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目的:探讨以消化道症状为首发表现的混合型过敏性紫癜的临床特点,以减少误诊。方法:分析我院2006年1月至2012年12月收治的18例以消化道症状为首发表现的混合型过敏性紫癜患儿的临床资料,总结易致误诊的因素。结果:6例首发表现以呕吐、腹泻为主,伴有腹部不适,误诊为急性胃肠炎;10例首发表现以腹痛反复阵发性发作为主,脐周疼痛(其中3例发热,发热症状先于腹痛症状),误诊为肠系膜淋巴结炎;2例首发表现为脐周及右下腹腹痛,误诊为急性阑尾炎。早期治疗阶段,腹痛均无缓解,4 h~7 d出现不同程度的双下肢皮疹而诊断为混合型过敏性紫癜,给予泼尼松2 mg/(kg·d)分次口服、抗生素、氯雷他定、大剂量维生素C等治疗,治疗3 d后腹痛均缓解,治疗10~15 d治愈出院。结论:临床遇到以消化道症状首发的混合型过敏性紫癜时,要时刻观察疾病的演变过程。对无皮疹表现,早期对症治疗效果不佳者,要认真分析病史资料,结合相关实验室检查(胃镜、腹部B超、血沉等)以减少误诊的发生。
Objective: To investigate the clinical features of mixed allergic purpura with digestive symptoms as the first manifestation to reduce misdiagnosis. Methods: The clinical data of 18 patients with mixed type hypersensitivity purpura with gastrointestinal symptoms as the first manifestation in our hospital from January 2006 to December 2012 were analyzed. The factors leading to misdiagnosis were summarized. Results: The first episode of 6 cases was mainly vomiting and diarrhea with abdominal discomfort, which was misdiagnosed as acute gastroenteritis. The first episode of 10 cases was recurrent paroxysmal abdominal pain, and umbilical pain (3 of them were fever and fever) Before abdominal pain symptoms), misdiagnosed as mesenteric lymphadenitis; 2 cases of first manifestation of abdominal pain and right lower quadrant abdominal pain, misdiagnosed as acute appendicitis. Early stage of treatment, abdominal pain were not relieved, 4 h ~ 7 d appeared varying degrees of lower extremity rash diagnosed as mixed allergic purpura, given prednisone 2 mg / (kg · d) points oral, antibiotics, He set, high-dose vitamin C and other treatment, abdominal pain after 3 days were relieved, the treatment of 10 ~ 15 d cured. Conclusions: When clinical encounter with mixed allergic purpura with initial symptoms of gastrointestinal tract, observe the evolution of the disease. No rash performance, early symptomatic treatment ineffective, careful analysis of medical history data, combined with related laboratory tests (endoscopy, abdominal B, ESR, etc.) to reduce the incidence of misdiagnosis.