先天性巨结肠小肠结肠炎反复发作危险因素分析
Analysis of risk factors for recurrent Hirschsprung-associated enterocolitis

目的 探讨先天性巨结肠小肠结肠炎反复发作的非手术影响因素。方法 回顾性分析上海交通大学医学院附属上海儿童医学中心2007年1月—2014年1月收治的67例接受巨结肠根治术患儿的临床资料，将小肠结肠炎发作≥3次者纳入肠炎反复发作组，1~2次者纳入肠炎组，未发肠炎者纳入无肠炎组。分析肠炎反复发作的非手术影响因素。结果 3组间性别和根治术年龄差异均无统计学意义（P>0.05）；肠炎反复发作组病变类型、低白蛋白血症发生率与肠炎组相比差异均无统计学意义（P>0.05），但与无肠炎组比较均存在统计学差异（P>0.05）。肠炎反复发作组术前营养不良、小肠结肠炎、上呼吸道或肺部感染发生率与肠炎组相比差异均有统计学意义（P<0.05），而肠炎组与无肠炎组差异均无统计学意义（P>0.05）。多因素Logistic回归分析显示，术前营养不良、术前小肠结肠炎为小肠结肠炎反复发作的危险因素（OR=9.000,95%CI=1.355~59.783；OR=8.667,95%CI=1.526~49.220）。结论 术前营养不良、术前小肠结肠炎可能是先天性巨结肠小肠结肠炎反复发作的危险因素。
： Objective To investigate non-surgical risk factors for recurrent Hirschsprung-associated enterocolitis (HAEC). Methods A retrospective analysis was conducted on clinical data of 67 cases with Hirschsprungs disease (HD) treated by the radical operation between January 2007 and January 2014 at Shanghai Childrens Medical Center affiliated to Shanghai Jiao Tong University School of Medicine. Patients suffered 3 or more episodes of enterocolitis were assigned to the recurrent HAEC group (HAEC-R group). Patients with 1 or 2 episodes were assigned to the HAEC group. Patients without enterocolitis were assigned to the control group. The non-surgical risk factors for recurrent HAEC were analyzed. Results Gender and age at radical surgery had no statistical differences among three groups (P>0.05). Clinical types of HD and the incidence of hypoalbuminemia had no statistical differences between the HAEC-R group and the HAEC group (P>0.05), but had significant statistical differences between the HAEC-R group and the control group (P<0.05). The differences in the incidences of preoperative malnutrition, enterocolitis, upper respiratory tract infection, and pneumonia between the HAEC-R group and the HAEC group were statistically significant (P<0.05) and the differences between the HAEC group and the control group were not statistically significant (P>0.05). The multivariate logistic regression analysis showed that preoperative malnutrition and enterocolitis were independent risk factors for recurrent HAEC (OR=9.000, 95%CI=1.355-59.783; OR=8.667, 95%CI=1.526-49.220). Conclusion The preoperative malnutrition and enterocolitis may be risk factors for recurrent HAEC