儿童血管内压力增高性紫癜误诊为过敏性紫癜临床分析  

Clinical Analysis of Purpura Due to Raised Intravascular Pressure Misdiagnosed as Henoch-Sch nlein Purpura

作　　者：宋雨宸 赵文文 胡艳[1] SONG Yuchen;ZHAO Wenwen;HU Yan(Department of Traditional Chinese Medicine,Beijing Children's Hospital Affiliated to Capital Medical University/National Center for Children's Health,Beijing 100045,China;Clinical Research Center,Beijing Children's Hospital Affiliated to Capital Medical University/National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心、首都医科大学附属北京儿童医院中医科,北京100045 [2]国家儿童医学中心、首都医科大学附属北京儿童医院临床研究中心,北京100045

出　　处：《临床误诊误治》2024年第15期1-4,共4页Clinical Misdiagnosis & Mistherapy

基　　金：北京市中医药科技发展基金重点项目(BJZYZD-2023-03);北京市中医药科技发展资金项目(BJZYQN-2023-40)。

摘　　要：目的探讨儿童血管内压力增高性紫癜误诊为过敏性紫癜的原因、鉴别要点及防范措施。方法回顾性分析2023年3月至2024年3月收治的误诊为过敏性紫癜的血管内压力增高性紫癜患儿38例的临床资料。结果38例患儿初诊时出现不同程度的双侧下肢或双足、踝部针尖大小皮疹,散在或密集分布,不高出皮肤,压之不褪色。8例患儿皮疹亦可见于头面部、双侧上肢及躯干部。既往诊断为过敏性紫癜,予相应治疗未见明显缓解,详细询问患儿病史,观察皮疹形态及分布特点,完善实验室检查排除其他血液系统及免疫系统疾病后诊断为血管内压力增高性紫癜,予停药观察,随访24周。38例患儿中27例皮疹复发,未予药物干预自行消退。误诊时间为2~28周。全部病例均未出现肾脏损害。结论血管内压力增高性紫癜临床表现不典型,无特异性检查指标,易被误诊。临床需加强病史询问、皮疹形态的鉴别诊断,及时完善相关检查,减少误诊。Objective To investigate the causes,differentiation points and preventive measures of misdiagnosis of purpura due to raised intravascular pressure as Henoch-Sch nlein purpura(HSP)in children.Methods The clinical data of 38 children with purpura due to raised intravascular pressure who were misdiagnosed with HSP from March 2023 to March 2024 were retrospectively analyzed.Results All 38 children presented with different degrees of needle sized rashes on both lower limbs,feet,and ankles during initial diagnosis,scattered or densely distributed,which did not exceed the skin surface nor fade when pressed.In 8 children,rashes were also found on the head and face,both upper limbs and trunk.The previous diagnosis was HSP,but no significant relief was found after corresponding treatment.The patient's medical history was inquired in detail,and the shape and distribution characteristics of the rash were observed.After completing laboratory examination to exclude other diseases of the blood system and immune system,the diagnosis of purpura due to raised intravascular pressure was made,and the drug was discontinued for observation and followed up for 24 weeks.The rashes recurred in 27 of 38 patients and resolved spontaneously without medical intervention.Misdiagnosis lasted 2-28 w.No kidney damage was found in all patients.Conclusion The clinical manifestations of purpura due to raised intravascular pressure are not typical,and there is no specific examination index,which often leads to misdiagnosis.Clinical inquiry about medical history and differential diagnosis of rash morphology should be strengthened,and relevant examinations should be performed in time to reduce misdiagnosis.

关 键 词：血管内压力增高性紫癜 误诊 紫癜 过敏性 疹 抗组蛋白抗体 抗双链DNA抗体 抗核抗体 儿童 

分 类 号：R554.6[医药卫生—血液循环系统疾病]