儿童功能性便秘的病因探索与多元化干预策略研究进展

Exploration of the Etiology of Functional Constipation in Children and Research Progress on Diversified Intervention Strategies

摘要: 在儿童消化系统疾患中较为常见者为功能性便秘(FC)，其发生多由非器质性因素所致。排便频率降低、排便过程困难、粪便质地干结以及大便失禁现象，连同腹部疼痛等消化道症状群构成了该病症的主要临床表现。依据流行病学调查数据可见，儿童便秘病例中约90%归属于FC范畴。病因学层面显示复杂性特征的是FC病症，现有研究尚未能完全阐明其发病机制。饮食结构异常、排便行为模式不当、精神心理状态波动以及遗传易感性等因素被认为与该病的发生发展存在关联性。一项全球范围的系统综述结果显示，儿童的FC患病率为0.5%~32.2%，且发病率呈上升趋势。2.3岁为平均发病年龄的报道见于既往研究，而2至4岁年龄段则构成发病高峰区间，且近三分之一的功能性便秘患儿的症状会持续到成年，FC很少会导致危及生命的并发症，但会影响患儿的身体发育和心理健康，长期便秘不仅导致肠道和周病变，严重时需行外科手术干预，还可伴随焦虑、失眠和抑郁等心理障碍，极大影响患者的身心健康，亦对其家庭生活产生负面影响并加重医疗资源负担。由此可见，正确理解儿童功能性便秘的本质特征并实施早期干预措施已成为公共卫生领域亟待解决的重要课题之一。本文主要从儿童功能性便秘的发病机制、影响因素、治疗与预防进展方面进行综述，以期降低儿童功能性便秘的发生率，为功能性便秘的防治提供参考依据。

Abstract: Functional constipation (FC) is more common in children’s digestive system diseases, which is mostly caused by non-organic factors. Reduced bowel frequency, difficulty in the bowel movement, dry stool texture, and fecal incontinence, along with abdominal pain, constitute the main clinical manifestations of this condition. According to epidemiological survey data, about 90% of constipation cases in children are classified as FC. FC disease is characterized by complexity at the etiological level, and existing studies have not been able to fully elucidate its pathogenesis. Factors such as abnormal dietary structure, improper bowel movement behavior patterns, fluctuations in mental and psychological state, and genetic predisposition are thought to be related to the occurrence and development of the disease. The results of a global systematic review showed that the prevalence of FC in children was 0.5%~32.2%, and the incidence was on the rise. 2.3 years old is reported to be the average age of onset in previous studies , while the age group of 2 to 4 years constitutes the peak incidence interval, and nearly one-third of children with functional constipation will continue into adulthood, FC rarely causes life-threatening complications, but affects the physical development and mental health of children, long-term constipation not only leads to intestinal and peri-lesions, but also requires surgical intervention in severe cases. It can also be accompanied by psychological disorders such as anxiety, insomnia, and depression, which greatly affects the physical and mental health of patients, and also negatively affects their family life and increases the burden of medical resources. It can be seen that correctly understanding the essential characteristics of functional constipation in children and implementing early intervention has become one of the important issues that need to be solved urgently in the field of public health. This paper mainly reviews the pathogenesis, influencing factors, treatment and prevention progress of functional constipation in children, in order to reduce the incidence of functional constipation in children and provide a reference for the prevention and treatment of functional constipation.