切换至 "中华医学电子期刊资源库"

中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (03) : 185 -189. doi: 10.3877/cma.j.issn.2095-7157.2023.03.008

论著

小肠胶囊内镜在儿童克罗恩病患者中的应用
马昕, 金萌, 宁慧娟, 刘文雯, 宫幼喆, 张艳玲, 钟雪梅()   
  1. 100020 北京,首都儿科研究所附属儿童医院消化内科
  • 收稿日期:2023-04-03 出版日期:2023-08-15
  • 通信作者: 钟雪梅

Application of small intestinal capsule endoscopy in children with Crohn′s disease

Xin Ma, Meng Jin, Huijuan Ning, Wenwen Liu, Youzhe Gong, Yanling Zhang, Xuemei Zhong()   

  1. Department of Gastroenterology, Hospital of Capital Institute of Pediatrics, Beijing 100020, China
  • Received:2023-04-03 Published:2023-08-15
  • Corresponding author: Xuemei Zhong
引用本文:

马昕, 金萌, 宁慧娟, 刘文雯, 宫幼喆, 张艳玲, 钟雪梅. 小肠胶囊内镜在儿童克罗恩病患者中的应用[J/OL]. 中华胃肠内镜电子杂志, 2023, 10(03): 185-189.

Xin Ma, Meng Jin, Huijuan Ning, Wenwen Liu, Youzhe Gong, Yanling Zhang, Xuemei Zhong. Application of small intestinal capsule endoscopy in children with Crohn′s disease[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(03): 185-189.

目的

研究小肠胶囊内镜在儿童克罗恩病中应用的安全性和应用价值。

方法

回顾性分析2016年1月至2021年12月经首都儿科研究所附属儿童医院消化内科诊断为克罗恩病并进行胶囊内镜检查的患儿的临床资料、胶囊内镜完成情况及相关化验检查结果。通过胶囊内镜的Lewis评分评估患儿小肠黏膜炎症活动度,并分析其与临床积分、生物标志物及多种细胞因子水平之间的关系。

结果

纳入22例患儿共进行33例次胶囊内镜检查,其中,男患儿21例次、女患儿12例次,年龄7~16岁、平均年龄(11.27±2.10)岁,体重17~74 kg、平均体重(40.06±17.17)kg。患儿全部自主吞咽胶囊,除1例外均完成全小肠检查。所有患儿未发生胶囊滞留、胶囊嵌顿等并发症。肠道准备及胶囊内镜检查阶段部分患儿有轻度不适,可自行缓解。32例次发现部分小肠黏膜水肿,27例次发现不同程度的小肠溃疡,6例次发现息肉样增生,3例次小肠黏膜病变呈卵石样改变。Lewis评分分值为0~1404分,非活动期≤135分的9例、轻度黏膜炎性反应135~790分的19例、中-重度黏膜炎性反应≥790分的5例。Lewis评分与pCDAI评分具有相关性,与血IL-2受体水平具有相关性。

结论

克罗恩病患儿能够安全地接受胶囊内镜检查,可通过CE对病情进行有效地评估,为治疗提供参考。

Objective

To study the safety and value of small intestinal capsule endoscopy(CE) in children with Crohn′s disease(CD).

Methods

We reviewed the clinical data, CE data and relevant laboratory examination results of patients with CD diagnosed in the Department of Gastroenterology from January 2016 to December 2021.Lewis score of CE was used to evaluate the inflammatory activity of small intestinal mucosa, and the relationship between it and clinical scores, biomarkers and levels of various cytokines was analyzed.

Results

A total of 33 cases of CE tests were performed in 22 patients.Ages range from 7 to 16 years old, average age (11.27±2.10) years old. Weight ranged from 17 to 74 kg with average of (40.06±17.17) kg. All patients swallowed the capsule independently, and all completed the whole intestine examination except 1 case.No complications such as capsule retention and capsule incarceration occurred.During intestinal preparation and CE test, some patients reported gastrointestinal discomfort and could relieved themselves.Intestinal mucosal edema was found in 32 cases, intestinal ulcer of different degrees was found in 27 cases, polypoid hyperplasia was found in 6 cases, and pebble like changes were found in 3 cases of intestinal mucosal lesions. The Lewis score of capsule endoscopy was 0-1404 points, 9 cases with inactive period ≤135 points, 19 cases with mild mucosal inflammatory reaction 135-790 points, and 5 cases with moderate to severe mucosal inflammatory reaction ≥790 points.Lewis score was correlated with pCDAI score and circulating IL-2R level.

