儿童迁延性、慢性腹泻病因及临床特征分析  

Analysis of the etiology and clinical features of prolonged and chronic diarrhea in children

作　　者：郝建云 朱丹[1] 马昕[1] 王美娟[1] 钟雪梅[1] Hao Jianyun;Zhu Dan;Ma Xin;Wang Meijuan;Zhong Xuemei(Department of Gastroenterology,Children′s Hospital of Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院消化内科,北京100020

出　　处：《中国小儿急救医学》2023年第12期937-941,共5页Chinese Pediatric Emergency Medicine

基　　金：西藏自治区自然科学基金组团式医学援藏项目(XZ2021ZR-ZY28(Z))。

摘　　要：目的探讨小儿迁延性、慢性腹泻的病因、发病情况及临床特点。方法收集2017年1月至2020年6月在首都儿科研究所附属儿童医院消化内科诊治的迁延性、慢性腹泻患儿临床资料并进行分析。结果迁延性、慢性腹泻患儿共190例,男女比例为1.64∶1(118/72),中位年龄11.2(5.0,48.0)个月。其中0~3岁婴幼儿占74.2%(141/190),0~1岁婴儿占54.3%(103/190)。总体治愈、好转率为83.7%(159/190)。消化道伴随症状以腹痛、呕吐及腹胀为主,消化道外伴随症状以发热、体重减轻及生长发育障碍为主。常见合并症有营养不良(46.3%)、贫血(35.3%)、电解质紊乱(20.5%)等。电子胃肠镜及胶囊内镜的病变发现率达93.1%(122/131)。基因检测的检出率为60.0%(9/15)。明确病因者169例,确诊率88.9%。引起儿童迁延性、慢性腹泻的主要病因为食物过敏(36.8%)、炎症性肠病(12.6%)、肠易激综合征(9.5%),但仍有11.1%的患儿经过较全面的检查未能明确病因。结论小儿迁延性、慢性腹泻以婴幼儿为主,尤其是婴儿高发,病因多样,以非感染性因素为主,食物过敏及炎症性肠病是重要病因。易出现营养不良、贫血等合并症,内镜检查有助于病因的诊断及鉴别诊断,必要时需行基因检测明确病因。Objective To investigate the etiology,incidence and clinical characteristics of pediatric prolonged and chronic diarrhea.Methods The clinical data of children with prolonged and chronic diarrhea were collected and analyzed,which were hospitalized in the Department of Gastroenterology of the Children′s Hospital Affiliated to the Capital Institute of Pediatrics from January 2017 to June 2020.Results A total of 190 children with prolonged and chronic diarrhea were collected,with a male-to-female ratio of 1.64∶1(118/72)and a median age of 11.2(5.0,48.0)months.Among them,74.3%(141/190)were infants aged 0-3 years,and 54.3%(103/190)were infants aged 0-1 years.The overall cure and improvement rate was 83.7%(159/190).Gastrointestinal concomitant symptoms were dominated by abdominal pain,and vomiting,bloating,and extraintestinal concomitant symptoms were mainly fever,weight loss,and growth and development disorders.Common comorbidities included malnutrition(46.3%),anemia(35.3%),and electrolyte abnormalities(20.5%).The lesion detection rate of electronic gastrointestinal endoscopy and capsule endoscopy reached 93.1%(122/131).The detection rate of genetic testing was 60.0%(9/15).In this group of studies,169 patients had a clear cause,and the confirmed diagnosis rate was 88.9%.The main causes of childhood prolonged and chronic diarrhea were food allergy(36.8%),inflammatory bowel disease(12.6%),and irritable bowel syndrome(9.5%),but 11.1%of the children did not identify the cause after comprehensive examination.Conclusion Children with prolonged and chronic diarrhea are mainly infants and young children,especially infants,with diverse etiology,mainly non-infectious factors,food allergy and inflammatory bowel disease are important causes.Malnutrition,anemia and other complications are easy to occur.Endoscopy is helpful in diagnosing and differentiating the cause,if necessary,genetic testing could help to determine the cause.

关 键 词：迁延性腹泻 慢性腹泻 儿童 病因 

分 类 号：R725.7[医药卫生—儿科]