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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 430 -432. doi: 10.3877/cma.j.issn.1674-0785.2024.04.019

病例报告

儿童自身免疫性胃炎一例
王一1, 张俐1,()   
  1. 1. 150010 哈尔滨,北京儿童医院黑龙江医院哈尔滨医科大学附属第六医院江南院区消化内科
  • 收稿日期:2024-01-26 出版日期:2024-04-15
  • 通信作者: 张俐

Autoimmune gastritis in children: a case report

Yi Wangy, Li Zhang()   

  • Received:2024-01-26 Published:2024-04-15
  • Corresponding author: Li Zhang
引用本文:

王一, 张俐. 儿童自身免疫性胃炎一例[J]. 中华临床医师杂志(电子版), 2024, 18(04): 430-432.

Yi Wangy, Li Zhang. Autoimmune gastritis in children: a case report[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(04): 430-432.

患儿,男,11岁7月,因“厌食、发现维生素B12缺乏6个月”入院,该患儿入院前6个月开始出现进食明显减少,早饱,偶有呕吐,无恶心及腹痛,尿便正常。在当地医院体检时发现维生素B12水平降低,家长给予患儿维生素B12间断口服治疗,具体情况不详,口服药物期间患儿食欲曾有所好转,但停药后症状反复,复查维生素B12水平逐渐降低,病程中患儿无发热、鼻衄、无牙龈及皮下出血症状,但有多汗、脱发表现,在我院门诊检查血维生素B12水平为9 pg/ml。故因“维生素B12缺乏”收入院治疗。既往病史:患儿第1胎第1产,生长发育同正常同龄儿,无食物及药物过敏史、无传染病及遗传病史,饮食结构正常。患儿自1岁开始反复呼吸道感染病史,每年数次因“上呼吸道感染”“支气管炎”“支气管肺炎”入院治疗。有“慢性鼻炎”“鼻窦炎”“免疫紊乱”病史,6岁时患有“Evans”贫血。3年前曾因“肺炎、肺不张”在北京儿童医院就诊,曾考虑患儿可能存在“免疫功能缺陷”已完善基因测定检查,但检查结果未见异常,多年来因“缺铁性贫血”间断补充铁剂治疗,曾完善骨髓穿刺检查,结果提示“缺铁性贫血”,患儿补铁后血红蛋白可升至正常,停用铁剂后血红蛋白降低,最低时80~90 g/L,最高时130 g/L左右,但入院前半年血常规检查正常范围。家族史:父母及同胞妹妹身体健康,无相关免疫性疾病病史。查体:体温:36.2 ℃;脉搏:96次/分;呼吸:20次/分;体重:40 kg;血压:116/62 mmHg,神志清楚,精神略萎靡,呼吸平稳,面色略白,周身未见皮疹及出血点,浅表淋巴结无肿大,头部有斑片状脱发,咽部无充血,双肺呼吸音清晰,心音有力,节律规整,腹部平坦,无压痛,无肌紧张及反跳痛,肝脾肋下未触及,肠鸣音4次/分,四肢温暖,神经系统查体未见阳性体征。入院后辅助检查:胃镜检查图(),黏液湖混浊,轻度胆染,胃底及胃角黏膜未见明显异常,胃体大弯黏膜变薄,颜色发白,血管显露,胃窦黏膜颜色红白相间,以红为主,幽门前区黏膜轻度发红。十二指肠球部及降部未见明显异常。结肠镜检查未见明显异常。

图1 胃镜检查图
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