2026 年第 3 期 第 21 卷

以慢性腹泻为主要症状的小肠疾病病因分析

Analysis of the etiology of small intestinal diseases with chronic diarrhea as the main symptom

作者：李可敏李景南李骥

英文作者：

单位：中国医学科学院北京协和医学院北京协和医院消化内科，北京100730

英文单位：Department of Gastroenterology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Beijing 100730 China

关键词：慢性腹泻；小肠疾病；免疫相关疾病

英文关键词：Chronicdiarrhea;Smallintestinal-relateddiseases;Immune-relateddiseases

• 摘要：

• 目的 探讨以慢性腹泻为主要症状的小肠疾病，针对其病因、临床特点和诊疗方法进行分析，提高对相关小肠疾病的认识和及时诊治。方法 回顾性选取2016年1月至2020年1月以慢性腹泻为首发及主要症状、于中国医学科学院北京协和医院消化内科住院的患者，经影像学及内镜检查均无食管、胃及结直肠受累证据，存在小肠病变，且最终诊断明确的患者。分析患者一般资料、病因、临床表现、营养及炎症状态。结果 共纳入23例患者，其中男17例、女6例，其中19~44岁患者最多［12例（52.2%）］。患者病程迁延，从出现症状至最终确诊中位时间1年。病因以免疫相关疾病为主［17例(73.9%)］，其次为小肠吸收不良综合征［4例（17.4%）］和感染性疾病［2例（8.7%）］。消化系统症状除慢性腹泻外，常伴有腹痛［17例（73.9%）］、便血［5例（21.7%）］、恶心呕吐［6例（26.1%）］等症状。患者多存在营养不良风险，主要表现为消瘦、贫血和低白蛋白血症。结论 以慢性腹泻为主要表现且单独小肠受累的疾病谱较广，多为少见小肠疾病，如自身免疫相关性肠炎，临床诊断存在困难。针对不明原因慢性腹泻应注重小肠疾病的病因，及时诊治。

• Objective To investigate the etiology, clinical characteristics, diagnosis and treatment of small intestinal diseases with chronic diarrhea as the main symptom, and to improve the understanding and timely diagnosis and treatment of related small intestinal diseases. Methods From January 2016 to January 2020, patients hospitalized in the Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences with chronic diarrhea as the first and main symptom, without evidence of esophageal, gastric or colorectal involvement by imaging and endoscopy, and with small intestinal lesions were retrospectively enrolled. The general information, etiology, clinical manifestations, nutritional and inflammatory status of the patients were analyzed. Results A total of 23 patients were enrolled, including 17 males and 6 females, with the most patients aged 19-44 years［12 cases (52.2%)］. The median time from the onset of symptoms to the final diagnosis was 1 year. The main cause was immune-related diseases ［17 cases (73.9%)］, followed by small intestinal malabsorption syndrome ［4 cases (17.4%)］ and infectious diseases ［2 cases (8.7%)］. In addition to chronic diarrhea, the symptoms of digestive system were often accompanied by abdominal pain ［17 cases (73.9%)］, hematochezia ［5 cases (21.7%)］, nausea and vomiting ［6 cases (26.1%)］. Most patients were at risk of malnutrition, mainly manifested as emaciation, anemia and hypoalbuminemia. Conclusion sThere is a wide spectrum of diseases with chronic diarrhea as the main manifestation and small intestinal involvement alone. Most of them are rare small intestinal diseases, such as autoimmune enteritis, which are difficult to diagnose. For patients with unexplained chronic diarrhea, we should pay attention to the etiology of small intestinal diseases and make timely diagnosis and treatment.