以消化道症状为首发表现的HSP患儿的临床特点  

Clinical characteristics in children patients with allergic purpura with gastrointestinal tract symptoms as initial manifestation

作　　者：陈晨 高源[1] 赵玉霞[1] 罗丹 陈琼 余志 CHEN Chen;GAO Yuan;ZHAO Yuxia;LUO Dan;CHEN Qiong;YU Zhi(Department of Gastroenterology,Affiliated Wuhan Children’s Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan,Hubei 430010,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院消化内科,武汉430010

出　　处：《重庆医学》2024年第15期2330-2333,2338,共5页Chongqing Medical Journal

基　　金：湖北省自然科学基金项目(2022CFB442);湖北省武汉市医学科研项目(WX21C06)。

摘　　要：目的探讨以消化道症状为首发表现的过敏性紫癜(HSP)患儿的临床表现、内镜、组织病理学及免疫荧光IgA检测特点。方法回顾性分析2018年4月至2019年12月该院住院的以消化道症状为首发表现且初诊为HSP的29例患儿临床资料,分析临床表现、实验室及影像学检查结果、内镜及组织病理学检查结果、免疫荧光IgA检测结果、治疗方案及转归情况。结果临床表现主要为反复腹痛、呕吐、便血、皮疹、关节肿痛、睾丸肿痛等。血红蛋白降低(<110 g/L)3例(10.34%),嗜酸性粒细胞计数增高(>0.6×10^(9)/L)1例(3.45%),血清总IgE增高8例(27.59%)。食物特异性IgE阳性4例(13.79%),包括蟹、坚果、大豆、艾蒿各1例(3.45%)。22例行腹部影像学检查,其中腹腔积液5例(17.24%),盆腔积液4例(13.79%),肠壁水肿增厚15例(51.72%)。内镜下表现为黏膜充血水肿29例(100.00%),糜烂24例(82.76%),黏膜粗糙10例(34.48%),溃疡8例(27.59%),点状出血灶6例(20.69%)。黏膜病理主要表现为黏膜炎症伴IgA沉积10例(34.48%)。免疫荧光IgA检测阳性10例(34.48%)。结论在高度怀疑腹型HSP时,可尽早行内镜检查评估黏膜病变程度并完善免疫荧光IgA检测进一步明确病因。Objective To investigate the clinical manifestations,endoscopic,histopathological and immunofluorescence IgA detection characteristics in children patients with Henoch-Schonlein purpura(HSP)with gastrointestinal tract symptoms as initial symptoms.Methods The clinical data of 29 children admitted to this hospital from April 2018 to December 2019 with gastrointestinal symptoms as the first manifestation and initially diagnosed with HSP were retrospectively analyzed.The clinical manifestations,laboratory and imageological examination results,endoscopic and histopatological examination results,immunofluoresence IgA detection results,treatment regimen and outcome were analyzed.Results The clinical manifestations were mainly abdominal pain,vomiting,hematochezia,rash,joint swelling and pain,testicular swelling pain,etc.Hemoglobin was decreased(<110 g/L)in 3 cases(10.34%),the eosinophilic cells count was increased(>0.6×10^(9)/L)in 1 case and serum total IgE was increased in 8 cases(27.58%).The food specificity IgE was positive in 4 cases(13.79%),including crab,nut,soybean and mugwort 1 case each(3.45%).Twentytwo cases conducted the abdominal imageological examination,in which there were 5 cases of abdominal cavity hydrops,4 cases(13.79%)of pelvic cavity hydrops and 15 cases of intestinal wall edema and thickness.The endoscopic manifestations were mucosal hyperemia and edema in 29 cases(100.00%),erosion in 24 cases(82.76%),mucosal roughness in 10 cases(34.48%),ulceration in 8 cases(27.59%),and punctated bleeding in 6 cases.The main manifestations of mucosal pathology were mucosal inflammation with IgA deposition in 10 cases(34.48%).Immunofluorescence IgA detection was positive in 10 cases(34.48%).Conclusion When abdominal HSP is highly suspected,the endoscopic examination could be performed as soon as possible to evaluate the degree of mucosal lesions and perfect the immunofluorescence IgA detection to further identify the disease cause.

关 键 词：过敏性紫癜 内镜 病理 黏膜 免疫荧光IgA 

分 类 号：R725.7[医药卫生—儿科]