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目的研究腹型过敏性紫癜患儿的临床表现、内镜及病理学特点,以提高对腹型过敏性紫癜的诊断水平。方法以浙江大学医学院附属儿童医院2002年1月-2007年5月住院的57例行上消化道内镜检查时未出现皮肤紫癜患儿为研究对象,回顾性分析腹型过敏性紫癜患儿的临床、内镜及病理学资料。结果消化道症状主要为腹痛46例(80.7%)、呕吐32例(56.1%)、便血11例(19.3%)、腹泻4例(7.0%)、腹胀1例(1.8%);同时伴关节肿痛3例(5.3%)。实验室检查主要为外周血白细胞增高(33例,57.9%),1/5左右的病例出现 C 反应蛋白升高、白蛋白降低或腹腔积液情况。内镜下主要表现37例为略高出黏膜的点状出血和淤斑或成片状(64.9%),14例出现糜烂或多发溃疡伴出血(24.6%),4例颗粒状或结节状增生(7.0%),弥漫性出血2例(3.5%)。病变在十二指肠降段出现率最高且最严重(55例,96.5%),其次为十二指肠球部(32例,56.1%)、胃(18例,31.6%),食道较少(1例,1.8%)。组织病理学呈毛细血管炎表现,3例(5.3%)的患儿同时伴幽门螺杆菌感染。49例(86.0%)患儿在内镜检查后1～7 d 内出现皮肤紫癜,8例至出院未出现皮肤紫癜,其中2例失访,6例(10.5%)随访至今(1～5年)未见皮肤紫癜。结论十二指肠降部病变在腹型过敏性紫癜极其常见,上消化道内镜检查对腹型过敏性紫癜有极高的诊断价值。
Objective To study the clinical manifestations, endoscopic and pathological features of children with abdominal Henoch-Schonlein purpura in order to improve the diagnosis of idiopathic purpura. Methods A total of 57 pediatric patients with cutaneous purpura who were admitted to Children’s Hospital of Zhejiang University from January 2002 to May 2007 were enrolled in this study. Retrospective analysis of children with idiopathic purpura Clinical, endoscopic and pathological data. Results Gastrointestinal symptoms were mainly abdominal pain 46 cases (80.7%), vomiting 32 cases (56.1%), blood in the stool 11 cases (19.3%), diarrhea 4 cases (7.0%) and abdominal distension 1 case Pain in 3 cases (5.3%). Laboratory tests were mainly peripheral blood leukocytes increased (33 cases, 57.9%), about 1/5 cases of C-reactive protein increased, albumin decreased or ascites. Endoscopic showed 37 cases were slightly higher than the punctate mucosa bleeding and ecchymosis or sheet (64.9%), 14 cases of erosion or multiple ulcer with bleeding (24.6%), 4 cases of granular or nodular Hyperplasia (7.0%), diffuse hemorrhage in 2 cases (3.5%). The lesions were highest and most severe in the descending segment of the duodenum (55 cases, 96.5%), followed by the duodenal bulb (32 cases, 56.1%), stomach (18 cases, 31.6%), (1 case, 1.8%). Histopathology showed capillary inflammation, 3 cases (5.3%) of children with Helicobacter pylori infection. Purpura was found in 1 ~ 7 days after endoscopy in 49 cases (86.0%), and no purpura was found in 8 cases. 2 cases were lost to follow-up and 6 cases (10.5%) were followed up for 1 to 5 years No skin purpura. Conclusion The descending part of duodenum is extremely common in abdominal anaphylactoid purpura. Upper gastrointestinal endoscopy has a very high diagnostic value for abdominal anaphylactoid purpura.