Clinical Endoscopy

  • 제34권4호
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  • Pages.193-199
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  • 2007
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

소아 크론병의 임상적 특징과 경과

Clinical Features and Course of Crohn Disease in Children

이나영;박재홍
Lee, Na-Young;Park, Jae-Hong

  • 발행 : 2007.04.30
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 우리나라에서 크론병의 발생이 증가하고 있고 소아 및 청소년이 호발 연령이며 성인과는 임상소견에서 많은 차이가 있지만 이에 대한 연구가 부족한 실정이다. 이에 소아 크론병 환자들의 진단 시 임상 양상과 경과에 대해 알아보고자 본 연구를 시행하였다. 대상 및 방법: 1996년 1월부터 2005년 12월까지 8년간 부산대학교병원 소아과에서 크론병으로 진단한 24명의 환자들의 의무 기록을 후향적으로 분석하여 임상 양상 및 경과에 대하여 알아보았다. 결과: 대상 환자의 남녀비는 2：1이었고 진단 시 평균 나이는 10.6±4.3세였다. 환자 발생은 2001년 이후 증가하는 추세를 보였다. 진단 시 증상으로는 복통(79.2%), 체중 감소(54.2%), 항문 주위 병변(54.2%), 설사(45.8%), 혈변(41.7%), 빈혈(29.2%), 발열(23.3%) 등이 있었다. 크론병 침범 부위는 소장이 33.3%, 대장이 12.5%, 대장과 소장을 모두 침범한 경우가 54.2%였다. 내시경 소견에서 아프타성 궤양이 100%, 종주 궤양이 50%, 조약돌 점막상이 41.7%에서 관찰되었다. 11명에서 상부 위장관 내시경 검사가 시행되었으며 위와 십이지장의 이상 소견이 각각 7예에서 관찰되었다. 조직학적 소견에서 육아종은 54.2%에서 관찰되었다. 검사실 소견에서 ESR 증가가 83.3%, 백혈구 증가가 37.5%, 혈청 알부민 감소가 37.5%, 혈색소 감소가 25%에서 동반되었다. Pediatric Crohn disease activity index (PCDAI)가 진단 당시 30 이상이었던 군에서 30 미만이었던 군에 비해 재발률이 유의하게 높았으며, 육아종이 있었던 경우 누적 재발률은 1년 후 30.7%, 5년 후 53.8%였고 육아종이 없었던 경우는 1년 후 9.1%, 5년 후 36.4%였다. 결론: 소아 크론병의 빈도가 점차 증가하는 경향을 보였으며 임상적 소견과 경과가 성인과 차이를 보였다. 육아종 형성과 높은 PCDAI 점수는 심한 임상 경과와 연관성이 있었다.

Background/Aims: The aim of this study was to evaluate the clinical features and course of Crohn disease (CD) in children. Methods: The medical records of 30 patients diagnosed with CD between January 1996 and December 2005 were reviewed retrospectively. Results: The actual number of newly diagnosed patients with CD has increased during the 8-year period. The male/female ratio was 2：1 and the mean age at diagnosis was 10.6 4.3 years. The major symptoms of CD at diagnosis were abdominal pain (79.2%), weight loss (54.2%), perianal lesion (54.2%), diarrhea (45.8%), hematochezia (41.7%), anemia (29.2%), and fever (23.3%). The disease location of CD was the small bowel in 33.3%, the large bowel in 12.5% and both the small and large bowel in 54.2%. Granuloma was found in 54.2% of patients. The relapse rate of CD in the group with a higher pediatric Crohn disease activity index (PCDAI) at diagnosis ( 30) was higher than in the group with a lower PCDAI (＜30). The cumulative relapse rates of the patients with granuloma were 30.2% within 1 year and 53.8% within 5 years after the diagnosis. Conclusions: The incidence of CD in children appears to be increasing. Granuloma formation and a higher score of the PCDAI are associated with a more severe disease course. Pediatric CD may have a somewhat different clinical presentation from older-onset CD. (Korean J Gastrointest Endosc 2007;34:193-199)

키워드

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