腹型过敏性紫癜患儿的临床、内镜及病理学特点  

Clinical manifestations and endoscopic features of abdominal type Henoch purpura in children

作　　者：李中跃[1] 黄晓磊[1] 陈洁[1] 陈飞波[1] 楼金玕[1] 江米足[1] 章许平[1] 赵正言[2] 

机构地区：[1]浙江大学医学院附属儿童医院消化科,杭州310003 [2]浙江大学医学院附属儿童医院儿童保健科,杭州310003

出　　处：《中华儿科杂志》2007年第11期814-817,共4页Chinese Journal of Pediatrics

摘　　要：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 investigate the clinical manifestations and endoscopic features of abdominal type Henoch purpura in children and improve the diagnostic level. Methods Retrospective review was made on the clinical, endoscopic and histopathological features of 57 cases of children with Henoch purpura abdominal type who had been hospitalized from Jan. 2002 to May 2007. Upper gastrointestinal endoscopy was performed in all cases. All the cases had various digestive system symptoms without cutaneous purpura before endoscopy. Mucosal specimens were taken from sinus ventriculi and duodenum for histopathological analysis. Helicobacter pylori （H. pylori） infection was identified by rapid urease test and histology, and diagnosis of H. pylori infection was made when both were positive. Results The common gastrointestinal symptoms of Henoch purpura were abdominal pain （46 cases ）, vomiting （32 cases）, hematochezia （ 11 cases）, diarrhea （4 cases） and abdominal distention （ 1 case）. Three cases had arthralgia and joint swelling. The main laboratory findings were increased peripheral white blood cells （33 cases, 57.9%）, 1/5 of cases had elevated C reactive protein （CRP）, low serum albumin and seroperitoneum. Endoscopy demonstrated the damages to the mucosa, which varied from congestion,edema, petechia and ecchymosis（37 cases,64. 9% ） to erosive and multiple ulcers（ 14 cases,24. 6% ）, granulation of mucosa in descendent duodenum （4 cases, 7.0% ）, and diffuse hemorrhage of mucosa （ 2 cases, 3.5 % ）. The upper gastrointestinal endoscopy showed that the commonest and most serious position involved was the descendent duodenum （ 55 cases, 96. 5 % ）, followed by duodenal bulb （ 32 cases, 56. 1% ） and stomach （ 18 cases, 36. 1% ）, esophagus was less involved （ 1 case, 1.8% ）. Histological manifestations showed swollen vascular endothelial cells of capillary vessels and small blood vessels, fibrotic necrosis of small vessels and bleeding, diffuse perivascular lymphocytic and n

关 键 词：紫癜 过敏性 内窥镜检查 胃肠道 儿童 

分 类 号：R725.5[医药卫生—儿科]