儿童肛周瘘管型克罗恩病的临床特征及预后

doi:10.7499/j.issn.1008-8830.2308119

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摘要目的分析儿童肛周瘘管型克罗恩病（perianal fistulizing Crohn's disease, pfCD）患儿的临床特征、治疗及预后。方法回顾性选择2015年4月—2023年4月间诊断为克罗恩病（Crohn's disease, CD）的6~17岁患儿142例为研究对象，根据是否存在肛周瘘管型病变，分为pfCD组（60例）和非pfCD组（82例），比较两组患儿的临床特征、治疗及预后。结果 pfCD发生率为42.3%（60/142）。pfCD组男性比例，病变范围累及结肠、小肠结肠比例，以及合并上消化道病变的比例高于非pfCD组（P<0.05）。pfCD组英夫利西单抗诱导缓解及维持缓解治疗比例高于非pfCD组（P<0.05）。pfCD组中，复杂性肛瘘患儿占62%（37/60），肛瘘非切割性挂线引流术治疗在复杂性肛瘘患儿中比例为62%（23/37），显著高于简单性肛瘘患儿（4%，1/23）（P<0.05）。两组患儿治疗54周黏膜愈合率和临床缓解率差异均无统计学意义（P>0.05）。pfCD组治疗54周瘘管愈合率为57%（34/60），其中简单性肛瘘患儿瘘管愈合率高于复杂性肛瘘患儿（P<0.05）。结论儿童CD患者中pfCD发生率高，pfCD患儿生物制剂使用比例高，复杂性肛瘘非切割性挂线引流术比例高，CD患儿随访中需要密切关注pfCD的发生。

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	方优红
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关键词 ：克罗恩病, 肛周瘘管型克罗恩病, 临床特征, 治疗, 儿童

Abstract：Objective To investigate the clinical characteristics, treatment, and prognosis of children with perianal fistulizing Crohn's disease (pfCD). Methods A retrospective analysis was conducted on the children, aged 6-17 years, who were diagnosed with Crohn's disease (CD) from April 2015 to April 2023. According to the presence or absence of perianal fistulizing lesions, they were divided into two groups: pfCD (n=60) and non-pfCD (n=82). The two groups were compared in terms of clinical characteristics, treatment, and prognosis. Results The incidence of pfCD was 42.3% (60/142). The proportion of males in the pfCD group was higher than that in the non-pfCD group. Compared with the non-pfCD group, the pfCD group had a significantly higher proportion of children with involvement of the colon and small intestine or those with upper gastrointestinal lesions (P<0.05). Compared with the non-pfCD group, the pfCD group had a significantly higher rate of use of infliximab during both induction and maintenance treatment (P<0.05). In the pfCD group, the children with complex anal fistula accounted for 62% (37/60), among whom the children receiving non-cutting suspended line drainage accounted for 62% (23/37), which was significantly higher than the proportion among the children with simple anal fistula patients (4%, 1/23) (P<0.05). There were no significant differences between the two groups in mucosal healing rate and clinical remission rate at week 54 of treatment (P>0.05). The pfCD group achieved a fistula healing rate of 57% (34/60) at week 54, and the children with simple anal fistula had a significantly higher rate than those with complex anal fistula (P<0.05). Conclusions There is a high incidence rate of pfCD in children with CD, and among the children with pfCD, there is a high proportion of children with the use of biological agents. There is a high proportion of children receiving non-cutting suspended line drainage among the children with complex anal fistula. The occurrence of pfCD should be closely monitored during the follow-up in children with CD.

Key words： Crohn's disease Perianal fistulizing Crohn's disease Clinical characteristic Treatment Child

收稿日期: 2023-08-31

通讯作者: 陈洁，女，主任医师。Email：6185020@zju.edu.cn。 E-mail: 6185020@zju.edu.cn

作者简介: 方优红，女，博士，副主任医师；

引用本文:

方优红,罗优优,张瑞方等. 儿童肛周瘘管型克罗恩病的临床特征及预后[J]. 中国当代儿科杂志, 2024, 26(1): 42-47.

FANG You-Hong,LUO You-You,ZHANG Rui-Fang et al. Clinical characteristics and prognosis of children with perianal fistulizing Crohn's disease[J]. CJCP, 2024, 26(1): 42-47.

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