儿童腹型过敏性紫癜的内镜特点及病因分析

Endoscopic manifestation of purpura abdominalis and the pathogen of purpura abdominalis

目的了解儿童腹型过敏性紫癜（HSP）的内镜特点，探讨儿童腹型过敏性紫癜的相关病因。方法对本科住院的91例儿童腹型过敏性紫癜行内镜检查；并检测食入性变应原及应用13↑C尿素呼气试验检测幽门螺杆菌感染；观察治疗过程中腹痛缓解情况。结果91例行胃镜检查患儿中胃十二指肠黏膜均有不同程度受损占89例（97．8％）。内镜下主要表现59例为略高出黏膜的点状出血和淤斑伴周围渗出（66．3％），22例出现糜烂或多发溃疡伴出血（24．7％），其中病变以十二指肠降段出现率最高（81例，91．0％），其次为十二指肠球部（45例，50．6％）、胃（29例，32．6％）。91例患儿中13↑C尿素呼气试验阳性64例；其中有82例对一种或多种食物不耐受。结论腹型过敏性紫癜患儿内镜下胃十二指肠为出血斑及溃疡为特点，内镜检查对儿童腹型过敏性紫癜早期诊断具有一定价值；食物过敏及幽门螺杆菌感染为其发病的危险因素。

Objective To evaluate the endoscopic manifestation of purpura abdominalis in child patients for early diagnosis and discuss the pathogen of purpura abdominaiis. Methods The endoscopic and clinical manifestation of 91 patients with purura abdominalis were studied. Ten kinds of food allergenspecific IgG were detected by ELISA method in 91 patients with purpura abdominalis. 13↑ C-UBT was detected in 91 patients with purpura abdominalis. Results Endoscopy revealed congestion, edema, splotch hemorrhage and erosion, mostly in duodenum descendent and bulb. IgG positive rate of various foods was detected in 82 patients. 13↑C-UBT positive rate was 70. 3%. Conclusions Early endoscopy was an important treatment in the differential diagnosis of purura abdominalis. Both Helicobacterpylori infection and food intolerance could be the reason of purpura abdominalis.