腹型过敏性紫癜的临床及内镜特点分析

Analysis of clinical and endoscopic characteristics of abdominal-type Henoch-Schonlein purpura

目的分析腹型过敏性紫癜患者的临床及内镜特点,提高对此病的认识,避免误诊。方法对安徽医科大学第一附属医院2009年12月至2015年3月消化内科收治的70例腹型过敏性紫癜患者临床资料进行回顾性研究。结果腹型过敏性紫癜好发于青年(75.7%),春夏冬季(85.7%),发病前有可疑诱因的51.4%,临床表现常为恶心呕吐和消化道出血,伴有腹痛,腹痛性质常为阵发性绞痛、胀痛或隐痛,腹部体征以压痛为主97.1%(68/70),无明显反跳痛及肌紧张;皮疹出现先于消化道症状易于诊断,皮疹出现迟于消化道症状容易误诊,以消化道症状为首发症状患者误诊率47.1%(33/70)。误诊原因常为急性胃肠炎、阑尾炎者、胆道疾病、消化道溃疡等;腹型过敏性紫癜内镜下表现常累及上消化道胃体、胃窦和十二指肠的球、降部,下消化道常累及回肠末端和直肠,内镜下表现形式常为黏膜的红斑、充血、糜烂、溃疡,常成广泛性病变,其病理表现为黏膜慢性炎、炎性细胞的浸润并伴有不同程度的黏膜坏死;腹型过敏性紫癜合并消化道出血组的上肢、躯干紫癜和CRP值升高高于过敏性紫癜无消化道出血组(P<0.05)。结论十二指肠球降部和胃体、胃窦、在腹型过敏性紫癜常累及;腹型过敏性紫癜中上肢、躯干的皮疹和CRP的升高有助于过敏性紫癜合并消化道出血的预测。

Objective To analyze the clinical and endoscopic features of the abdominal-type Henoch-Schonlein purpura( HSP) patients,so as to improve our understanding of this disease and to avoid misdiagnosis. Methods 70 patients with abdominal-type HSP ever treated in the gastroenterology department of our hospital from Dec 2009 to Mar 2015 were retrospectively analyzed. Results The abdominal-type HSP often occurred in the young( 75. 7%),and in the seasons of spring,summer and winter( 85. 7%). 51. 4% of them had suspicious incentives before disease onset. The clinical manifestations often included nausea and vomiting,gastrointestinal bleeding,and abdominal pain,usually being paroxysmal colic,distending or dull pain,with signs of tenderness( 97. 1%,68 /70) and no obvious rebound tenderness and muscle tension. It was easy to diagnose the disease when the appearance of rash was prior to digestive symptoms,but when the appearance of rash was later,the disease would be easily misdiagnosed,with a misdiagnosis rate of 47. 1%( 33 /70) in the patients with an initial gastrointestinal symptom. The abdominal-type HSP was often misdiagnosed as acute gastroenteritis,appendicitis,biliary tract diseases and gastrointestinal ulcers,and its endoscopic performance often involved the gastric body,the gastric antrum,the duodenum bulb and the descending duodenum of upper gastrointestinal tract,and the terminal ileum and the rectum of lower gastrointestinal tract. The endoscopic features usually indicated extensive lesions of mucosal erythema,congestion,erosion and ulcer,with the pathological changes of mucosal chronic inflammation,inflammatory cell infiltration and different degrees of mucosal necrosis. The abdominal-type HSP patients with gastrointestinal hemorrhage showed higher probability of purpura on the upper limbs and trunk and elevation of serum C-reactive protein( CRP) levels,when compared with those without gastrointestinal hemorrhage( P < 0. 05). Conclusion The gastric body,gastric antrum and descending duodenum were often involved in the abdominal-type HSP. Purpura on the upper limbs and trunk and elevation of CRP levels are helpful to predict gastrointestinal hemorrhage in the abdominal-type HSP patients.