儿童炎症性肠病临床及结肠镜下特点分析

目的 探讨儿童炎症性肠病的临床特点,分析结肠镜及活组织学检查对疾病诊断的重要性.方法 研究在我院住院的34例炎症性肠病患儿的临床表现、实验室检查、结肠镜下特点及活检组织学特点,分析其诊断价值.其中克罗恩病(CD)10例,溃疡性结肠炎(UC)24例.结果 CD组中,轻-中度活动型4例,重度活动型6例.临床表现以腹痛多见(80%,8/10);并发症:肠穿孔1例,肠梗阻2例,肛瘘2例.UC组中,轻度5例,中度14例,重度5例.临床表现以腹泻为主(23/24,96%);肛周疾病3例,并发慢性肠套叠1例.CD组血沉、C反应蛋白水平较UC组高(X2=15.938、11.184,P均<0.01).10例CD中,小肠结肠型6例(60%),结肠型1例(10%),小肠捌3例(30%).结肠镜下表现有节段性分布、溃疡多样性、修复性改变、部分肠管狭窄僵硬等特点.24例UC中,全结肠累及者6例(25%),乙状结肠、直肠累及者14例(58%),左半结肠累及者7例(29%),结肠镜下表现为连续性黏膜充血水肿、糜烂,多发浅溃疡多见,溃疡多不规则,7例(29%)可见假息肉形成,黏膜桥未见.CD活检组织学均有淋巴细胞浸润,1例见裂隙状溃疡,2例见上皮性肉芽肿.UC活检标本均有多量中性粒细胞、淋巴细胞、浆细胞等炎性细胞浸润表现,其中4例(17%)见隐窝脓肿.结论 儿童炎症性肠病的临床特点具有非特异性,结肠镜结合组织活检对UC的诊断有可靠的价值.对于结肠型或小肠结肠型CD,结肠镜检查有重要意义,组织活检特异性不高,可多部位、深凿活检以提高阳性率,协助诊断.

Clinical and colonoscopic characteristics of pediatric Inflammatory bowel disease

Objective To analyze clinical manifestations, endoscopic and histological features for establishing a diagnosis of pediatric inflammatory bowel disease (IBD). Method Thirty-four inpatients with inflammatory bowel disease (ulcerative eolitis/UC/: 24; Crohn's disease/CD/: 10) were enrolled into this study. Data of clinical manifestations, laboratory values, endoscopic findings and histopathological features of biopsy material were analyzed. Result Four children had mild/moderate active Crohn's discase. Six had severe active disease. The most common presenting symptom in CD was abdominal pain (80%, 8/10). One child had intestinal perforation; 2 had obstruction. Anal fistula was found in 2 patients. There were 5 mild, 14 moderate and 5 severe diseases in UC group. Diarrhea (23/24,96%) was the most eommou symptom. Three children with UC suffered from perianal diseases. One had chronic intussusception. ESR and C reactive protein values were significantly higher in patients with CD compared with patients with UC(X2=15.938, P<0.01;X2=11.184, P<0.01). The pattern of anatomic involvement in CD was: ileocolic 60%, colon 10% and small bowel 30%. Endoscopically, discontinuous lesions, diverse ulcers, proliferative/regenerative patterns and narrowed bowel lumen were observed. Histologically, lymphocytes aggregation in the lamina propria and submucosa were observed. Nou-caseating granulomas were found in 22% cases. Twenty-five percent of patients with UC had pancolitis. Colonoscopy showed diffusely distributed multiple erosions and ulcers in UC cases. Twenty-nine percent of children had paeudopolyps. No mucosal bridge was found. Mucosal biopsies showed chronic inflammatory cells, neutrophils and eosinophils diffusely infiltrated in the lamina propria. Crypt abscess was found in 4 cases. Conclusion The clinical manifestations in pediatric inflammatory bowel disease are nonspecific. Colonoscopic examination and biopsy axe valuable in establishing the diagnosis of pediatric ulcerative colitis. It is important for colon involved CD children to have a colonoscopic examination. But the mucosal biopsies were short of specificity. Multi-place and deep biopsy are needed to improve the diagnosis.