儿童克罗恩病10 例临床分析

Clinical analysis of 10 cases of pediatric Crohn’s disease

摘要:

目的 探讨儿童克罗恩病（CD） 的临床特点，并对其治疗进行初步探讨。方法 回顾性分析2005 年1 月至2013 年12 月间10 例确诊为CD 患儿的临床资料，包括其临床表现、内镜表现及内镜下黏膜活检病理特点、腹部B 超、实验室检查结果及治疗情况等。结果 患儿临床表现以腹痛、腹泻、便血为主，多伴有不同程度的生长发育障碍及营养障碍，肠外表现以发热为主。肠镜检查常见表现为非连续性阶段性黏膜充血、糜烂、黏膜呈鹅卵石样增生病变、黏膜溃疡等。腹部B 超检查示肠壁的不均匀阶段性增厚。病理表现主要为固有膜内较多淋巴细胞、嗜酸性粒细胞、浆细胞浸润，黏膜腺体部分萎缩。疾病缓解期CRP 明显低于急性发作期及疾病复发期（P<0.05）；疾病缓解期ESR 低于疾病复发期（P<0.05）。疾病初期儿童CD 活动指数（PCDAI）评分为轻度的患儿，使用5 氨基水杨酸（5-ASA）联合肾上腺皮质激素口服治疗诱导缓解率为100%，维持缓解率为67%；PCDAI 评分为中/重度的患儿，使用5-ASA 联合肾上腺皮质激素治疗部分缓解率为100%，但维持缓解效果欠佳，疾病复发率高。结论 儿童CD 的临床表现及实验室检查均缺乏特异性。ESR 及CRP 可作为疾病进展评估的指标。5-ASA 在儿童CD 的诱导和维持缓解中有一定的疗效。治疗转归与疾病初期PCDAI 评分的高低有一定的相关性。

Abstract:

Objective To study the clinical features and treatment of pediatric Crohn's disease (CD). Methods Clinical data of 10 children with active CD diagnosed between 2005 and 2013 were retrospectively reviewed. Results Abdominal pain, diarrhea, and bloody stools were the most common symptoms in these patients, usually accompanied by different degrees of growth retardation and nutritional disorders. Fever was the main extraintestinal manifestation. Enteroscopy showed discontinuous and segmental mucosal hyperaemia and erosion, cobblestone appearance and mucosal ulceration. Abdominal ultrasound revealed uneven and segmental thickening of the intestinal wall. The pathological esamination showed many lymphocytes, eosinophils and plasma cells infiltrating into the lamina propria and partial atrophy of mucosal gland. C-reactive protein (CRP) level was significantly lower in the remission stage than in the acute stage and the recurrence stage (P<0.05). The erythrocyte sedimentation rate (ESR) was significantly lower in the remission stage than in the recurrence stage (P<0.05). Among mild cases identified by the pediatric Crohn's disease activity index (PCDAI) in the early stage of disease, the induced remission rate and maintained remission rate were 100% and 67%, respectively, with oral 5-aminosalicylic acid (5-ASA) and adrenocortical hormone. Among moderate and severe cases identified by the PCDAI, the partial remission rate was 100% with 5-ASA and adrenocortical hormone, but the maintained remission rate was not so good and the recurrence rate of disease was high. Conclusions Pediatric CD has no specific clinical manifestations and laboratory test results. ESR and CRP can be used as the markers for evaluating the disease progression. 5-ASA has certain efficacy in inducing and maintaining remission of pediatric CD. There is a certain correlation between treatment outcome and the PCDAI score in the early stage of disease.