540例儿童消化性溃疡临床分析

发布时间：2017-12-27 07:39

本文关键词：540例儿童消化性溃疡临床分析　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的本文对儿童消化性溃疡(peptic ulcer,PU)的一般情况、诱因、继发因素、家族史、临床表现、并发症、辅助检查、治疗效果等资料进行回顾性分析,以提高临床医师对儿童PU的认知和诊治水平。对象和方法1.对象:重庆医科大学附属儿童医院2005年10月至2015年10月期间所有出院诊断有PU的病例。2.方法:回顾性分析儿童PU相关临床资料、电话随访结果等情况。3.统计学分析:应用SPSS19.0版统计软件及Microsoft Office Excel2003进行数据的统计和分析,以P0.05为差异有统计学意义。结果1.共收集病例540例,其中男391例(72.4%),女149例(27.6%),男:女=2.6:1,来自城镇217例(40.2%),农村280例(51.9%)。胃溃疡(gastric ulcer,GU)154例(28.5%),十二指肠溃疡(duodenal ulcer,DU)357例(66.1%),复合型溃疡(composite ulcer,CU)29例(5.4%)。其中婴儿组18例(3.3%),幼儿组73例(13.5%),学龄前期组91例(16.9%),学龄期组220例(40.7%),青少年期组138例(25.6%)。婴儿期、学龄期及青少年期组以du为主,幼儿期及学龄前期组以gu为主。2.发病前有不洁、不规律等饮食史的患儿169/540例(31.3%),有nsaids及其他成分不明的“感冒药”服用史的患儿78/540例(14.4%),有手术、外伤等应激的患儿10/540例(1.9%),有消化道异物病史9/540例(1.7%)。3.存在原发疾病53/540例(9.8%),其中分别为过敏性紫癜35/53例(66.0%)、急性荨麻疹7/53例(13.2%)、急性白血病6/53例(11.3%)等。其中婴幼儿期、学龄前期组继发性溃疡的发生率明显高于学龄期、青少年组(p0.00833)。4.有胃炎、十二指肠炎、pu家族史的患儿127/540例(23.5%),其中为一级亲属104/540例(19.3%),二级亲属23/540例(4.3%),有幽门螺杆菌(helicobacterpylori,hp)感染的家族史8/540例(1.5%)。其中102/127例(80.3%)为原发性溃疡。5.起病症状主要有腹痛(274/540例,50.7%)、呕吐(103/540例,19.1%)及消化道出血(80/540例,14.8%),其次为面色苍白(37/540例,6.9%)、腹泻(15/540例,2.8%)、恶心(12/540例,2.2%)、头晕或头痛(9/540例,1.7%)等。6.临床表现主要有腹痛(398/540例,73.7%)、消化道出血(360/540例,66.7%)、呕吐(352/540例,65.2%)、面色苍白、乏力、头晕、晕厥等贫血症状(196/540例,36.3%)、食欲减低(130/540例,24.1%)、恶心(99/540例,18.3%)、发热(84/540例,15.6%)、反酸和嗳气(46/540例,8.5%)、腹泻(45/540例,8.3%)、腹胀(23/540例,4.3%)等。其中105/540例(19.4%)表现为慢性腹痛。7.腹痛部位主要在中腹部(125/540例,23.1%),其次为中上腹部(124/540例,23.0%)、上腹部(111/540例,20.6%)。腹痛大部分无明显时间规律性(398/540例,73.7%),仅142/540例(26.3%)有明确时间规律性,其中gu以进食后疼痛为主(14/29例,48.3%),du以饥饿痛和夜间痛为主(61/105例,58.1%;38/105例,36.2%)。8.422/540例(78.1%)发生有并发症,主要为消化道出血(397/540例,73.5%),其次为梗阻(63/540例,11.7%)、穿孔(5/540例,0.9%)。9.535/540例血常规中wbc计数平均为(8.77±5.08)×109/l。wbc计数升高占28.4%(152/535例)。hb平均为(95.66±28.98)g/l,贫血占62.1%(332/535例),主要与消化道出血有关(282/332例,84.9%),其中缺铁性贫血占15.4%(51/332例)。525/540例血常规中eos%平均为(1.68±2.63)%,eos%增高占6.5%(34/525例),其中有粘膜组织活检中eos计数增高5例,肠蛔虫症1例。10.480/540例肝功能中tp平均为(60.23±9.56)g/l,其中低蛋白血症占42.7%(205/480例),主要与消化道出血有关(183/205例,89.3%)。11.289/540例行abo血型鉴定,其中o型血占44.6%(129/289例),a型血占27.7%(80/289例),b型血占22.1%(64/289例),ab型血占5.5%(16/289例)。且存在并发症的259例病例中,o型血占45.6%(118/259例),a型血占27.8%(72/259例),b型血占21.6%(56/259例),ab型血占5.0%(13/259例),有无并发症发生的两组之间血型构成比未见统计学差异(p0.05)。12.539/540例行无痛胃镜,gu占28.6%(154/539例),du占66.0%(356/539例),cu占5.4%(29/539例)。13.154例gu中,47.4%(73/154例)为单发,41.6%(64/154例)为多发。溃疡位置主要分布在胃窦部(122/154例,79.2%),其次为胃角(25/154例,16.2%)、胃体(10/154例,6.5%)等,其中分布在小弯侧占12.3%(19/154例),大弯侧5.8%(9/154例)。356例du中,50.1%(180/356例)为单发,28.7%(102/356例)为多发,其中霜斑样占13.8%(49/356例),对吻性占4.2%(15/356例)。溃疡位置主要分布在球部(292/356例,82.0%),其次为球后(35/356例,9.8%)、球降交界处(30/356例,8.4%),其中前壁占16.3%(58/356例),后壁占12.3%(45/356例)。溃疡形态均以圆形或椭圆形为主,其次为不规则形状、线状等。29例cu中,以发生在胃窦部和十二指肠球部为主(18/29例,62.1%)。