过敏性紫癜患者胃和十二指肠黏膜病变的观察

目的:观察过敏性紫癜患者胃和十二指肠黏膜的改变,探讨其与临床症状之间的关系。方法:对18例过敏性紫癜患者进行纤维胃镜检查、幽门螺杆菌(Hp)检测及胃和十二指肠病变黏膜组织病理学检查。结果:18例患者均有胃、十二指肠黏膜改变,1例食管受累。损害主要表现为黏膜呈花斑样充血、水肿及点状糜烂和多发性溃疡,且伴有胃肠道症状者的胃肠道黏膜病变程度更严重,但与皮损严重程度无关。15例患者Hp检测阳性。胃黏膜组织病理学改变为毛细血管和细小血管内皮细胞肿胀,血管壁纤维蛋白性坏死、出血、管腔缩小,血管周围大量淋巴细胞、中性粒细胞浸润,可见核碎裂。结论:临床各型过敏性紫癜均可出现胃和十二指肠黏膜改变,其严重程度与胃肠道症状密切相关,与皮损的严重程度无关;纤维胃镜及组织病理学检查有助于过敏性紫癜的早期诊断。

The mucosa manifestations of stomach and duodenum in the patients with Henoch-Schonlein purpura

Objective: To investigate the intra-abdominal manifestations of Henoch-Schonlein purpura and the relationship to its clinical symptoms. Methods: Fibre gastroscope, Helicobacter pylori (Hp) detection and biopsy were employed for 18 patients with Henoch-Schonlein purpura. Results: The gastric and duodenal mucosa were involved in all 18 patients and the esophagus was affected in one patient. The changes of mucosa were petechial hemorrhage erosions and multiple ulcers which were more serious in patients with abdominal pain than those without abdominal symptom. 85% patients (15/18) were positive of Hp. Histological manifestations showed swelled vascular endothelial cells of capillary vessels and small blood vessels, fibrotic necrosis of small vessels and bleeding, diffused perivascular lymphocytic and neutrophilic infiltration and nuclear debris in mucosa and submucosa. Conclusions: The involvment of gastrointestinal mucosa may be found in any clinical types of Henoch-Schonlein purpura, which is correlated with the gastrointestinal symptoms but not to skin rash. Fibre gastroscope and the mucosal biopsy are useful for the early diagnosis of Henoch-Schonlein purpura.