35例腹型过敏性紫癜临床特点和转归分析

Clinical Characteristics and Outcome of Gastrointestinal Involvement of Henoch-Schnlein Purpura:Analysis of 35 Cases

背景:腹型过敏性紫癜(HSP)临床表现缺乏特异性,诊断困难,易发生误诊。目的:分析全年龄段腹型HSP患者的临床特点及其转归,为该病的早期诊断和治疗提供依据。方法:对2006年1月—2016年1月上海长征医院收治的35例腹型HSP患者的临床资料进行回顾性分析,并以电话形式进行预后随访。结果:入组患者中男性22例,女性13例,平均发病年龄33.6岁。最常见的发病季节为冬春两季,常见诱因为发病前异种蛋白饮食史和上呼吸道感染。57.1%的患者以腹痛为首发表现,腹痛部位最常见于脐周(42.9%),以阵发性绞痛为主(48.6%),腹部体征较轻。实验室检查中57.1%的患者白细胞计数升高,25.0%血清IgA升高。内镜下病变主要位于胃、十二指肠和直、结肠,表现为不同程度的黏膜点状出血、弥漫性充血水肿和糜烂,活检病理提示非特异性炎性细胞浸润。该病预后良好,复发率为21.9%,所有复发患者入院时均存在血清纤维蛋白原降解产物(FDP)和D-二聚体升高。结论:腹型HSP皮疹常晚于消化道症状出现,典型的临床和内镜表现有助于早期诊断和治疗。FDP和D-二聚体升高对预测复发可能有一定价值。

Background： Gastrointestinal involvement of Henoch-Sch（o）nlein purpura （HSP） lacks specific clinical manifestations, which makes it difficult to be diagnosed and easy to misdiagnose.Aims： To analyze the clinical characteristics and outcome of gastrointestinal involved HSP across all ages and provide evidence for early diagnosis and treatment of the disease.Methods： A retrospective analysis was conducted on 35 gastrointestinal involved HSP patients admitted to Shanghai Changzheng Hospital from Jan.2006 to Jan.2016.The clinical outcome was followed up by phone interview.Results： Of the 35 gastrointestinal involved HSP patients, 22 were male and 13 were female, with a mean age of disease onset at 33.6 years.The frequent disease onset seasons were winter and spring, and the most frequent precipitating events were eating foreign proteins and upper respiratory tract infection shortly before disease onset.Abdominal pain was the presenting manifestation in 35 patients （57.1%） and was most frequently at periumbilical area （42.9%）, and 48.6% of the pain was of paroxysmal colicky pain.The abdominal signs were mild.Laboratory tests showed 57.1% of the patients had elevated leukocyte count and 25.0% had elevated serum IgA.Stomach, duodenum, rectum and colon were frequently involved endoscopically, and the endoscopic lesions included mucosal petechia, diffuse mucosal erythema, edema and erosion.Nonspecific inflammatory cells infiltration was demonstrated by biopsy pathology.The overall prognosis was good with a recurrence rate of 21.9%.Elevated serum fibrinogen degradation product （FDP） and D-dimer were found in all the recurrent patients at admission.Conclusions： Purpura rash usually appeared later than gastrointestinal symptoms in gastrointestinal involved HSP.Typical clinical manifestations and endoscopic appearances are helpful for early diagnosis and treatment.Elevated FDP and D-dimer might be the predictor of recurrence.