24例腹型过敏性紫癜的临床?内镜及病理学特征分析

目的:探讨腹型过敏性紫癜的临床、内镜及病理学特征,为该病的早期诊断提供依据。方法:回顾性分析2005年6月～2012年6月南京医科大学第一附属医院收治的24例腹型过敏性紫癜患者的临床资料。结果:24例腹型过敏性紫癜患者常见的消化道症状依次为腹痛(95.8%)、消化道出血(87.5%)、恶心呕吐(37.5%)和腹泻(8.3%)。14例患者紫癜样皮疹晚于消化道症状1～30 d,平均(13.7±9.8)d出现。24例患者中19例行内镜检查,73.7%(14/19)患者见十二指肠受累,其余依次为胃31.6%(6/19)、回肠31.6%(6/19)、空肠26.3%(5/19)、食管10.5%(2/19)、结直肠10.5%(2/19)。内镜下病变主要表现为黏膜弥漫性充血水肿;出血点;黏膜下出血及血肿;点片状糜烂;多发形状不规则溃疡,沿皱襞环行分布;结节样改变。内镜活检病理主要表现为:消化道黏膜及黏膜下层见大量中性粒细胞和淋巴细胞浸润,黏膜固有层见红细胞渗出,并可见溃疡形成。仅1例出现毛细血管炎症性改变,血管壁可见灶性坏死。结论:腹型过敏性紫癜患者的紫癜样皮疹晚于消化道症状出现较为多见,为早期诊断带来困难。典型的临床特征及内镜表现对早期诊断治疗有一定帮助。

Clinical manifestation,endoscopic and histological features of abdominal type Henoch-Schonlein purpura

Objective:To analyze the gastrointestinal manifestation of abdominal type Henoch-Schonlein purpura (HSP),including clinical,endoscopic and histological features. Methods:There were 24 patients with a final diagnosis of abdominal type HSP admitted to our hospital from June 2005 to June 2012. Their medical records,including clinical presentation,laboratory data,endoscopy and pathology reports,were reviewed retrospectively. Results:The common gastrointestinal symptoms of HSP were abdominal pain (95.8%),gastrointestinal bleeding (87.5%),nausea and vomiting (37.5%)and diarrhea (8.3%). In the cases of 14 patients the skin eruptions occurred after the onset of abdominal symptom from 1 to 30 (mean 13.7 ± 9.8) days. There were 19 of 24 patients underwent endoscopy. Duodenal lesions were found in 14(73.7%) patients,followed by stomach lesions in 6(31.6%),ileum lesions in 6(31.6%),jejunum lesions in 5(26.3%),esophagus lesions in 2(10.5%) and colorectal lesions in 2(10.5%). The endoscopic lesions included mucosal diffuse hyperemia edema,bleeding spots,submucosal hemorrhage and hematoma,erosion,multiple irregular ulcers and nodular changes. Histological manifestations showed swollen vascular endothelial cells of capillary vessels,nonspecific inflammation with infiltration of neutrophil and lymphocytes. Typical vasculitis was found in one case. Conclusion:The skin eruptions may occur after the onset of abdominal symptom,which results from the difficulty of early diagnosis of abdominal type HSP. Typical clinical manifestations and endoscopic features can be helpful in the early diagnosis of abdominal type HSP.