Conclusion

CE is safe for children with CD, which can effectively evaluate the condition and provide reference for treatment.

表1 患儿疾病分型、疾病行为
图1 胶囊内镜所见儿童克罗恩病患儿的病变注:A:十二指肠多发溃疡;B:空肠溃疡;C:空肠纵行溃疡;D:十二指肠多发溃疡
表2 临床生物标志物数值及与Lewis评分相关性
[1]
中华医学会儿科学分会消化学组,中华医学会儿科学分会临床营养学组.儿童炎症性肠病诊断和治疗专家共识[J].中华儿科杂志201957(7):501-507.
[2]
Gralnek IMDefranchis RSeidman E,et al.Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change[J]. Aliment Pharmacol Ther200827(2):146-154.
[3]
Levine AGriffiths AMarkowitz J,et al.Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification[J].Inflamm Bowel Dis201117(6):1314-1321.
[4]
Friedlander JALiu QYSahn B,et al.NASPGHAN Capsule Endoscopy Clinical Report[J].J Pediatr Gastroenterol Nutr, 2017, 64(3):485-494.
[5]
Iwama IShimizu HNambu R,et al.Efficacy and safety of a capsule endoscope delivery device in children[J].Eur J Gastroenterol Hepatol, 201931(12):1502-1507.
[6]
Westerhof JWeersma RKKoornstra JJ.Risk factors for incomplete small-bowel capsule endoscopy[J].Gastrointest Endosc200969(1): 74-80.
[7]
Bass LMMisiewicz L.Use of a real-time viewer for endoscopic deployment of capsule endoscope in the pediatric population[J].J Pediatr Gastroenterol Nutr201255(5):552-555.
[8]
Huang LHu YChen F,et al.Effectiveness of Improved Use of Chewing Gum During Capsule Endoscopy in Decreasing Gastric Transit Time:A Prospective Randomized Controlled Study[J].Front Med (Lausanne)20218:605393.
[9]
Liao ZGao RXu C,et al.Indications and detection, completion,and retention rates of small-bowel capsule endoscopy:a systematic review [J].Gastrointest Endosc201071(2):280-286.
[10]
Cohen SAKlevens AI.Use of capsule endoscopy in diagnosis and management of pediatric patients, based on meta-analysis[J].Clin Gastroenterol Hepatol20119(6):490-496.
[11]
Pasha SFPennazio MRondonotti E,et al.Capsule Retention in Crohn′s Disease:A Meta-analysis[J].Inflamm Bowel Dis202026(1): 33-42.
[12]
Miyazu TOsawa STamura S,et al.Modified method of patency judgement using patency capsule prior to capsule endoscopy in clinical practice[J].Sci Rep202212(1):14335.
[13]
Lee HSLim YJKim KO,et al.Research Group for Capsule Endoscopy/Small Bowel Endoscopy.Outcomes and Management Strategies for Capsule Retention:A Korean Capsule Endoscopy Nationwide Database Registry Study[J].Dig Dis Sci201964(11): 3240-3246.
[14]
Wang YLiao ZWang P,et al.Treatment strategy for video capsule retention by double-balloon enteroscopy[J].Gut201766(4):754-755.
[15]
Rondonotti E.Capsule retention:prevention,diagnosis and management[J]. Ann Transl Med20175(9):198-205.
[16]
Gralnek IMDefranchis RSeidman E,et al.Development of a capsule endoscopy scoring index for small bowel mucosal in flammatory change[J].Aliment Pharmacol Ther200827(2):146-154.
[17]
国家消化系统疾病临床医学研究中心(上海),国家消化内镜质控中心,中华医学会消化内镜学分会胶囊内镜协作组,等.中国小肠胶囊内镜临床应用指南(2021,上海)[J].中华消化内镜杂志2021, 38(8):589-614.
[18]
张艳玲.儿童炎症性肠病的疾病评估[J].中华实用儿科临床杂志201631(19):1444-1448.
[19]
