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54例儿童克罗恩病肠外表现和肠道并发症分析
Extraintestinal manifestations and intestinal complications in children with Crohn's disease: an analysis of 54 cases
目的 总结克罗恩病（CD）患儿的肠外表现和肠道并发症，以期为儿科医师更全面地认识儿童CD提供帮助。方法 收集2008年1月至2018年12月期间诊断为CD的54例患儿的临床资料，依据病变部位可分为回结肠型30例，回肠型18例，结肠型6例，回顾性分析患儿的肠外表现及肠道并发症。结果 54例CD患儿中，诊断时年龄为14.5±2.7岁，自起病至明确诊断的中位病程为20（1~36）个月。24例CD患儿（44%）有肠外表现，以生长迟缓（11例，20%）和口腔黏膜溃疡（10例，19%）最为常见，其次为关节炎（2例，4%），结节性红斑（2例，4%），胆囊炎（2例，4%）。回肠型、结肠型及回结肠型患儿之间肠外表现发生率比较差异无统计学意义（P=0.792）。肠道病变相关的并发症最常见为肛瘘或肛周脓肿（13例，24%），其次为肠瘘（5例，9%）和肠梗阻（4例，7%）。回肠型、结肠型及回结肠型患儿之间肠道并发症发生率比较差异有统计学意义（P=0.041），且结肠型病例中未见到有患儿合并肠道并发症。结论 儿童CD肠外表现及肠道并发症较为多见，需提高对儿童CD肠外表现及肠道并发症的认识，加强系统管理，疑诊CD时重视肛周检查。结肠型CD患儿可能病情较缓和，更少发生肠道并发症。
Objective To summarize the extraintestinal manifestations and intestinal complications in children with Crohn's disease (CD). Methods The clinical data of 54 children who were diagnosed with CD in Peking Union Medical College Hospital from January 2008 to December 2018 were collected for retrospective analysis of extraintestinal manifestations and intestinal complications. According to the location of the lesion, the children were divided into ileocolonic group (30 cases), colonic group (6 cases), and ileal group (18 cases). Results In the 54 children, the mean age at diagnosis was 14.5±2.7 years, and the median duration from disease onset to definite diagnosis was 20 months (range:1-36 months). Twenty-four patients (44%) had extraintestinal manifestations, with the two most common manifestations being growth retardation (11 cases, 20%) and oral mucosal ulcer (10 cases, 19%), followed by arthritis (2 cases, 4%), erythema nodosum (2 cases, 4%), and cholecystitis (2 cases, 4%). There were no significant differences in the incidence of extraintestinal manifestations among the three groups (P=0.792). The most common intestinal complications were anal fistula/perianal abscess (13 cases, 24%), followed by intestinal fistula (5 cases, 9%) and intestinal obstruction (4 cases, 7%). There was a significant difference in the incidence of intestinal complications among the three groups (P=0.0406). No intestinal complications were reported in the colonic group. Conclusions Extraintestinal manifestations and intestinal complications are common in children with CD. Perianal examinations should be performed in children with suspected CD. Intestinal complications are less common in children with colonic CD, which may be associated with relatively mild disease condition.
Crohn's disease / Extraintestinal manifestation / Complication / Child
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