过敏性紫癜

过敏性紫癜又称亨诺 -许兰氏紫癜 ( Henoch- Sch o·· nleinpurpura) ,为一种侵犯细小动脉及毛细血管的过敏性血管炎 ,多见于儿童及青少年 ,主要表现为可触及的紫癜 ,胃肠道、关节及肾脏病变。本病多为良性及自限性 ,肾脏受累的程度决定预后。约 5 0 %的病例会复发 ,尤其在最初的 3个月内。1　病因及发病机理该病病因尚不清楚。链球菌感染、病毒感染、药物、食物等可能与发病有关。由上述物质作为变应原而引发的速发型和免疫复合物型变态反应可能是造成一系列组织免疫损伤的主要原因。2　临床表现该病多发于春秋季节 ,好发年龄 3～ 17岁 ,…     

过敏性紫癜的诊断与治疗

过敏性紫癜(anaphylactoid purpura)又称亨一舒综合征(HSP)，是儿童时期最常见的血管炎之一。以非血小板减少性紫癜、关节炎、腹痛、胃肠道出血及肾炎为主要临床表现。     

过敏性紫癜肾炎的诊断及治疗

过敏性紫癜肾炎的诊断及治疗南京金陵医院解放军肾脏病研究所尹广，黎磊石过敏性紫癜是一种与免疫异常有关的系统性小血管炎性疾病，临床上以皮肤紫癜，出血性胃肠炎，关节炎及肾脏损害为特征。因１９３７年Ｓｃｈｏｎｌｅｉｎ首先描述皮肤紫癜及关节炎综合征，１９７４年...     

过敏性紫癜伴急性心肌损伤1例

患者男 ,15岁。既往身体健康 ,因 10日前患感冒 ,自服克感敏、板兰根、感冒清等药 ,症状缓解。后无意发现双下肢皮肤散在分布的瘀点、瘀斑 ,大小不等 ,呈紫红色 ,瘀点先出现于双侧小腿 ,逐渐向上蔓延至大腿 ,成批出现。 2 7ｄ前 ,患者自觉双上肢浮肿 ,逐渐加重 ,并出现胸痛 ,疼痛尖锐 ,持续不缓解 ,阵发性加剧 ,急入院门诊 ,诊断为“过敏性紫癜”。心电图示 :心率 67次 ｍｉｎ ,Ｐ -Ｒ间期 0 13ｓ,ＱＲＳ 0 0 8ｓ,Ｑ -Ｔ间期 0 46ｓ ,ＳＴ段Ｖ1～ 5呈弓背型抬高 0 2 5～ 0 45ｍＶ ,Ｖ6 呈上斜型抬高 0 4ｍＶ ,ＴＶ1～ 6 、ａＶＬ倒置…     

藻酸双酯钠治疗小儿过敏性紫癜30例疗效观察

过敏性紫癜 ( AP)是一种主要侵犯毛细血管的变态反应性疾病 ,其基本病变是弥漫性血管炎、严重时可发生坏死性小动脉炎 ,血管壁通透性增加 ,导致皮肤粘膜和内脏器官出血及水肿。2 0 0 0～ 2 0 0 2年 ,我们采用藻酸双酯钠 ( PSS)治疗 AP患儿 30例 ,并对其临床效果、肾损害及血液粘度改变、药物副作用等进行观察。现报告如下。1　资料与方法1 .1　临床资料　本文 60例 AP患儿 ,均符合《儿科学》第五版中的诊断标准 [1]。男 2 8例 ,女 32例 ;年龄 4～1 2岁 ;病程 2～ 1 0天。患儿除有典型的皮肤紫癜外 ,伴有关节症状 2 2例 ,消化道症状 1 9…     

