过敏性紫癜合并急性胰腺炎23例临床分析

Allergic purpura complicated with acute pancreatitis:a report of 23 cases

目的总结过敏性紫癜(过敏性紫癜)合并急性胰腺炎(急性胰腺炎)的临床特征,提高临床认识,减少误诊,改善预后。方法回顾性分析23例诊断为过敏性紫癜合并急性胰腺炎患儿的临床资料。分析临床特征,实验室检查结果,影像学表现,治疗和总体预后。结果所有患儿均有腹部表现,包括明显腹痛20例,呕吐18例,腹胀12例,13例柏油样粪便。虽然所有患儿都有典型的皮肤紫癜,但8例患儿在临床上表现为急性腹痛为首发症状。所有患儿血液中血清淀粉酶,血清脂肪酶,尿淀粉酶水平增高。并且腹部超声检查发现14例胰腺肿胀。胃镜检查阳性率100%。糖皮质激素治疗可有效缓解腹痛症状。所有患儿均预后良好。出院后6~12个月未出现任何腹部并发症。结论在过敏性紫癜儿童中急性胰腺炎发病率低,与过敏性紫癜的腹部表现在临床上无特异性。因此,在过敏性紫癜患儿有严重的腹痛时,应评估血清淀粉酶水平确诊急性胰腺炎。早期诊断过敏性紫癜伴急性胰腺炎,并及时治疗有助于改善预后。

Objective To summarize the clinical features of allergic purpura complicated with acute pancreatitis,improve clinical understanding,reduce misdiagnosis and improve prognosis.Methods A retrospective analysis was made on 23 patients with allergic purpura complicated with acute pancreatitis from September 2009 to September 2018 in our hospital.The clinical features,laboratory findings,imaging findings,treatment and overall prognosis were analyzed.Results All patients had abdominal manifestations,including obvious abdominal pain in 20 cases,vomiting in 18 cases,abdominal distention in 12 cases,and tar like stool in 13 cases.Although all patients had typical skin purpura,the first clinical manifestation was acute abdominal pain in 8 patients.The levels of serum amylase,lipase and urine amylase increased in all patients.Abdominal ultrasonography showed 14 cases of pancreatic swelling.The positive rate of gastroscopy was 100%.Glucocorticoid treatment can effectively alleviate abdominal pain symptoms.All patients had a good prognosis.There was no abdominal complication 6-12 months after discharge.Conclusion The incidence of acute pancreatitis is low in children with allergic purpura,and it is clinically non-specific with the abdominal manifestations of allergic purpura.Therefore,patients with allergic purpura have severe abdominal pain,and serum amylase levels should be assessed to confirm acute pancreatitis.Early diagnosis of allergic purpura complicated with acute pancreatitis,and timely treatment can help improve prognosis.