目的 分析儿童腹水的病因及临床特点，为儿童腹水的诊治提供理论依据，减少漏诊、误诊。 方法 回顾性分析2010年1月1日至2019年12月31日间住院诊断腹水患儿的临床特征。 结果 165例腹水儿童，男女比例1.53∶1，平均发病年龄（6±4）岁。腹水病因依次为：外科急腹症（39例，23.6%）、感染性疾病（39例，23.6%）、肿瘤性疾病（27例，16.4%）、肝源性疾病（18例，10.9%）、胰腺炎（10例，6.1%）、心源性疾病（8例，4.8%）、风湿免疫性疾病（6例，3.6%）、肾源性疾病（5例，3.0%）等。按发病年龄分为婴儿33例，幼儿24例，学龄前期30例，学龄期41例，青春期37例。外科急腹症、肝源性疾病是引起婴儿组腹水的主要原因（P<0.05），幼儿组的首要病因是肿瘤性疾病（P<0.05），青春期组的首要病因为感染性疾病（P<0.05）。 结论 外科急腹症、感染性疾病、肿瘤性疾病、肝源性疾病是儿童腹水的常见病因；不同年龄段儿童腹水的主要病因存在一定差异。
Abstract
Objective To study the etiology and clinical features of children with ascites, so as to provide a basis for the diagnosis and treatment of ascites in children. Methods The medical data of the children with ascites, who were hospitalized from January 1, 2010 to December 31, 2019, were retrospectively reviewed. Results Among the 165 children with ascites, the male/female ratio was 1.53:1, and the mean age of onset was (6±4) years. The causes of ascites included surgical acute abdomen (39 children, 23.6%), infectious diseases (39 children, 23.6%), neoplastic diseases (27 children, 16.4%), hepatogenic diseases (18 children, 10.9%), pancreatitis (10 children, 6.1%), cardiogenic diseases (8 children, 4.8%), rheumatic immune diseases (6 children, 3.6%), and nephrogenic diseases (5 children, 3.0%). According to the age of onset, there were 33 infants, 24 young children, 30 preschool children, 41 school-aged children, and 37 adolescents. Surgical acute abdomen and hepatogenic diseases were the main causes of ascites in infants (P<0.05). Neoplastic disease was the leading cause in young children (P<0.05). Infectious diseases were the most common cause in adolescents (P<0.05). Conclusions Surgical acute abdomen, infectious diseases, neoplastic diseases, and hepatogenic diseases are the common causes of ascites in children, and there are some differences in the leading cause of ascites between different age groups.
关键词
腹水 /
病因 /
儿童
Key words
Ascites /
Etiology /
Child
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参考文献
1 Bes DF, Fernández MC, Malla I, et al. Management of cirrhotic ascites in children. Review and recommendations. Part 1: pathophysiology, diagnostic evaluation, hospitalization criteria, treatment, nutritional management[J]. Arch Argent Pediatr, 2017, 115(4): 385-390. PMID: 28737869. DOI: 10.5546/aap.2017.eng.385.
2 Karnsakul W, Ingviya T, Seaberg E, et al. Ascites in children: a single-center experience of 27 years[J]. J Pediatr Gastroenterol Nutr, 2017, 64(1): 83-88. PMID: 27050055. DOI: 10.1097/MPG.0000000000001209.
3 Menon J, Venkatesh V, Bhatia A, et al. Ascites: an unusual presentation of eosinophilic gastroenteritis in a child[J]. Trop Doct, 2020, 50(3): 277-279. PMID: 32178592. DOI: 10.1177/0049475520911230.
4 Ming G, Bo Y, Li-Ping Y. Eosinophilic gastroenteritis with ascites in a child[J]. Indian Pediatr, 2015, 52(8): 707-708. PMID: 26388635. DOI: 10.1007/s13312-015-0703-1.
5 Chinese Society of Hepatology, Chinese Medical Association, Xu X, et al. Chinese guidelines on the management of ascites and its related complications in cirrhosis[J]. Hepatol Int, 2019, 13(1): 1-21. PMID: 30656520. DOI: 10.1007/s12072-018-09923-2.
