新生儿炎症性肠病七例临床分析  

Inflammatory bowel disease in neonates：report of seven cases

作　　者：林云峰[1,2] 花少栋[2] 王海红[3] 樊燕宇 韩涛[2] 封志纯[2] 

机构地区：[1]福建医科大学福建省妇幼保健院教学医院新生儿科,福州350001 [2]南方医科大学解放军陆军总医院临床医学院附属八一儿童医院新生儿重症监护病房,北京100700 [3]南方医科大学解放军陆军总医院临床医学院消化内镜中心,北京100700

出　　处：《中华围产医学杂志》2016年第7期506-510,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的：探讨新生儿期起病的炎症性肠病的临床特点。方法2010年7月至2015年7月，南方医科大学解放军陆军总医院临床医学院附属八一儿童医院共诊断7例新生儿期起病的炎症性肠病患儿，收集患儿临床资料，总结临床特点，并与文献报道的儿童炎症性肠病进行对比，分析新生儿炎症性肠病的特点。采用t检验和χ^2检验进行统计学分析。结果7例患儿中溃疡性结肠炎6例，克罗恩病1例，均于生后2～20 d起病，均表现为腹泻、体重不增和贫血，超敏C-反应蛋白间歇性升高。与儿童炎症性肠病相比，腹痛和腹部包块更少见，贫血更常见。7例患儿多次粪便培养、血培养均为阴性。腹部X射线检查有4例肠壁增厚。7例结肠镜检查示回盲部至直肠的多发溃疡，病理组织学表现为肠黏膜组织慢性炎症伴急性炎。6例使用5-氨基水杨酸治疗（4例联合糖皮质激素治疗），1例单用糖皮质激素治疗。其中1例2岁开始使用英夫利昔单抗治疗。1例因拒绝继续治疗，出院后1个月内死亡，其他6例均用药得到控制。1例出院后6个月失访；2例（生后9个月和1周岁）停药，考虑治愈；3例继续服药，病情控制良好。结论对于腹泻、体重不增、贫血的新生儿，如果抗生素治疗效果不佳，间歇发病，应及早行肠镜检查。诊断IBD后早期坚持规范治疗可取得较好效果。ObjectiveTo analyze the clinical characteristics of inflammatory bowel disease （IBD） in neonates.MethodsFrom July 2010 to July 2015, seven neonates were diagnosed with IBD in Affiliated BaYi Children＆#39;s Hospital, Clinical Medical College in Chinese People＆#39;s Liberation Army General Hospital, Southern Medical University. The data regarding these neonatal cases were analyzed and compared with 45 children with IBD from literature. Thet-test andChi-square test were used for statistical analysis of the data.ResultsSix cases had ulcerative colitis, and one case had Crohn＆#39;s disease, both occurred 2-20 days after birth, and were characterized by diarrhea, no increase in body weight, anemia and intermittent higher hypersensitive C-reactive protein. Compared with IBD in children, abdominal pain and abdominal mass were rarer, while anemia was more common in neonatal IBD. All fecal cultures and blood cultures in the seven cases of neonatal IBD were negative. Abdominal X-ray revealed intestinal wall thickening in four cases. Multiple ulcers were observed from the cecum to the rectum by colonoscopy. Chronic intestinal mucosal inflammation associated with acute inflammation were found on pathological examination. Six infants received treatment with 5-aminosalicylic＆amp;nbsp;acid （combined with glucocorticoid in four cases）, and one received glucocorticoid treatment only. One infant was started on infliximab treatment from two years old. One of these seven cases died one month after discharge due to refusal to continue treatment, and the disease was controlled in the other six cases. After treatment, one infant was lost to follow-up six months after discharge, two were cured at six and 12 months old without further treatment, and three improved and continued treatment.ConclusionsIn neonates with diarrhea, anemia and no increase in body weight, especially when antibiotic treatment is ineffective, colonoscopy should be performed to facilitate early diagnosis of IBD. Standard treatments result in good outc

关 键 词：炎性肠疾病 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]