临床儿科杂志 ›› 2017, Vol. 35 ›› Issue (10): 737-.doi: 10.3969/j.issn.1000-3606.2017.10.005

• 消化系统疾病专栏 • 上一篇    下一篇

儿童腹型过敏性紫癜临床及内镜特征

王跃生, 张敬, 李小芹, 周方, 于静   

  1. 郑州儿童医院消化内科(河南郑州 450052)
  • 收稿日期:2017-10-15 出版日期:2017-10-15 发布日期:2017-10-15
  • 通讯作者: 李小芹  E-mail:lixiaoqinys@126.com

The clinical and endoscopic features of abdominal type Henoch-Schonlein purpura in children

WANG Yuesheng, ZHANG Jin, LI Xiaoqin, ZHOU Fang, YU Jing   

  1. Department of Gastroenterology, Zhengzhou Children's Hospital, Zhengzhou 450052, Henan, China
  • Received:2017-10-15 Online:2017-10-15 Published:2017-10-15

摘要: 目的 探讨儿童腹型过敏性紫癜(HSP)的临床表现、内镜改变及病理组织学特点。方法 回顾分析2011年6 月至2016年6月住院治疗的151例以腹痛为首发主要表现的HSP患儿的临床资料。结果 151例HSP患儿,男87例、女64 例,年龄4.8~11.5岁。所有患儿均有腹痛,皮肤紫癜100例(66.22%)、呕吐72例(47.68%)、呕血59例(39.07%)、便血 44例(29.13%),伴关节肿痛8例(5.29%)。114例(75.49%)外周血白细胞增高、48例(31.78%)C 反应蛋白升高、21例 (13.90%)白蛋白降低。49例(32.45%)患儿B超示局限性肠壁增厚。96例患儿行胃镜检查,主要表现为,点片状出血、红 斑89例(92.70%),糜烂或溃疡伴出血68例(70.83%),淤斑37例(38.54%),血肿样突起13例(8.60%);十二指肠降部 病变最常见且最严重,其次为胃窦部、十二指肠球部。病理组织学呈毛细血管炎表现37例,伴幽门螺杆菌感染10例。55例 患儿行肠镜检查,主要表现为点片状出血、红斑49例(89.09%),糜烂或多发溃疡伴出血27例(49.09%);回肠末端病变 最常见且最严重,其次为直肠。结论 儿童腹型HSP的临床表现多样,常累及十二指肠降部、回肠末端,内镜检查对儿童 腹型HSP诊断有价值。

Abstract: Objective To explore the clinical features, endoscopic changes, and histopathological features of abdominal type Henoch-Schonlein purpura (HSP) in children. Methods The clinical data of 151 children with HSP who had abdominal pain as the primary symptom from June 2011 to June 2016 were analyzed retrospectively. Results A total of 151 children with HSP, (87 males and 64 females) aged 4.8 - 11.5 years, were enrolled. All of them had abdominal pain. There were 100 cases of cutaneous purpura (66.22%), 72 cases of vomit (47.68%), 59 cases of haematemesis (39.07%), 44 cases of hematochezia (29.13%) and 8 cases of joint swelling and pain (5.29%). Peripheral blood leucocytes increased in 114 cases (75.49%), C-reactive protein increased in 48 cases (31.78%), and albumin decreased in 21 cases (13.90%). It indicated the localized thickening of the intestinal wall in 49 cases (32.45%) by B-ultrasound. Gastroscopy was performed in 96 cases and main findings were patchy hemorrhage and erythema (89 cases, 92.70%), erosion or ulcer accompanied by bleeding (68 cases, 70.83%), ecchymosis (37 cases, 38.54%) and hematoma like process (13 cases, 8.60%). The descendent duodenum was the most common and had the most serious lesions, followed by gastric antrum and duodenal bulb. Histopathology showed capillary inflammation in 37 cases, 10 of which were accompanied by Helicobacter pylori infection. Enteroscopy was performed in 55 cases and main findings were punctate hemorrhage and erythema (49 cases, 89.09%), and erosion or multiple ulcer with hemorrhage (27 cases, 49.09%). The terminal ileum was the most common and had the most serious lesions, followed by rectum. Conclusions The clinical features of abdominal type HSP in children are varied, and it often involves descendent duodenum and terminal ileum. Endoscopic examination is valuable for the diagnosis of abdominal type HSP in children.