胃镜联合腹部彩超在腹型过敏性紫癜早期诊断中的临床应用价值

Application of gastroscope and Doppler ultrasonography in early diagnosis of abdominal Henoch-Schonlein purpura

目的:分析腹型过敏性紫癜(Henoch-Schonlein purpura,HSP)患儿的胃镜、腹部彩超特点,探讨胃镜联合腹部彩超检查早期协助诊断腹型过敏性紫癜的临床应用价值。方法:以我院2010年1月至2013年10月住院的32例腹型HSP患儿为研究对象,所有患儿以急性腹痛为首发症状,行胃镜和腹部彩超检查时未出现皮肤紫癜,回顾性分析其胃镜、腹部彩超特点。结果:胃镜异常表现29例(29/32=90.6%),主要显示胃和十二指肠黏膜呈现充血、水肿、出血灶、糜烂甚至溃疡,以十二指肠降部病变为著;腹部彩超异常表现25例(25/32=78.1%),受累肠壁主要表现为单发或多发部分肠管壁增厚并血流丰富。胃镜及腹部彩超均有异常改变23例(23/32=71.9%)。2项检查均异常的患儿腹痛后(9.780±3.190)d出现紫癜样皮疹,而其影像检查结果于腹痛后(6.130±1.914)d获得,较临床诊断时间平均提前3.65 d(t=9.23,P<0.01)。结论:腹型HSP患儿的胃镜、腹部超声检查均有异常者较为常见,两者联合检查有助于早期协诊腹型HSP,并能有效地指导治疗。

Objective：To analyze the characteristics of gastroscope and Doppler uhrasonography in the abdominal type Henoch- Schonlein purpura（HSP） and to investigate its clinical value for early diagnosis. Methods ：Retrospective review was made on the gas- troscope and Doppler ultrasonography features of 32 children with abdominal type HSP who had been hospitalized from Januanry 2010 to October 2013. Gastroscope and Doppler ultrasonography were performed on all patients. All cases had acute abdominal pain without cutaneous purpura before gastroscope and doppler ultrasonography. Results ： Abnormal finding of gastroscope was observed in 29 cases（90.6%）. The gastroscopic characteristics of stomach and duodenal mucous were congestion, swelling, hemorrhage, erosion and even ueler. Mucosal lesions became more serious in the descending duodenum. Abnormal finding of Doppler uhrasonography was ob- served in 25 cases（78.1%）. The characteristics of the injured wall was single or multiple areas of intestinal wall thickening with plenty of blood flow. Of the 35 children, 23 （71.9%） had both gastroscope and Doppler ultrasonography abnormal findings;cutaneous purpu- ra appeared on（9.780 ± 3.190） d after abdominal pain;imaging results were obtained on（6.130 ± 1.914） d after abdominal pain,for- warding clinical diagnosis of HSP for 3.65 d（t=9.23 ,P〈0.01 ）. Conclusion：Both gastroscope and Doppler ultrasonography abnormal findings are common in HSP. Gastroscope combined with doppler uhrasonography is useful for early diagnosis and treatment of abdominal type HSP effectively.