儿童腹型过敏性紫癜合并急性胰腺炎11例临床分析

Clinical analysis on 11 cases of Henoch-Sch nlein purpura complicated by acute pancreatitis in children

目的总结腹型过敏性紫癜(HSP)合并胰腺炎的临床特点及诊治过程。方法对2001年5月至2011年5月收治的162例HSP中11例腹型HSP合并胰腺炎患儿的临床特点、实验室检查、治疗经过及结果进行回顾性分析和比较。结果 11例合并胰腺炎腹型HSP患儿与151例未合并胰腺炎HSP患儿临床特点比较,在年龄、持续腹痛发生率、皮疹出现晚于腹痛症状及复发率方面差异有统计学意义(P均<0.05);11例合并胰腺炎患儿均有腹痛,大部分呈持续性腹痛伴呕吐,皮疹于腹痛后2～10 d出现;血、尿淀粉酶均升高;7例腹部超声检查胰腺体积增大,6例CT腹部检查胰腺体积增大;经综合治疗后,其中2例好转,其余9例于2～3周痊愈出院;经随访,无1例胰腺炎复发。结论腹型HSP合并胰腺炎患儿有一定的临床特点,治愈率较高,不易复发,但是容易误诊,对于腹痛患儿要考虑到HSP的可能性,对腹型HSP患儿要进行胰腺炎方面的检查。重症急性胰腺炎病死率较高,若不及时治疗,造成不良后果,在临床中应引起高度重视。

Objective To summarize the clinical features and treatment process of Henoch-Schfinlein purpura （HSP） com- plicated by acute pancreatitis in children. Methods In 162 cases of allergic purpura admitted to our hospital from May 2001 to May 2011, there were 11 cases of HSP complicated by acute pancreatitis and their clinical features, laboratory examination, treat- ment and the final outcomes were retrospectively analyzed and compared with the rest of cases. Results There were significant differences between HSP patients with （n=11） and without （n=151） pancreatitis in age, the incidence of persistent abdominal pain, rash appeared after the abdominal symptoms, and relapse rate （all P〈0.05）. All of the 11 children with panereatitis had abdominal symptoms, most of whom had a persistent abdominal pain accompanied with vomiting; the skin rash appeared 2 to10 days after abdominal pain; amylase in both blood and urine of those 11 children increased; 7 children were found an increase in the volume of the pancreas by an abdominal ultrasound and the same was found in 6 children by CT-scan; after treatment, 2 cases improved and the other 9 cases cured in 2-3 weeks; no patients had relapsing panereatitis in the follow-up. Conclusions HSP with compli- cation of panereatitis in children has certain clinical characteristics, its cure rate is high and recurrence is rare, but it is easy to be misdiagnosed. For the children with abdominal pain, HSP should be considered. Examination of pancreatitis is needed for HSP children. Severe acute panereatitis has high mortality rate, and, if not treated in time, adverse consequences will be resulted inclinical process. So it should be taken seriously.