256例过敏性紫癜患者临床分析

目的探讨过敏性紫癜的病因、临床表现及治疗。方法对256例过敏性紫癜住院患者的临床资料进行回顾性分析。结果冬春季节发病174例（67．97％）,夏秋季节发病82例（32．03％）;发病前有上呼吸道感染史179例（69．92％）;38例成人腹型患者行幽门螺旋杆菌检查（^14C呼气试验）,26例结果异常,其中22例有不同程度的腹部症状。结论该病好发于冬春季节,上呼吸道感染是发病的主要病因,与成人过敏性紫癜患者相比,儿童更易出现消化道受累。而成人腹型过敏性紫癜患者,幽门螺旋杆菌感染作为病因之一应予重视。对于腹型过敏性紫癜患者,应早期、足量给予糖皮质激素治疗。     

过敏性紫癜患者结肠粘膜的改变

我院 1987～ 1998年共收治过敏性紫癜 30例,其中并发结肠粘膜病变 16例,现报告如 下。 1.对象和方法： 30例过敏性紫癜患者,男 23例,女 7例,年龄 15～ 66岁,其中 15 ～ 20岁 17例, 21～ 30岁 6例, 30～ 40岁 4例, 40岁以上 3例。发病季节： 2～ 4月 11例 (36.6％ ), 5～ 7月 7例 (23.3％ ), 8～ 10月 5例 (16.6％ ), 12～ 1月 7例 ( 23.3％ )。诱因：有诱因可查者 17例 (56.6％ ),其中与各种感染有关者 8例 (26.6％ ) ,与药物有关者 4例 (13.3％ ),与食物有关者 5例 (16.6％ )。 2.临床表现：实验室检查：血小板计数 21例, …     

幽门螺杆菌相关过敏性紫癜

自 198 2年Warren和Marshall成功地从胃粘膜分离出幽门螺杆菌 (helicobacterpylori,以下简作Hp)以来 ,随着研究的不断深入 ,目前已确定该菌与慢性胃炎、消化性溃疡、胃癌、粘膜相关淋巴样组织淋巴瘤密切相关 ,1994年WHO将其列为第一类生物致癌因子。近年来 ,研究已涉及Hp与胃肠外疾病的关系 ,包括 :冠状动脉粥样硬化性心脏病、高血压、脑血管病、偏头痛、原发雷诺现象、干燥综合征、自身免疫性血小板减少性紫癜、过敏性紫癜、自身免疫性甲状腺炎、糖尿病、慢性荨麻疹、酒糟鼻等[1] 。本文将专题报告幽门螺杆菌相关过敏性紫癜。幽门螺杆菌…     

西米替丁治疗儿童过敏性紫癜70例疗效观察

过敏性紫癜是由于某些过敏因素引起的变态反应性疾病 ,在儿科较为常见。 1995～ 2 0 0 0年 ,我们收治过敏性紫癜患儿 140例 ,对其中 70例采用西米替丁治疗 ,效果满意 ,现报告如下。资料与方法 :本文观察对象为 140例过敏性紫癜患儿 ,其中男 82例 ,女 5 8例 ,年龄 3～ 14岁 ,平均 8.4岁。紫癜为单纯皮肤型 37例 ,腹型 2 8例 ,关节型 2 4例 ,肾型 16例 ,混合型 35例。外周血常规检查 ,血小板计数及出、凝血时间均正常 ;白细胞增高 5 2例。轻度贫血 2 1例 ,均排除其它原因引起的出血性疾病。心电图检查异常 31例 ,主要为窦性心动过速、窦性心律…     

中西医结合治疗小儿过敏性紫癜105例

1994年 5月～ 2 0 0 1年 2月 ,我们采用中西医结合疗法治疗 5 5例小儿过敏性紫癜 ,取得满意疗效。现报告如下。一般资料 :同期收治 10 5例过敏性紫癜患儿 ,随机分为两组 :1治疗组 :5 5例。其中男 35例 ,女 2 0例 ;年龄 3～ 13岁 ,平均 6 .9岁 ;腹型 2 5例、关节型 14例 ,肾型 16例。中医分型 :风热型 34例、湿毒型 2 1例。 2对照组 :5 0例。其中男 30例 ,女2 0例 ;年龄 3～ 12岁 ;关节型 18例 ,肾型 12例 ,腹型 2 0例。两组患儿按《儿科学》第 4版过敏性紫癜诊断标准确诊。治疗方法 :对照组采用以下治疗 :1用激素地塞米松 ,缓解后改为强的松…     

