215例有消化道症状的过敏性紫癜临床特点及胃镜表现

Endoscopic and clinical features of 215 cases of pediatric Henoch-Schonlein purpura with digestive tract symptoms

目的探讨有消化道症状的过敏性紫癜(HSP)相关临床特点及在胃镜下的改变。方法 2014年1月至2015年1月湖南省儿童医院消化内科收治住院有消化道症状的HSP患儿215例,分析其临床表现,并对119例胃镜检查患儿的镜下表现进行分析总结,根据胃镜下黏膜损害程度将患儿分成两组,分析两组腹痛总时间、腹痛缓解时间、住院时间、并发胰腺炎情况及并发紫癜性肾炎的情况,并分析发生重度黏膜损害的高危因素。结果消化道症状主要表现为腹痛、呕吐、便血,以腹痛为首发症状的有90例(41.9%)。胃镜下表现为不同程度的充血、水肿、花斑、糜烂、出血、溃疡,可多种病损同时出现。两组患儿在腹痛总时间及住院期间胰腺炎并发率比较差异无统计学意义(P>0.05);黏膜损害重组腹痛缓解时间、住院时间和住院期间紫癜性肾炎发生率高于黏膜损害轻组,差异有统计学意义(P<0.05);发生肾脏受累在HSP患儿消化道黏膜严重损伤的易感因素中有统计学意义(P<0.05)。结论 HSP腹痛可作为首发症状。胃镜下特征性表现可辅助诊断。胃镜下黏膜损害程度与腹痛总时间、胰腺炎发生比例无关,与腹痛缓解时间、住院时间及住院期间发生紫癜性肾炎的比例相关,且发生肾脏受累是过敏性紫癜患儿消化道黏膜严重损伤的相关因素。

Objective To study the endoscopic and clinical features of Henoch-Schonlein purpura（HSP）in children with digestive tract symptoms.Methods Analyze the clinical features of 215 children with HSP in our hospital and summarize endoscopic results of 119 children who took gastroscopy.According to severity of mucosa damage under endoscopy,the children were divided into two groups.The total time of abdominal pain,the time of abdominal pain after admission,the hospital stay,the rate of pancreatitis and HSPN were compared between the two groups,and the high risk factors of severe mucosal damage were analyzed.Results The major digestive clinical manifestations of HSP were abdominal pain,emesia and hematochezia;abdominal pain was found as the first-onset symptom in 90cases（41.9%）.No significant difference was observed in the total time of abdominal pain and rate of pancreatitis between the two groups（P〈0.05）.Significant differences was observed in the time of abdominal pain after admission,the hospital stay and the rate of HSPN between the two groups（P〈0.05）.The rate of renal damage was of statistical significance in the risk factors of HSP children with severe digestive mucosa damage.Conclusion Abdominal pain can be the first-onset symptom.The endoscopic results of HSP in children can help to make the diagnosis.The severity of mucosa damage under endoscopy of HSP in children is not correlated with the total time of abdominal pain or the rate of pancreatitis,but is significantly correlated with the time of abdominal pain after admission,the hospital stay and the rate of HSPN.The risk factor associated with severe mucosa damage in HSP is renal damage.