其中溃疡以处于活动期为主(254/539例,47.1%)。14.发生消化道出血病例中,gu主要发生在胃窦(82/109例,75.2%)、胃角(23/109例,21.1%),du主要发生在球部(222/268例,82.8%)、球后(27/268例,10.1%);发生梗阻病例中,gu主要发生在胃窦(29/32例,90.6%),其中主要在幽门管(15/29例,51.7%),du主要发生在球部(10/29例,34.5%)、球降交界处(4/29例,3.8%);发生穿孔的5例病例中,3例发生在十二指肠球部,1例发生在胃窦。15.hp检测:13c尿素呼气试验阳性率77.5%(31/40例)。快速尿素酶试验阳性率25.8%(117/453例)。组织病理学检查阳性率31.1%(19/61例)。快速尿素酶试验与组织病理学检查对hp感染检测的阳性率未见统计学差异(p0.05),为中度一致性(kappa=0.543,p0.001)。其中hp感染率为25.4%(137/540例),gu中hp感染率为9.1%(14/154例),du中hp感染率为32.2%(115/357例),du的hp感染率明显高于gu(p0.001)。16.172/540例行组织病理学检查,150/172例(87.2%)为慢性、活动性炎症,15/172例(8.7%)为粘膜充血水肿,13/172例(7.6%)可见灶性溃疡,3/172例(1.7%)可见灶性坏死。粘膜活检中eos计数大于20个/hpf的病例占15.1%(26/172例),其中有外周血eos%增高5例。17.合并有鉴别意义的疾病有感染性腹泻11/540例(2.0%)、鼻衄3/540例(0.5%)、肠蛔虫症3/540例(0.5%)、胆囊结石3/540例(0.5%)、肺结核2/540例(0.37%)、胰腺炎2/540例(0.37%)、幽门前瓣膜2/540例(0.37%)、急性阑尾炎2/540例(0.37%)、肾结石1/540例(0.19%)。18.共成功电话随访69例行hp根除术病例,依从性100%,其中使用序贯疗法27例,显效率96.3%;使用传统三联疗法40例,显效率85.0%,所有治疗方案中均无无效病人。其中序贯疗法与传统三联疗法抗hp感染的临床疗效未见统计学差异(p0.05)。结论本组中儿童pu以学龄期儿童为主,以du多见,婴儿期、学龄期及青少年期组以du多见,幼儿期及学龄前期组以gu多见。病前常有不洁、不规律等饮食史,有非甾体类抗炎药及其他成分不明的“感冒药”服用史,有手术等应激因素。pu患儿临床症状不如成人典型,常易误诊,故对有反复发作的腹痛、消化道出血、呕吐及面色苍白、乏力、头晕、晕厥等贫血症状的患儿;反复胃肠道不适,且有胃炎、十二指肠炎、PU家族史者等,均应警惕PU的可能性,及时行上消化道内镜等相关辅助检查,尽早明确诊断,同时需警惕Hp感染,并且积极寻找其他相关病因、诱因及并发症,提高诊疗水平。
[Abstract]:The purpose of this paper on children's peptic ulcer (peptic ulcer PU) data of the general situation, causes, secondary factors, family history, clinical manifestations, complications, diagnosis and treatment effect were retrospectively analyzed, in order to improve the clinical diagnosis and treatment of water on children's cognitive and PU level. Object and method 1. objects: all cases of PU in the hospital from October 2005 to October 2015 of the Affiliated Children's Hospital of Medical University Of Chongqing. The 2. method: retrospective analysis of children's PU related clinical data, telephone follow-up results, and so on. 3. statistical analysis: the statistics and analysis of data were carried out by SPSS19.0 software and Microsoft Office Excel2003, and the difference was statistically significant with P0.05. Results 1. cases were collected in 540 cases, including 391 male (72.4%), 149 female (27.6%), male: female =2.6:1, 217 from town (40.2%), 280 in rural area (51.9%). Gastric ulcer (gastric ulcer, GU) in 154 cases (28.5%), duodenal ulcer (duodenal ulcer, DU) in 357 cases (66.1%), compound ulcer (composite ulcer, CU) in 29 cases (5.4%). Among them, there were 18 cases (3.3%) in infant group, 73 in infant group (13.5%), 91 in pre school age group (16.9%), 220 in school age group (40.7%) and 138 in teenage group (25.6%). Du was the dominant group in infancy, school age and adolescence, and Gu was the main group in early childhood and pre school age group. 