儿童过敏性紫癜56例临床分析

目的 探讨儿童过敏性紫癜的临床特点,提高该病的诊断和治疗水平.方法 回顾性分析56例过敏性紫癜住院患儿的临床资料,并予以统计分析.结果 5～12岁儿童是过敏紫癜的高发群体,男多于女.秋冬季是其高发季节.以双下肢、臀部皮肤紫癜为首发症状的达45例,占80.4％;以消化道症状为首发者9例,占16.1％;以关节为首发症状的1例,占1.8％;以肾脏表现为首发症状的1例,占1.8％.结论过敏性紫癜临床表现多样,皮肤型紫癜较为多见,腹型、关节型、肾型过敏性紫癜较少见,且首发症状常因缺乏皮肤紫癜表现而易造成误诊,值得临床关注.     

86例腹型过敏性紫癜的临床及内镜特点分析

目的观察成人腹型过敏性紫癜的临床及内镜特点,以提高对腹型过敏性紫癜的认识。方法1995年1月～2004年7月在我院住院的腹型过敏型紫癜患者86例,其中有52例患者行胃镜检查,20例患者行肠镜检查。结果临床表现排在前3位的分别是腹痛(76例)、便血(53例)和腹泻(11例)。内镜下胃肠黏膜成不同程度充血、水肿、点状出血和瘀斑,重者形成糜烂或多发溃疡。胃镜检查发现十二指肠降段病变出现率最高,病变最严重。肠镜检查以直肠病变出现率最高,末段回肠病变最严重。结论腹型过敏性紫癜虽表现多种多样,但仍有一定的规律可循。     

Nine years of cascade filtration for thrombotic thrombocytopenic purpura

Thrombotic thrombocytopenic purpura (TTP) continues to attract physicians' attention because of its unpredictable course and underlying pathogenetic mechanisms. It is also attractive because of its optimal response to therapeutic plasma exchange (PE) even in the most severe cases. The usual approach to its treatment is conventional PE with plasma substitution and only recently fresh frozen plasma (FFP) has been substituted by cryodepleted or virally inactivated plasma with clinical results that are, if not better, at least comparable with the ones attained when FFP is employed. Nonetheless, no consensus exists regarding the optimal PE fluid and this is not of marginal interest as even after PE treatment mortality is still from 15 to 20%. On the contrary, some consensus exists on the pathogenetic relevance of the exceedingly large Von Willebrand (vWF) multimers whose presence parallels the clinical course and appears to be determined by the abnormalities in the production or function and survival of vWF-cleaving proteases which is auto-antibody mediated. In both cases plasmapheresis without plasma infusion is relatively ineffective, perhaps because it does not increase protease activity. Paradoxically, cascade filtration (CF) can produce the same favorable results without replacing any protease activity. As with CF, the replacement is the autologous plasma with approximately 20% levels of vWF, fibrinogen, fibronectin, IgM and circulating immune complexes and 75% of albumin, IgGs, AT III and proteins whose molecular weight exceeds 250-300000 Da. Our experience with CF for TTP began in 1994. Since then, 16 patients have undergone CF combined with decreasing amounts of FFP supplementation and since 1998 without any allogeneic FFP supplementation in 9 cases. Twenty-four patients (96%) treated with no or minimal amounts of FFP survived but four (16%) experienced from one to four recurrences associated with cutaneous, paradental, cholecystic and vaginal infections. Only one patient died (5%) after the second CF procedure. There were no untoward effects related to the procedure itself and up to 18 procedures in one patient were carried out over 16 months, 10 with the patient in her sixth month of pregnancy and four in the post partum period in preparation for a splenectomy. Remission was achieved after an average number of treatments (10.7 +/- 6.8); a result that compares favorably with those of our historical control group of 47 cases (14 +/- 13). The patient's exposure to allogenic plasma which was 10.8 +/- 4.6 plasma U/session was reduced to 0 in 10 patients, to 1.4 +/- 1.2 and 4.4 +/- 2.3 plasma U/session, respectively, for seven and nine patients receiving PE + CF and CF with same plasma supplementation as described in our previous article. Based on our experience, we believe CF is presently the optimal treatment for patients with classic, sporadic TTP.     

