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目的探讨儿童过敏性结肠炎(AC)的临床特点及诊治方法。方法回顾性分析浙江大学医学院附属儿童医院2008年1月至2010年12月收治的53例AC患儿的临床、结肠镜及病理学表现以及实验室检查和治疗情况等。结果 (1)AC以2岁以下儿童多见,共49例(92.5%)。临床表现以血便[46例(86.8%),包括黏液血便和鲜血便]及腹泻(35例)最常见。(2)内镜下表现为局部红斑33例(62.3%),颗粒样结节31例(58.5%),表面糜烂10例(18.9%),溃疡形成1例(1.9%),镜下黏膜正常3例(5.7%),病变主要累及直肠[43例次(81.1%)]及乙状结肠[45例(84.9%)]。组织病理学主要表现为黏膜固有层嗜酸粒细胞浸润,以6～20个/HP浸润为主(62.3%)。(3)病史及实验室检查结果:16例患儿有特应性体质史,部分食物蛋白及吸入性过敏原特异性抗体检测阳性8例,外周血嗜酸粒细胞升高16例,贫血12例,外周血总IgE升高5例。(4)患儿平均住院时间(6.9±4.0)d,均好转出院。<1岁患儿纯母乳喂养者单独使用白三烯受体拮抗剂较单独更换特殊配方奶粉及二者合用平均住院天数少(P<0.05),而非纯母乳喂养组各种治疗方法的住院天数差异无统计学意义。(5)结肠镜下多发淋巴样颗粒结节表现与组织病理上嗜酸粒细胞浸润程度有相关性(P<0.05)。结论儿童AC临床表现以腹泻及血便为主,内镜下表现各异,多发淋巴样颗粒结节可能是AC较特异性表现,详细的病史询问、体格检查、辅助检查对诊断具有重要意义。回避饮食疗法及抗过敏奶粉治疗是目前儿童AC的主要治疗方法,白三烯受体拮抗剂可能对AC患儿有效。
Objective To investigate the clinical features and diagnosis and treatment of childhood allergic colitis (AC). Methods The clinical, colonoscopic and pathological findings of 53 AC children admitted to Children’s Hospital Affiliated to Zhejiang University School of Medicine from January 2008 to December 2010 were analyzed retrospectively. The laboratory examination and treatment were also reviewed. Results (1) AC was more common in children under 2 years old, a total of 49 cases (92.5%). Clinical manifestations were bloody stools (46 cases (86.8%), including mucus bloody stools and blood stools] and diarrhea (35 cases). (2) 33 cases (62.3%) of local erythema, 31 cases of granular nodules (58.5%), 10 cases of surface erosion (18.9%) and 1 case of ulcer (1.9% Three cases (5.7%) had lesions involving the rectum (43 cases, 81.1%) and the sigmoid colon (45 cases, 84.9%). Histopathology mainly manifested as eosinophilic infiltration of the lamina propria of the mucosa, predominated by 6-20% HP infiltration (62.3%). (3) The history and laboratory test results: 16 patients had atopic history, some of the food protein and inhaled allergen-specific antibody test positive in 8 cases, 16 cases of peripheral blood eosinophilia, anemia 12 Cases, the total increase in peripheral blood IgE in 5 cases. (4) The average length of stay in hospital children (6.9 ± 4.0) d, were better discharged. In the 1-year-old children with exclusive breastfeeding, patients who received leukotriene receptor antagonist alone had a lower mean number of days of hospitalization (P <0.05) than single replacement formula alone and hospitalized for various treatments other than exclusively breast-feeding group No significant difference in the number of days. (5) The incidence of multiple lymphoid nodules under colonoscopy correlated with histopathological eosinophil infiltration (P <0.05). Conclusions The clinical manifestation of AC in children is mainly diarrhea and bloody stool. The endoscopic manifestations are different. Multiple nodular lymphoid nodules may be the specific manifestation of AC. Detailed history inquiry, physical examination and auxiliary examination are of great significance for the diagnosis. Avoidance of diet therapy and anti-allergy milk powder treatment is the main treatment of children with AC, leukotriene receptor antagonists may be effective in children with AC.