2., there were 169/540 cases (31.3%) with unclean and irregular eating history before onset. There were 78/540 cases (14.4%) with NSAIDs and other unknown components of the "cold medicine" history, 14.4% cases of children with stress and other stressors such as surgery and trauma (1.9%), and a history of gastrointestinal foreign bodies in 9/540 cases (1.7%). 3., there were primary diseases in 53/540 cases (9.8%), including allergic purpura 35/53 cases (66%), acute urticaria 7/53 cases (13.2%), acute leukemia 6/53 cases (11.3%) and so on. The incidence of secondary ulcers in infantile and pre school age group was significantly higher than that of school age group and adolescent group (p0.00833). 4., children with gastritis, duodenal inflammation and family history of PU were 127/540 cases (23.5%), among them were first-degree relatives, 104/540 cases (19.3%), two degree relatives 23/540 cases (4.3%), and family history of Helicobacter pylori (Helicobacterpylori, HP) infection was 8/540 cases (1.5%). Of these, 102/127 cases (80.3%) were primary ulcers. 5. the main symptoms were abdominal pain (274/540 cases, 50.7%), vomiting (103/540 cases, 19.1%), gastrointestinal bleeding (80/540 cases, 14.8%), followed by pale complexion (37/540 cases, 6.9%), diarrhea (15/540 cases, 2.8%), nausea (12/540 cases, 2.2%), dizziness or headache (9/540 cases, 1.7%). The main clinical manifestations were abdominal pain (6. cases of 398/540, 73.7%), gastrointestinal bleeding (360/540 cases, 66.7%), vomiting (352/540 cases, 65.2%), pallor, fatigue, dizziness, syncope and other symptoms of anemia (196/540 cases, 36.3%), and decreased appetite (130/540 cases, 24.1%), nausea (99/540 cases. 18.3%), fever (84/540 cases, 15.6%), acid reflux and belching (46/540 cases, 8.5%), diarrhea (45/540 cases, 8.3%), abdominal distension (23/540 cases, 4.3%). Of these, 105/540 (19.4%) showed chronic abdominal pain. 7. sites of abdominal pain were mainly in the middle abdomen (125/540, 23.1%), followed by middle and upper abdomen (124/540, 23%), upper abdomen (111/540, 20.6%). Most of the abdominal pain had no obvious regularity in time (398/540 cases, 73.7%). Only 142/540 cases (26.3%) had a clear time regularity. Among them, Gu was mainly after eating pain (14/29 cases, 48.3%), and Du was mainly caused by hunger pain and nocturnal pain (61/105 cases, 58.1%, 38/105 cases, 36.2%). 