缺血性结肠炎9例

缺血性结肠炎是由于胸壁血液灌注不良所致结肠缺血性疾病。是一种少见病。该病无特异性诊断 ,早期不易鉴别 ,常延误诊断或误诊 ,失去内科保守治疗时机。待发生明显腹膜炎时结肠已广泛性坏死 ,失去手术时机 ,死亡率较高。我科自1985年以来共收治 9例 ,经肠镜病理或手术病理证实。报道如下。临床资料本组病例男 6例 ,女 3例 ,年龄 2 8-70岁 ,平均 6 0 8岁 ,5 0岁以上者 7例 (78% )。全部病例发病前二周均未使用抗生素。9例均急性起病、腹痛 9例、血性腹泻 7例、腹胀 2例、恶心呕吐2例、发热 1例 ,体温 37 5℃ -38℃。其中伴随冠心病 3例、糖…     

Two siblings with allergic purpura following Salmonella O9 enterocolitis

Two siblings with allergic purpura after Salmonella O9 infection were reported. A girl (patient 1) aged 4 years and 4 months started to have knee joint pain and abdominal pain followed by purpura of the lower extremities and was referred to us for treatment of allergic purpura. She had contracted enterocolitis one month before visiting our hospital and Salmonella enteritidis was identified. During the course of the illness she had nephritis associated with allergic purpura. However, she made a favorable progress and proteinuria and hematuria disappeared within 6 months. A boy (an elder brother of patient 1) aged 6 years was admitted to our hospital because of the allergic purpura. He similarly had contracted Salmonella enterocolitis. He had severe gastro-intestinal symptoms including abdominal pain, vomiting and bloody stool, which rapidly subsided after initiation of treatment with intravenous hyperalimentation combined with prednisolone. It is possible that allergic purpura in our patients was closely associated with Salmonella enteritidis infection. Further accumulation of cases is a requisite to clarify an association of Salmonella enteritidis infection with allergic purpura and pathogenesis of allergic purpura.     

心电图评价小儿过敏性紫癜合并的心肌损害

目的探究心电图在不同类型小儿过敏性紫癜合并心肌损害的评估、疗效、转归中的指导价值。方法回顾性分析本院82例已确诊过敏性紫癜合并心肌损害患儿的临床资料,住院当日全部行常规12导联心电图检查,以后每周查1次心电图,动态观察心电图变化。结果 82例过敏性紫癜合并心肌损害患儿中63例（76.82%）有心电图改变,63例患儿中混合型紫癜47例（74.60%）,单纯型紫癜5例（7.94%）,其他类型11例（17.46%）;心电图改变呈多样性、易变性;全病程均可出现;心电图改变多数随原发病主要症状消失后1～3w恢复正常,混合型重症病例心电图恢复期需3w以上。混合型紫癜的心电图改变多为2项以上。混合型紫癜心电图改变较重,恢复时间长。结论心电图改变对过敏性紫癜患儿合并心肌损害的评估、疗效、转归具有重要临床意义。     

Two cases of lupus cystitis with no bladder irritation symptoms

Lupus cystitis is a rare manifestation in systemic lupus erythematosus (SLE); it usually occurs in association with gastrointestinal manifestations. We report two cases of lupus cystitis without bladder irritation symptoms. Both cases developed severe abdominal pain, nausea, and diarrhea and showed no bladder irritation symptoms. The diagnosis of lupus cystitis was made by abdominal ultrasonography and bladder biopsy. The patients were treated with intravenous methylprednisolone pulse therapy followed by oral prednisolone. Their symptoms were ameliorated, and hydroureteronephrosis improved. Thus, when a patient with SLE shows gastrointestinal symptoms, further examinations are required to determine whether the patient has lupus cystitis.