成人过敏性紫癜腹型病例临床特点分析

The clinical features of adult Henoch-Schonlein purpura patients with gastrointestinal involvement

目的分析成人过敏性紫癜腹型病例的临床特点及其与非腹型患者之间的差异。方法回顾性分析北京大学第一医院2000年1月至2006年12月63例过敏性紫癜住院患者中有腹痛症状患者的临床特点,并与无腹痛症状患者进行比较。结果32例患者(50.8%)具有腹痛症状,其中脐周腹痛占43.8%、中上腹痛40.6%、下腹痛15.6%、恶心呕吐15.6%、便潜血阳性50.0%、血或尿淀粉酶升高占25.0%。胃镜检查显示以十二指肠降部黏膜损害为主,表现为充血性红斑、糜烂及不规则溃疡形成。结肠镜检查显示回肠末段的黏膜充血性红斑、糜烂及不规则浅溃疡和直、乙状结肠黏膜的充血、红斑。病变部位活检病理为非特异性炎症细胞浸润。有腹痛症状和无腹痛症状者比较,两组在年龄、性别、过敏史、前驱感染史方面差异无统计学意义。腹痛组混合型显著多于无腹痛组(78.1%比22.6%,P<0.01)。两组患者在蛋白尿、血尿和血IgA升高、血总IgE升高的发生率差异无统计学意义。结论成人过敏性紫癜患者中腹型为50.8%,以中、青年为主。有腹痛症状的患者混合型多,内镜检查阳性率高,且内镜表现具有一定的特征性,应重视过敏性紫癜腹型患者的内镜检查。

Objective To investigate the clinical features of aduh inpatients with abdominal type Henoeh-Schonlein purpura（HSP） and to compare them with those without gastrointestinal symptoms. Methods The aduh inpatients with HSP during January 2000 and December 2005 were reviewed retlrospectively, and the clinical features of those with or without abdominal pain were compared, Results Sixty-three patients were included. Thirty-two patients（50. 8% ）eomplained of abdominal pain. Of these patients, 43. 8% had peri-umbilieal colicky pain,40. 6% middle-upper abdomunal pain and 15.6% lower abdominal pain. The other clinical manifestations included nausea/vomiting（ 15. 6% ） ,positive feces occult blood test（50. 0% ）and elevated blood/urine amylase（25.0% ）. EGD showed mncosal congestion, red macula, erosion and ulceration mainly in the descending duodenum. Colonseopy showed inflammatory and ulcerative lesions at distal ileum and rectosigmoid. The biopsy pathology showed non-specific inflammatory cell infihration. There were no differences in age,gender,allergic hislory and predisposing infection between those with abdominal pain and those without abdominal symptoms. The patients with abdominal pain had more mixed-type HSP（78. 1% vs 22. 6%, P 〈 0.01 ）. Also, there were no significant differences in the rates of proteinuria, hematuria,elevated serum IgA and tIgE between those with or without ahdomiual pain. Conclusion Gastrointestinal involvements account for 50. 8% adult patients with HSP,mainly young adults;The abdominal-type HSP patients have more mixed type and higher prevalence and characteristic gastrointestinal mucosal damages proved by endoscopy,and endoscopy procedures should be paid more attention to.