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目的:评估糜烂性食管炎患儿初步治疗临床和内窥镜复发比率;方法:选择2009年2月~2013年3月在我院确诊和治疗的糜烂性食管炎患儿75例,患儿在临床初始治疗和维持治疗期间每周评估一次临床症状,治愈后每三个月评估一次。结果:糜烂性食管炎患儿治愈后临床复发比率达82.7%,其中45.2%为内窥镜复发;维持治疗结束后首次临床复发的中位时间为15.25个月(95%CI 6.67~26.78),内窥镜复发的中位时间为24.8个月(95%CI 9.13~33.72);Cox风险分析模型表明,临床具有复发表现的患儿需要较高的兰索拉唑剂量以达到初步治愈(HR=2.88,0.98~7.83,P=0.041);患儿基线时BMI和B或C分级会增加内窥镜复发风险(HR=2.99,1.01~4.26,P=0.048;HR=5.88,0.99~47.32,P=0.045)。结论:内窥镜复发和临床症状相关度差,高食管炎程度和高BMI指数是内窥镜复发的危险因素。
Objective: To evaluate the clinical and endoscopic recurrence rates of children with esophagitis with initial treatment. METHODS: Seventy-five children with erosive esophagitis diagnosed and treated in our hospital from February 2009 to March 2013 were enrolled. Clinical symptoms were evaluated weekly during initial and maintenance treatment and assessed every three months after cure. Results: The cure rate of erosive esophagitis children after cure was 82.7%, of which 45.2% were endoscopic recurrences. The median time to initial clinical relapse after maintenance therapy was 15.25 months (95% CI 6.67-26.78) The median time to endoscopic recurrence was 24.8 months (95% CI 9.13 to 33.72). Cox risk analysis showed that patients with clinically relapsed patients required a higher lansoprazole dose to achieve a primary cure (HR = 2.88,0.98 ~ 7.83, P = 0.041). BMI and B or C grade at baseline increased the risk of endoscopic recurrent disease (HR = 2.99, 1.01 ~ 4.26, P = 0.048; HR = 5.88,0.99 ~ 47.32, P = 0.045). Conclusions: The relapse of endoscopy is associated with poor clinical symptoms, high degree of esophagitis and high BMI index are risk factors for endoscopic recurrence.