CAJ | 학술논문

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.
목적 탐토인동염증성장병적림상특점,분석결장경급활조직학검사대질병진단적중요성.방법 연구재아원주원적34례염증성장병환인적림상표현、실험실검사、결장경하특점급활검조직학특점,분석기진단개치.기중극라은병(CD)10례,궤양성결장염(UC)24례.결과 CD조중,경-중도활동형4례,중도활동형6례.림상표현이복통다견(80%,8/10);병발증:장천공1례,장경조2례,항루2례.UC조중,경도5례,중도14례,중도5례.림상표현이복사위주(23/24,96%);항주질병3례,병발만성장투첩1례.CD조혈침、C반응단백수평교UC조고(X2=15.938、11.184,P균<0.01).10례CD중,소장결장형6례(60%),결장형1례(10%),소장팔3례(30%).결장경하표현유절단성분포、궤양다양성、수복성개변、부분장관협착강경등특점.24례UC중,전결장루급자6례(25%),을상결장、직장루급자14례(58%),좌반결장루급자7례(29%),결장경하표현위련속성점막충혈수종、미란,다발천궤양다견,궤양다불규칙,7례(29%)가견가식육형성,점막교미견.CD활검조직학균유림파세포침윤,1례견렬극상궤양,2례견상피성육아종.UC활검표본균유다량중성립세포、림파세포、장세포등염성세포침윤표현,기중4례(17%)견은와농종.결론 인동염증성장병적림상특점구유비특이성,결장경결합조직활검대UC적진단유가고적개치.대우결장형혹소장결장형CD,결장경검사유중요의의,조직활검특이성불고,가다부위、심착활검이제고양성솔,협조진단.
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.