儿童周期性呕吐综合征63例临床与胃镜分析  

Clinical and gastroscopic features of children with cyclic vomiting syndrome:an analysis of 63 cases

作　　者：宋琳[1] 李玉佳 王健[1] 李宁宁[1] 杜燕燕 贺兰 徐樨巍 SONG Lin;LI Yu-Jia;WANG Jian;LI Ning-Ning;DU Yan-Yan;HE Lan;XU Xi-Wei(Department of Pediatrics,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院儿科,清华大学临床医学院,北京102218 [2]北京京都儿童医院消化科,北京102208

出　　处：《中国当代儿科杂志》2022年第12期1340-1344,共5页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨周期性呕吐综合征患儿的临床及胃镜下表现的特点。方法回顾性分析2019年8月—2022年3月在清华大学附属北京清华长庚医院住院及门诊随访的63例周期性呕吐综合征患儿的病例资料。结果63例患儿中,男30例,女33例;平均年龄6.11岁;平均病程2.57年;呕吐期平均4.04 d。伴随症状最常见的是精神萎靡或嗜睡(55/63,87%),其次是厌食(45/63,71%)、腹痛或腹部不适(40/63,63%)、便秘(19/63,30%)、流涎(12/63,19%)、恶心(11/63,17%)、头痛(11/63,17%)、发热(6/63,10%)、皮疹(1/63,2%)。63例均进行了胃镜检查,其中3例无明显异常,22例(35%)表现为单纯慢性浅表性胃炎或慢性非萎缩性胃炎,38例(60%)伴有除慢性胃炎以外的其他异常改变(反流性食管炎16例、胆汁反流性胃炎12例、十二指肠炎13例、糜烂性胃炎10例、胃或十二指肠溃疡5例)。63例患儿中,42例进行了胃黏膜病理学检查,5例无明显异常,34例轻度慢性胃炎,2例中度慢性胃炎,1例重度慢性胃炎。63例患儿中,15例在发作间期进行了24 h食管动态pH监测,9例显示存在病理性酸反流。结论周期性呕吐综合征除反复发作性呕吐外,多数伴随嗜睡或精神萎靡、厌食、腹痛等表现;胃镜下主要表现为慢性胃炎,多伴有反流性食管炎、胆汁反流性胃炎、糜烂性胃炎等改变。胃黏膜病理学改变多表现为轻度慢性胃炎。Objective To study the clinical and gastroscopic features of children with cyclic vomiting syndrome.Methods A retrospective analysis was performed on the medical data of 63 children with cyclic vomiting syndrome who were hospitalized and followed up in Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University from August 2019 to March 2022.Results Among the 63 children,there were 30 boys and 33 girls,with a mean age of 6.11 years,a mean course of disease of 2.57 years,and a mean vomiting period of 4.04 days.The most common accompanying symptom was listlessness or somnolence(55/63,87%),followed by anorexia(45/63,71%),abdominal pain or abdominal discomfort(40/63,63%),constipation(19/63,30%),salivation(12/63,19%),nausea(11/63,17%),headache(11/63,17%),fever(6/63,10%),and rash(1/63,2%).All 63 children underwent gastroscopy,among whom 3 had no marked abnormalities,22(35%)had chronic superficial gastritis or chronic non-atrophic gastritis alone,and 38(60%)had other abnormal changes aside from chronic gastritis(16 children with reflux esophagitis,12 with bile reflux gastritis,13 with duodenitis,10 with erosive gastritis,and 5 with gastric or duodenal ulcer).Among the 63 children,42 underwent pathological examinations of gastric mucosa,among whom 5 had no marked abnormalities,34 had mild chronic gastritis,2 had moderate chronic gastritis,and 1 had severe chronic gastritis.Among the 63 children,15 received 24-hour dynamic esophageal pH monitoring during the interictal period,among whom 9 children were found to have pathological acid reflux.Conclusions In addition to recurrent vomiting,most children with cyclic vomiting syndrome also have the symptoms such as somnolence or listlessness,anorexia,and abdominal pain.The main manifestation on gastroscopy is chronic gastritis,and most children may also have reflux esophagitis,bile reflux gastritis,and erosive gastritis.Mild chronic gastritis is the main pathological change of gastric mucosa.

关 键 词：周期性呕吐综合征 临床表现 胃镜 儿童 

分 类 号：R725.7[医药卫生—儿科]