内镜在以消化道症状为首发表现的腹型过敏性紫癜中的应用价值

Clinical value of endoscopy in diagnosis in henoch-sch nlein purpura with gastrointestinal symptoms as the first manifestation.

目的探讨内镜在以消化道症状为首发表现的腹型过敏性紫癜(HSP)中的应用价值,总结HSP临床特点及内镜特征,提高其诊疗水平。方法回顾性收集首都医科大学附属北京友谊医院自2012年1月至2020年5月收治的32例以消化道症状为首发表现的腹型HSP患者的临床资料,其中成人患者23例,儿童患者9例;男性19例,女性13例。患者均完善血常规、尿常规、便常规、肝肾功能、电解质、白蛋白、C反应蛋白、凝血功能、胸片、腹盆CT等一般检查,以腹痛或消化道出血为主要症状的患者进行胃镜、结肠镜、小肠镜或胶囊内镜检查。结果本研究中消化道症状最常见的是腹痛29例(90.6%),消化道出血13例(40.6%),腹泻9例(28.1%),恶心呕吐5例(15.6%),皮肤紫癜32例(100.0%)。19例患者紫癜症状与消化道症状同时出现,13例晚于消化道症状4~13 d出现。实验室检查发现,血常规示血白细胞升高15例(46.9%),血红蛋白降低25例(78.1%),生化示白蛋白降低11例(34.3%),尿蛋白阳性13例(40.6%),血肌酐升高2例(6.25%),凝血示D二聚体升高28例(87.5%),B超或CT提示腹腔、盆腔积液10例(31.3%)。内镜下的表现为黏膜充血水肿、红斑淤点、片状糜烂、浅表溃疡、点片状或弥漫性出血等,病灶呈多发性,不规则性,严重者出现环周黏膜病变,胃镜所见以十二指肠降部为多发、严重,结肠镜检查显示病变主要分布在回肠末端及直肠乙状结肠,溃疡性病变在回肠末端比直肠乙状结肠更常见。14例患者行内镜下病理活检,呈慢性炎14例(100.0%),伴炎性渗出物4例(28.6%),伴炎性肉芽组织增生3例(21.4%),伴嗜酸粒细胞浸润2例(14.3%)。结论腹型HSP的内镜表现以十二指肠降部、回肠末端最为常见,腹痛为最常见临床表现,结合内镜表现可提高该病认识,提高诊疗水平。

Objective To explore the clinical value of endoscopy in diagnosis in henoch-schonlein purpura(HSP)with gastrointestinal symptoms as the first manifestation,and to summarize the clinical and endoscopic features of HSP to improve the diagnosis and treatment.Methods Clinical data of 32 patients in abdominal HSP with gastrointestinal symptoms as the first manifestation admitted to Beijing Friendship Hospital affiliated to Capital Medical University from January 2012 to May 2020 were retrospectively collected,including 23 adults and 9 children.There were 19 male patients and 13 female patients.All the patients have completed general examinations such as blood routine,urine routine,stool routine,liver and kidney function,electrolytes,albumin,C-reactive protein,coagulation function,chest radiograph,and abdominal CT scan.Patients with abdominal pain or gastrointestinal bleeding performed gastroscopy,colonoscopy,enteroscopy,or capsule endoscopy.Results The most common symptoms of the gastrointestinal tract are abdominal pain in 29 cases(90.6%),gastrointestinal bleeding in 13 cases(40.6%),and diarrhea in 9 cases(28.1%),nausea and vomiting in 5 cases(15.6%),32 cases with skin purpura(100.0%).Nighty cases with skin purpura appeared at the same time with gastrointestinal symptoms,13 cases were 4-13 days later than gastrointestinal symptoms.Blood leukocytes increased in 15 cases(46.9%),hemoglobin decreased in 25 cases(78.1%),biochemical albumin decreased in 11 cases(34.3%),positive in urine protein in 13 cases(40.6%),blood creatinine increased in 2 cases(6.25%),d-dimer increased in 28 cases(87.5%).B-ultrasound or CT showed peritoneal and pelvic effusion in 10 cases(31.3%).Endoscopic manifestations included mucosal congestion and edema,erythema bruising,flaky erosion,superficial ulcer,flaky or diffuse bleeding,etc.The lesions were multiple and irregular.In severe cases,peripheral mucosal lesions occur.Gastroscopy showed that the descending part of the duodenum was multiple and severe.Colonoscopy showed that the lesions were mainly distributed at the end of the ileum and the sigmoid colon of the rectum.Ulcerative lesions were more common at the end of the ileum than the sigmoid colon of the rectum.Forteen cases underwent pathological biopsy,histopathology showed chronic inflammation in 14 cases(100.0%),with inflammatory exudate in 4 cases(28.6%),with inflammatory granulation tissue hyperplasia in 3 cases(21.4%),with addiction Acid granulocyte infiltration in 2 cases(14.3%).Conclusion Descending duodenum and terminal ileum lesions are the most common and severe position involved in abdominal type HSP.Abdominal pain is the most common clinical manifestation.Combining endoscopic manifestations could improve the understanding of the disease and improve the level of diagnosis and treatment.