6 林丽萍, 钟晓红, 李胜利, 等. 儿童急性阑尾炎的病理分型与超声声像对照分析[J]. 中国超声医学杂志, 2020, 36(7): 646-650. DOI: 10.3969/j.issn.1002-0101.2020.07.024.
7 Chakaya J, Khan M, Ntoumi F, et al. Global tuberculosis report 2020—reflections on the global TB burden, treatment and prevention efforts[J]. Int J Infect Dis, 2021, 113Suppl 1(Suppl 1): S7-S12. PMID: 33716195. PMCID: PMC8433257. DOI: 10.1016/j.ijid.2021.02.107.
8 刘二勇, 李惠民, 赵顺英, 等. 儿童结核病流行病学及诊治现状[J]. 中国实用儿科杂志, 2018, 33(6): 423-426. DOI: 10.19538/j.ek2018060606.
9 徐震. 68例儿童难治性支原体肺炎肺外并发症的临床分析[J]. 中国小儿急救医学, 2013, 20(3): 319-320. DOI: 10.3760/cma.j.issn.1673-4912.2013.03.030.
10 朱亮, 李文辉, 王新红, 等. 2012至2017年1138例儿童侵袭性肺炎链球菌病多中心临床研究[J]. 中华儿科杂志, 2018, 56(12): 915-922. PMID: 30518005. DOI: 10.3760/cma.j.issn.0578-1310.2018.12.006.
11 Gunadi, Kashogi G, Prasetya D, et al. Pediatric patients with mesenteric cystic lymphangioma: a case series[J]. Int J Surg Case Rep, 2019, 64: 89-93. PMID: 31622933. PMCID: PMC6796738. DOI: 10.1016/j.ijscr.2019.09.034.
12 汤静燕. 儿童常见肿瘤诊断治疗的进步[J]. 中国小儿血液与肿瘤杂志, 2020, 25(6): 313-315. DOI: 10.3969/j.issn.1673-5323.2020.06.001.
13 徐玫丽, 霍继荣, 刘德良. 213例不明原因腹水的病因分析[J]. 医学临床研究, 2009, 26(4): 590-592. DOI: 10.3969/j.issn.1671-7171.2009.04.011.
14 Ingviya T, Wasuwanich P, Scheimann AO, et al. Clinical predictors of morbidity and mortality in hospitalized pediatric patients with ascites[J]. J Pediatr Gastroenterol Nutr, 2021, 73(1): 86-92. PMID: 33633084. DOI: 10.1097/MPG.0000000000003104.
15 单姗, 赵连晖, 马红, 等. 肝硬化的定义、病因及流行病学[J]. 临床肝胆病杂志, 2021, 37(1): 14-16. DOI: 10.3969/j.issn.1001-5256.2021.01.003.
16 Liu J, Liang W, Jing W, et al. Countdown to 2030: eliminating hepatitis B disease, China[J]. Bull World Health Organ, 2019, 97(3): 230-238. PMID: 30992636. PMCID: PMC6453311. DOI: 10.2471/BLT.18.219469.
17 Venkatesh V, Lal SB, Rana SS, et al. Pancreatic ascites and pleural effusion in children: clinical profile, management and outcomes[J]. Pancreatology, 2021, 21(1): 98-102. PMID: 33349510. DOI: 10.1016/j.pan.2020.12.010.
18 Pohl JF, Uc A. Paediatric pancreatitis[J]. Curr Opin Gastroenterol, 2015, 31(5): 380-386. PMID: 26181572. PMCID: PMC4732740. DOI: 10.1097/MOG.0000000000000197.
19 万盛华, 李香莲, 张双红, 等. 牛奶蛋白过敏致婴儿嗜酸细胞性胃肠炎24例临床分析[J]. 中国内镜杂志, 2017, 23(1): 95-99. DOI: 10.3969/j.issn.1007-1989.2017.01.020.
基金
江西省卫生健康委员会科技计划（202130852）。
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