可靠的诊断方法,可用以指导临床饮食治疗。     

婴幼儿迁延性及慢性腹泻肠道菌群变化及病因探讨

为了探讨迁延性、慢性腹泻患儿的肠道菌群变化及病因 ,对３１例健康儿童及３５例迁延性、慢性腹泻患儿粪便中４种常见厌氧菌、需氧菌进行定量检测。病例选择 :①自１９９８年３月至２０００年３月在我科住院的迁延性、慢性腹泻患儿 ,年龄均在８个月至３岁半 ;②大便每日４次以上 ,为黄绿色稀便、粘液便 ;③在外均用过抗生素３天至１０天不等 ;④Ｘ线钡剂灌肠检查排除炎症性肠病 ;⑤３５例患儿均做大便致病菌培养未发现志贺氏菌、沙门氏菌。健康儿童选择同期本院托儿所儿童３１名 ,年龄为１岁～３岁 ,２周内无腹泻、未用抗生素者。结果 :３１…     

小儿慢性腹泻并乳糖不耐受及其治疗对策

小儿慢性腹泻病(chronic diarrhea disease,CDD)的治疗已成为当前儿科消化专业的重点研究课题之一。目前国内将病程在2周以上的腹泻称为迁延性腹泻(persistent diarrhea,PD),病程>2个月称为CDD,而国外将病程>2周者即称为CDD[1]。本文仅就CDD并乳糖不耐受(lactase intolerance,LI)的治疗对策进行重点讨论。一、CDD(或PD)的发病机制1.肠黏膜损害(1)对CDD患儿空肠黏膜活检标本电镜下观察到小肠黏膜超微结构异常,如绒毛萎缩、坏死,上皮细胞胞质溢出,细胞脱落,吸收上皮细胞表面微绒毛损害及糖萼丢失,导致肠细胞吸收面积减少;(2)双糖(尤…     

婴儿继发性乳糖不耐受54例临床分析

为了探讨婴儿继发性乳糖不耐受 (LI)的临床诊治特点 ,以单纯母乳喂养迁延和慢性腹泻的婴儿为观察对象 ,按照诊断标准和排除标准而诊断为继发性LI 5 4例 ,占观察对象的 2 9.7%。结果表明 :诱发该病的原因常是 2～ 4个月婴儿的肠道感染 ,临床上以轻型腹泻多见 ,大便为水样稀便 ,5 4例经暂停母乳喂养均治愈。提示 :迁延及慢性腹泻的婴儿 ,有继发肠粘膜损伤病史者 ,进食乳类发生腹泻而停用含乳糖食物则腹泻消失是婴儿LI的临床特点。因此 ,对于 2～ 4月龄开始出现慢性迁延腹泻一般情况尚好的婴儿 ,可暂停母乳 1 2～ 2 4h腹泻常减轻或停止 ,有助于临床诊断继发性LI。     

婴儿继发性乳糖不耐受54例临床分析

为了探讨婴儿继发性乳糖不耐受 (LI)的临床诊治特点 ,以单纯母乳喂养迁延和慢性腹泻的婴儿为观察对象 ,按照诊断标准和排除标准而诊断为继发性LI 5 4例 ,占观察对象的 2 9.7%。结果表明 :诱发该病的原因常是 2～ 4个月婴儿的肠道感染 ,临床上以轻型腹泻多见 ,大便为水样稀便 ,5 4例经暂停母乳喂养均治愈。提示 :迁延及慢性腹泻的婴儿 ,有继发肠粘膜损伤病史者 ,进食乳类发生腹泻而停用含乳糖食物则腹泻消失是婴儿LI的临床特点。因此 ,对于 2～ 4月龄开始出现慢性迁延腹泻一般情况尚好的婴儿 ,可暂停母乳 1 2～ 2 4h腹泻常减轻或停止 ,有助于临床诊断继发性LI。     

生理性腹泻—乳糖不耐受的一种特殊类型：附60例分析

多年来国内将生后不久出现腹泻、大便次数增多但不伴呕吐、食欲好、体重增加不受影响,到添加辅食后大便自然恢复正常者称之为“生理性腹泻”,其发病机理尚未阐明。作者近3年来用简易粪便乳糖检测法检查腹泻婴儿粪便987份,粪便乳糖≥++者410份,其中163例的临床表现与“生理性腹泻”酷似,今将临床资料较完整并有随访结果的60例报道如下。     

Association of indicators of hygiene behavior with persistent diarrhea of young children

