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目的探讨儿童过敏性结肠炎(AC)的临床特点及诊治方法。方法回顾性分析浙江大学医学院附属儿童医院2008年1月至2010年12月收治的53例AC患儿的临床、结肠镜及病理学表现以及实验室检查和治疗情况等。结果 (1)AC以2岁以下儿童多见,共49例(92.5%)。临床表现以血便[46例(86.8%),包括黏液血便和鲜血便]及腹泻(35例)最常见。(2)内镜下表现为局部红斑33例(62.3%),颗粒样结节31例(58.5%),表面糜烂10例(18.9%),溃疡形成1例(1.9%),镜下黏膜正常3例(5.7%),病变主要累及直肠[43例次(81.1%)]及乙状结肠[45例(84.9%)]。组织病理学主要表现为黏膜固有层嗜酸粒细胞浸润,以6～20个/HP浸润为主(62.3%)。(3)病史及实验室检查结果:16例患儿有特应性体质史,部分食物蛋白及吸入性过敏原特异性抗体检测阳性8例,外周血嗜酸粒细胞升高16例,贫血12例,外周血总IgE升高5例。(4)患儿平均住院时间(6.9±4.0)d,均好转出院。<1岁患儿纯母乳喂养者单独使用白三烯受体拮抗剂较单独更换特殊配方奶粉及二者合用平均住院天数少(P<0.05),而非纯母乳喂养组各种治疗方法的住院天数差异无统计学意义。(5)结肠镜下多发淋巴样颗粒结节表现与组织病理上嗜酸粒细胞浸润程度有相关性(P<0.05)。结论儿童AC临床表现以腹泻及血便为主,内镜下表现各异,多发淋巴样颗粒结节可能是AC较特异性表现,详细的病史询问、体格检查、辅助检查对诊断具有重要意义。回避饮食疗法及抗过敏奶粉治疗是目前儿童AC的主要治疗方法,白三烯受体拮抗剂可能对AC患儿有效。

Clinical features of allergic colitis in children:analysis of 53 cases.

??Objective To study the clinical features of allergic colitis??AC??in children in order to improve accurate diagnosis and treatment. Methods A retrospective analysis was performed about the clinical manifestations??endoscopic and histopathological features??laboratory test results and managements of 53 AC children admitted to DepartmentofGastroenterology??Children’s Hospital of Zhejiang University??from January 2008 to December 2010. Results ??1??AC was commonly found in children under 2 years old??49 cases??92.5%??.Hematochezia??46 cases??and diarrhea??35 cases??were the most common clinical features??while vomiting??abdominal pain and malnutrition were rare. ??2??Gross endoscopic findings included diffuse erythema-friability??62.3%???? lymphoid nodular hyperplasia??58.5%????superficial erosions??18.9%??and frank ulceration with surface exudates??1.9%??. Rectum??43 cases??81.1%??and sigmoid colon??45 cases??84.9%??were most frequently affected. Eosinophilic infiltration throughout the mucosal layer??mostly 6 ~ 20/HP??particularly in the lamina propria?? was the characteristic histopathologic change.??3??Clinical histories and laboratory tests results??16 children had atopic history??including drug allergy??5 cases????eczema ??8 cases??and so on?? 41 cases received allergen specific antibody test??and 8 showed positive results. Laboratory tests results showed high serum IgE??5/43 cases????peripheral eosinophilia??16/53 cases?? and anemia??12/53 cases??. ??4?? All children were hospitalized and dismissed after symptomatic relief??with an average of ??6.9 ± 4.0??days. Leukotriene receptor antagonist was more effective for breast feeding infants?? but special formulae and leukotriene receptor antagonist both had effect on non-breast feeding infants.??5??The relationship between gross endoscopy changes and eosinophilic infiltration showed that lymphoid nodular hyperplasia found by gross endoscopy was correlated with eosinophilic infiltration??P??0.05??. Conclusion AC has different clinical symptoms and endoscopic changes??so detailed clinical histories??laboratory and endoscopic findings??multiple mucosal biopsy are important for diagnosis and treatment. Avoiding suspected allergens and use of hypoallergic formulae are the main ways of treatments??leukotriene receptor antagonist may also be effective for AC??but it needs more studies.