8.422/540 cases (78.1%) had complications, mainly hemorrhage of the digestive tract (397/540, 73.5%), followed by obstruction (63/540, 11.7%), and perforation (5/540, 0.9%). In 9.535/540 blood routine, the average WBC count was (8.77 + 5.08) x 109/l. The increase of WBC count was 28.4% (152/535). The average Hb was (95.66 + 28.98) g/l, and anemia accounted for 62.1% (332/535 cases), which was mainly associated with digestive tract hemorrhage (282/332, 84.9%), of which iron deficiency anemia accounted for 15.4% (51/332). In 525/540 blood routine, the average eos% was (1.68 + 2.63)%, and eos% increased 6.5% (34/525 cases). Among them, there were 5 cases of EOS count in mucosa biopsy and 1 cases of intestinal ascariasis. In 10.480/540 cases, the average TP of liver function was (60.23 + 9.56) g/l, of which 42.7% (205/480 cases) were hypoproteinemia (205/480), which was mainly associated with digestive tract hemorrhage (183/205, 89.3%). The 11.289/540 routine ABO blood group identification, including O-negative blood accounted for 44.6% (129/289 cases), a blood accounted for 27.7% (80/289 cases), B blood type accounted for 22.1% (64/289 cases), blood type AB accounted for 5.5% (16/289 cases). And there are 259 cases of complications, O-negative blood accounted for 45.6% (118/259 cases), a blood accounted for 27.8% (72/259 cases), B blood type accounted for 21.6% (56/259 cases), blood type AB accounted for 5% (13/259 cases), there is no blood complications between the two groups had no statistical difference of ratio (P0.05). 12.539/540 routine painless gastroscopy, Gu accounted for 28.6% (154/539 cases), Du accounted for 66% (356/539 cases), Cu accounted for 5.4% (29/539 cases). Of the 13.154 cases of Gu, 47.4% (73/154 cases) were single, and 41.6% (64/154) were multiple. Ulcer location is mainly distributed in the gastric antrum (122/154 cases, 79.2%), followed by the angle of stomach (25/154 cases, 16.2%), stomach (10/154 cases, 6.5%), which accounted for 12.3% in the distribution of small curved side (19/154), greater curvature 5.8% (9/154 cases). In 356 cases of Du, 50.1% (180/356 cases) were single, 28.7% (102/356 cases) were multiple, of which 13.8% (49/356) were frosting and 4.2% (15/356). The location of ulcer was mainly distributed in the bulb (292/356 cases, 82%), followed by retrobulbar (35/356 cases, 9.8%), and descending junctions (30/356 cases, 8.4%), of which the anterior wall occupied 16.3% (58/356 cases) and the posterior wall occupied 12.3% (45/356 cases). The forms of ulcers were mainly round or oval, followed by irregular shape and linear. In 29 cases of Cu, they were mainly in the gastric antrum and duodenal sphere (18/29, 62.1%). The ulcers were mainly in the active period (254/539, 47.1%). 14. in the cases of gastrointestinal bleeding, Gu mainly occurred in gastric antrum (82/109 cases, 75.2%), gastric horn (23/109 cases, 21.1%), Du mainly occurred in the bulb (222/268 cases, 82.8%), after the ball (27/268 cases, 10.1%); in the cases of obstruction, Gu mainly occurred.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.7

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