以腹型为首发表现的儿童过敏性紫癜临床分析

目的了解以腹部症状为首发表现的儿童过敏性紫癜(HSP)临床特征,并探讨胃镜和全腹计算机断层扫描(CT)对其早期诊断价值。方法选取2017-09-01—2019-08-31就诊于中国医科大学附属盛京医院小儿消化内科以腹痛等消化道表现为首发症状的腹型HSP住院患儿169例为观察组,以皮疹为首发症状142例为对照组,对临床资料进行回顾性分析。结果两组HSP患儿性别、年龄与好发季节差异无统计学意义(P>0.05);观察组有前驱感染史和(或)病原学阳性者、ASO升高发生率低于对照组(P<0.05);观察组患儿中有33例(19.53%)无皮疹;两组间消化道出血发生率差异无统计学意义(P>0.05);观察组白细胞计数、C反应蛋白、血小板计数、D-二聚体水平较对照组升高(P<0.05),而白蛋白、IgA、补体C3水平较低(P<0.05);但两组间降钙素原水平、过敏原特异性IgE阳性率和总IgE水平差异均无统计学意义(P>0.05);两组间尿蛋白和红细胞升高率差异无统计学意义(P>0.05);观察组便潜血阳性率较高(P<0.05);腹腔三维超声及全腹CT对腹型HSP阳性检出率差异有统计学意义(P<0.05),而胃镜和全腹CT阳性检出率差异无统计学意义(P>0.05);两组对激素敏感度、紫癜肾炎发生率差异无统计学意义(P>0.05),但观察组复发率更高(P<0.05)。结论部分以腹痛为首发表现的HSP患儿可不出现皮疹,其白细胞计数、C反应蛋白、血小板计数、D-二聚体水平、便潜血阳性率、低白蛋白血症发生率较以皮疹为首发表现的HSP患儿升高。全腹CT和胃镜对腹型HSP的早期诊断有重要价值。以腹痛和皮疹为首发表现的HSP患儿激素敏感度、紫癜肾炎发生率差异无统计学意义,但以腹痛为首发表现的HSP患儿更易复发。

Clinical analysis of Henoch-Schonlein purpura in children with abdominal symptoms as the first manifestation

Objective To investigate the clinical features of Henoch-Schonlein purpura(HSP)with abdominal symptoms as the first manifestation,and to explore the value of gastroscopy and abdominal CT in its early diagnosis.Methods 169 hospitalized children with HSP with abdominal pain as the first manifestation were selected as the observation group.142 patients with rash as the first symptom were selected as the control group.The clinical data were analyzed.Results The observation group had a lower incidence of prodromal infection and/or positive etiology(P<0.05),33 cases showed no rash(19.53%).More children in observation group experienced vomiting(P<0.05).The white blood cell count,CRP,platelet count,D-dimer and fecal occult blood positive rate were higher in observation group(P<0.05),but Albumin,IgA and C3 were lower(P<0.05).There was no significant difference in gastrointestinal bleeding,procalcitonin,specific allergen positivity rate,immunoglobulin E,urine protein and erythrocyte elevation(P>0.05).There was no difference in positive detection rate between gastroscopy and abdominal CT(P>0.05).There was no difference in hormone sensitivity and the incidence of purpura nephritis between two groups(P>0.05),but recurrence rate was higher in observation group(P<0.05).Conclusion Children with HSP with abdominal pain as the first manifestation are more prone to vomiting,and some children may not have rashes.Their white blood cell count,CRP,platelet count,D-dimer level,positive rate of fecal occult blood,the incidence of hypoalbuminemia and recurrence were higher.There was no significant difference in the positive detection rate of gastroscopy and abdominal CT.