Mitselos IVKatsanos KHTatsioni A,et al.Association of clinical and inflammatory markers with small bowel capsule endoscopy findings in Crohn′s disease[J].Eur J Gastroenterol Hepatol2018, 30(8):861-867.
[20]
Le Berre CRicciuto APeyrin-Biroulet L,et al.Evolving Short- and Long-Term Goals of Management of Inflammatory Bowel Diseases: Getting It Right, Making It Last[J].Gastroenterology2022162(5): 1424-1438.
[21]
Melmed GYDubinsky MCRubin DT,et al.Utility of video capsule endoscopy for longitudinal monitoring of Crohn′s disease activity in the small bowel:a prospective study[J].Gastrointest Endosc2018, 88(6):947-955.e2.
[22]
Cotter JDias de Castro FMagalhães J,et al.Validation of the Lewis score for the evaluation of small-bowel Crohn′s disease activity[J]. Endoscopy201547(4):330-335.
[23]
Niv EFishman SKachman H,et al.Sequential capsule endoscopy of the small bowel for follow-up of patients with known Crohn′s disease[J].J Crohns Colitis20148(12):1616-1623.
[24]
Smids CHorjus Talabur Horje CSNierkens S,et al.Candidate Serum Markers in Early Crohn′s Disease:Predictors of Disease Course[J].J Crohns Colitis201711(9):1090-1100.
[25]
Moorman CDSohn SJPhee H.Emerging Therapeutics for Immune Tolerance:Tolerogenic Vaccines,T cell Therapy,and IL-2 Therapy[J].Front Immunol202112:657768.
[26]
赵玉洁,王奕文,王东,等.英夫利西单克隆抗体对克罗恩病患者肠黏膜屏障功能修复的研究[J].中华消化杂志202040(8):524-531.
[1] 陶宏宇, 叶菁菁, 俞劲, 杨秀珍, 钱晶晶, 徐彬, 徐玮泽, 舒强. 右心声学造影在儿童右向左分流相关疾病中的评估价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 959-965.
[2] 刘琴, 刘瀚旻, 谢亮. 基质金属蛋白酶在儿童哮喘发生机制中作用的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 564-568.
[3] 向韵, 卢游, 杨凡. 全氟及多氟烷基化合物暴露与儿童肥胖症相关性研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 569-574.
[4] 王雅楠, 刘丹, 曹正浓, 贾慧敏. 儿童迟发性先天性膈疝患儿的临床诊治特点分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 410-419.
[5] 陈桂华, 钟小玲, 谢雨, 王慧, 谢江, 杨涛毅. 合并肝脏疾病特殊健康状态儿童疫苗预防接种及时性临床分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 431-439.
[6] 丁召, 李翊, 徐天天. 开腹探查+回盲部切除+小肠结肠吻合术[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 281-281.
[7] 刘冉佳, 崔向丽, 周效竹, 曲伟, 朱志军. 儿童肝移植受者健康相关生存质量评价的荟萃分析[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 302-309.
[8] 丁荷蓓, 王珣, 陈为国. 七氟烷吸入麻醉与异丙酚静脉麻醉在儿童腹股沟斜疝手术中的应用比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 570-574.
[9] 中华医学会器官移植学分会, 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组, 华南劈离式肝移植联盟. 劈离式供肝儿童肝移植中国临床操作指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 593-601.
[10] 刘军, 丘文静, 孙方昊, 李松盈, 易述红, 傅斌生, 杨扬, 罗慧. 在体与离体劈离式肝移植在儿童肝移植中的应用比较[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 688-693.
[11] 张佳臣, 宋红欣. 儿童青少年等效球镜屈光度变化与屈光不正进展相关性的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2024, 14(04): 217-222.
[12] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
[13] 陈利, 杨长青, 朱风尚. 重视炎症性肠病和代谢相关脂肪性肝病间的串话机制研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 385-389.
[14] 陈晓胜, 何佳, 刘方, 吴蕊, 杨海涛, 樊晓寒. 直立倾斜试验诱发31 秒心脏停搏的植入心脏起搏器儿童一例并文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 488-494.
[15] 曹亚丽, 高雨萌, 张英谦, 李博, 杜军保, 金红芳. 儿童坐位不耐受的临床进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 510-515.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?