儿童溃疡性结肠炎合并肠外表现的临床特征及相关因素研究  

Clinical features and factors related to extraintestinal manifestations in children with ulcerative colitis

作　　者：官德秀[1] 郭姝[1] 梅天璐 于飞鸿[1] 周锦[1] 王国丽[1] 吴捷 Guan Dexiu;Guo Shu;Mei Tianlu;Yu Feihong;Zhou Jin;Wang Guoli;Wu Jie(Department of Gastroenterology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院消化科,100045

出　　处：《国际儿科学杂志》2023年第12期845-849,共5页International Journal of Pediatrics

基　　金：首都卫生发展科研专项(首发2022-2-2094);北京市医院管理中心"登峰"计划专项(DF20221003)。

摘　　要：目的探讨儿童溃疡性结肠炎(ulcerative colitis,UC)合并肠外表现(extraintestinal manifestations,EIM)的临床特征及相关危险因素。方法采用回顾性病例对照研究方法,分析2016年1月至2021年12月在首都医科大学附属北京儿童医院消化科诊治的99例UC患者的临床资料。根据患者是否合并EIM分为伴EIM组与不伴EIM组,采用秩和检验、χ2检验或Fisher确切概率法比较两组UC患者的临床特征、实验室检查和治疗药物情况,应用Logistic回归分析UC患者EIM存在的危险因素。结果共纳入99例UC患者,男57例,女42例,发病年龄10.3(6.4,12.6)岁,病程4.2(1.6,10.1)个月。该研究患者以广泛结肠(E3)和全结肠(E4)型(69/99,69.7%)、中重度活动(63/99,63.6%)、结肠黏膜中重度炎症(89/99,89.9%)为主。不伴EIM组77例(77.8%),伴EIM组22例(22.2%),其中5例患者出现2种EIM,EIM以口腔溃疡(9例)、关节病变(7例)、皮肤病变(6例)为主。与不伴EIM组比较,伴EIM组UC患者病变部位E4型(77.3%比44.2%,χ2=7.513,P=0.006)、疾病活动程度中重度活动(81.8%比58.4%,χ2=4.041,P=0.044)、儿童溃疡性结肠炎活动指数评分[47.5(35.0,57.5)分比35.0(25.0,50.0)分,Z=-2.260,P=0.024]、诊断时C反应蛋白≥8 mg/L的比例(54.5%比19.5%,χ2=10.607,P=0.001)、红细胞沉降率[30.0(13.8,47.8)mm/h比10.0(4.0,19.5)mm/h,Z=-3.918,P<0.001]、诊断后一年内糖皮质激素治疗比例(77.3%比49.4%,χ2=5.403,P=0.020)、生物制剂治疗比例(45.5%比23.4%,χ2=4.112,P=0.043)均明显升高;E3型明显低于不伴EIM组(0比23.4%,χ2=4.813,P=0.028),差异均有统计学意义。多因素Logistic回归结果显示,诊断时红细胞沉降率是EIM存在的独立危险因素(OR=1.063,95%CI:1.025~1.103,P=0.001)。结论伴EIM的UC患者病变范围更广泛,疾病活动程度更重,炎性指标明显升高,激素和生物制剂治疗更常见。红细胞沉降率升高是UC患者出现EIM的危险因素。Objective To investigate the clinical features and risk factors of the extraintestinal manifestations(EIM)in children with ulcerative colitis(UC).Methods A retrospective case-control study was conducted.The clinical data of 99 children with UC diagnosed in Department of Gastroenterology,Beijing Children′s Hospital,Capital Medical University from January 2016 to December 2021 were analyzed.According to whether the patients had EIM or not,they were divided into EIM-positive group and EIM-negative group.Rank sum test,χ2test or Fisher′s exact test were used to compare the variables between the 2 groups,including the clinical features,laboratory examination results and treatments.The Logistic regression was used to analyze the risk factors of EIM in children with UC.Results A total of 99 children with UC were enrolled,including 57 males and 42 females;the age of onset was 10.3(6.4,12.6)years,and the course of disease was 4.2(1.6,10.1)months.The patients were mainly characterized by extensive disease(E3)and pancolitis(E4)(69/99,69.7%),moderate to severe activity(63/99,63.6%)and moderate to severe inflammation of colonic mucosa(89/99,89.9%).There were 77 patients(77.8%)in the EIM-negative group and 22 patients(22.2%)in the EIM-positive group,of which 5 patients had two types of EIMs;the most common EIMs were oral ulcers(9 cases),joint lesions(7 cases),and skin lesions(6 cases).Compared with the EIM-negative group,those in the EIM-positive group,such as the E4 type(77.3%vs 44.2%,χ2=7.513,P=0.006),moderate to severe activity(81.8%vs 58.4%,χ2=4.041,P=0.044),pediatric ulcerative colitis activity index score[47.5(35.0,57.5)score vs 35.0(25.0,50.0)score,Z=-2.260,P=0.024],the proportion of C-reactive protein≥8mg/L at diagnosis(54.5%vs 19.5%,χ2=10.607,P=0.001),erythrocyte sedimentation rate[30.0(13.8,47.8)mm/h vs 10.0(4.0,19.5)mm/h,Z=-3.918,P<0.001],the proportion of glucocorticoid treatment within one year after diagnosis(77.3%vs 49.4%,χ2=5.403,P=0.020)and the proportion of biological agents treatment(45.5%vs 23.4%,

关 键 词：儿童 结肠炎 溃疡性 肠外表现 危险因素 

分 类 号：R725.7[医药卫生—儿科]