We examined the association between water and hygiene-related behaviors and persistent diarrhea (duration 14 days) among children under age three years in an indigenous rural Guatemalan community. Behavior indicators were specific aspects of the appearance of the mother, study child, other children and household that could be observed using a spot observation technique. Thirty-four percent of children had one or more episodes of persistent diarrhea during the year of study. Bivariate analyses found that a higher proportion of observations in which the anti-hygienic condition was observed was significantly associated with persistent diarrhea for 11 of 26 behavior indicators; these 11 indicators were also strongly correlated with each other. In individual logistic regression models, which included overall rate of diarrhea and other child characteristics associated with persistent diarrhea, six behavior indicators maintained significant association with persistent diarrhea: presence of toy on the ground, presence of baby bottle on the ground, the hands of the mother being dirty, presence of a fecally soiled diaper on the ground in the household compound, presence of feces in the yard, and the study child wearing a fecally soiled diaper. Three additional indicators closely approached significant association with persistent diarrhea. Excluding the three soiled diaper indicators, which might be the result rather than the cause of diarrhea, we found the six other behavior indicators to demonstrate a significant dose-response effect in increasing risk of persistent diarrhea. These findings suggest that behaviors which promote increased exposure of young children to enteric pathogens increase risk of persistent diarrhea.     

Epidemiology of persistent diarrhea among Guatemalan rural children

A prospective, longitudinal two-year study to determine the epidemiology of persistent ( 14 days'duration) diarrhea in rural children of Guatemala was undertaken. Three-hundred and twenty-one children aged 0-35 months were kept under surveillance by twice-a-week home visits. The overall incidence of diarrhea was 0.147 per child-week; the incidence of persistent diarrhea was 0.014 per child-week. The peak of persistent diarrhea was observed in infants below six months of age, with a continuous decline thereafter. This trend in incidence of persistent diarrhea was associated with a higher proportion (16%) of illnesses persisting for more than 13 days in children younger than six months of age as compared to children 30-35 months old (4%). Males had more diarrhea (0.156 per child-week) than females (0.139 per child week). Among children above 18 months of age, the proportion of episodes that lasted for more than 13 days was lower in females than in males.     

Immunological background in children with persistent diarrhea in Ghana

BACKGROUND: Persistent diarrheal diseases have become one of the most serious medical problems in developing countries, but few studies have been conducted to determine the risk factors. In the present study, we investigated the nutritional and immunological background in children with persistent diarrhea in comparison with those with acute diarrhea. METHODS: Children with diarrhea who were brought to the Oral Rehydration Salt Clinic of Princess Marie Louise Children's Hospital in Accra were evaluated from an immunological and nutritional aspect. In the follow-up visit, the cases whose diarrhea stopped within 2 weeks after onset were classified into the acute diarrhea group; those with diarrhea lasting more than 2 weeks were classed in the persistent group. Nutritional and immunological data at the initial visit were compared between these two groups. RESULTS: In general, the diarrhea cases had a tendency to undernutrition and impaired cellular immunity compared with healthy control. Persistent cases had lower values for longer half-life, rapid turn-over proteins. Persistent cases had a higher percentage of CD8+ cells and lower CD4/CD8 ratio. CD25 expression in CD4+ cells stimulated by anti-CD3 antibody was lower in the persistent diarrhea group. CONCLUSION: These results appear to support the hypothesis that more severe nutritional status and impairment of cellular immunity is related to the persistence of diarrhea.     

基因诊断在儿童慢性腹泻中的应用

儿童慢性腹泻是临床常见的消化系统疾病，其疾病种类繁多，临床症状复杂，且各种慢性腹泻疾病之间症状常重叠，故临床病因诊断困难，基因检测是明确诊断的有效手段。近年来，分子诊断技术的不断进步，尤其是二代基因测序（NGS）技术的广泛应用，使基因检测成本降低、时间缩短，因此，基因诊断策略选择及报告解读对临床医师十分重要。     

小儿慢性腹泻病的诊断

腹泻病是由多种因素所致的消化道疾病,我国的定义为大便性状改变或大便量增加,以大便性状改变为主要特征;根据病程分为急性腹泻病(≤2周)、迁延性腹泻病(≤2月)和慢性腹泻病(>2月)[1]。国外将腹泻病定义为大便内含有过多的水或电解质,或大便的重量>10g/(kg·24hr);腹泻病程>2周为慢性腹泻病[2]。正常儿童胃肠道能够吸收的液体约为285ml/(kg·24hr)和排出大便5～10g/(kg·24hr)。正常大便中含Na 20～25mEq/L、K 50～70mEq/L、Cl-20～25mEq/L。1慢性腹泻病的病因多种原因均可导致小儿慢性腹泻病,可引起慢性腹泻病的消化系统及非消化系统疾…     

A randomized controlled clinical trial of zinc, vitamin A or both in undernourished children with persistent diarrhea in Bangladesh

In a double-blind randomized controlled clinical trial, moderately malnourished Bangladeshi children (61-75% of the median weight/age) were studied for the effect of zinc and/or vitamin A supplementation on the clinical outcome of persistent diarrhea. Children 6 mo to 2 y of age with diarrhea for more than 14 d were randomly allocated into 4 groups of 24 receiving a multivitamin syrup and (i) zinc (20 mg elemental), (ii) vitamin A, (iii) both zinc and vitamin A, or (iv) neither, in 2 doses daily for 7 d. Clinical data on recovery and on stool output, consistency and frequency were recorded for 7 d, and weight change from day 1 to day 7 was assessed. The baseline characteristics of the four study groups were comparable. The mean daily stool outputs from days 2 to 7 of therapy were significantly less in the zinc and zinc plus vitamin A groups, but not in the vitamin A group, in comparison with the control group. In children receiving zinc, the cumulative stool weight in the 7 d was 39% less than in the control group (p < 0.001) and 32% less than in the vitamin A group (p = 0.006). The cumulative stool weight in the zinc plus vitamin A group was 24% less than in the control group (p < 0.001), but the 14% lower output than in the vitamin A group was not statistically different. The change in body weight over the 7 d study period was significantly different between the group receiving zinc and the control group (+111 g vs -90 g, p = 0.045). The rate of clinical recovery of children within 7 d was significantly greater in the zinc group (88%) compared with the control group (46%, p = 0.002) or vitamin A group (50%, p = 0.005), but not statistically different from the zinc plus vitamin A group (67%, p = 0.086). Conclusion: The results indicate that zinc, but not vitamin A, supplementation in persistent diarrhea reduces stool output, prevents weight loss and promotes earlier recovery.     

Detection of parasites in children with chronic diarrhea

The aim of this study was to investigate the frequency of intestinal parasites in patients with chronic diarrhea and clarify the importance of these parasitic pathogens in such cases. A total of 60 pediatric patients with chronic diarrhea between June 2012 and October 2014 were enrolled in the study. Out of 60 stool samples, five were positive for Giardia lamblia, two, Dientamoeba fragilis, and one, Blastocystis hominis. One stool sample was positive for Entamoeba hartmanni and B. hominis, another one was positive for G. lamblia and B. hominis, another, G. lamblia and E. hartmanni and one sample was positive for Enterobius vermicularis, D. fragilis and B. hominis together. Parasitic infection, which decreases quality of life and increases susceptibility to other infections, should not be neglected, particularly in patients with chronic diarrhea. Accurate diagnosis decreases morbidity and mortality in patients with parasite infection.     

Mortality associated with acute watery diarrhea, dysentery and persistent diarrhea in rural North India

Mortality associated with diarrhea was investigated in a longitudinally followed cohort of children under six years of age in rural North India. During the follow-up, 1663 episodes of diarrhea and 23 diarrhea related deaths were recorded in 1467 children followed up for 20 months. The case fatality rate was 0.56% for acute watery diarrhea, 4.27% for dysentery and 11.94% for non-dysenteric persistent diarrhea. Most of the episodes lasted less than a week; 5.2% became persistent (duration > 14 days). The case fatality rate was similar in episodes of one and two weeks'duration (0.64% and 0.8%) and increased to 13.95% for persistent episodes. Of the total 86 persistent episodes, 22.1% were dysenteric; the case fatality rate for such dysenteric persistent episodes was 21.1% and for watery persistent diarrhea 11.4%. Diarrheal attack rates were similar among different nutritional groups, but diarrheal case fatality rates progressively increased with increasing severity of malnutrition, these were 24 times higher in children with severe malnutrition (7.48%) compared to those normally nourished (0.31%). With availability and use of oral rehydration therapy, dysentery and persistent diarrhea emerge as major causes of diarrhea related mortality, with underlying malnutrition as a key associated factor.     

儿童慢性腹泻的诊断思路

儿童慢性腹泻病因复杂，严重影响儿童的健康和生活质量，儿童期慢性腹泻以婴幼儿期为常见，除后天因素外，还要考虑先天解剖结构异常及先天遗传性疾病。腹泻的诊断思路要结合年龄、病史、体检及实验室检查综合分析，根据不同的情况选择进一步检查，包括影像学、消化内镜、病理及特殊检查，怀疑遗传性疾病时采用基因测序及功能验证，最终大部分能找到病因。