以腹痛为首发症状儿童过敏性紫癜临床及胃镜分析.docVIP

以腹痛为首发症状儿童过敏性紫癜临床及胃镜分析 　【摘要】 目的：探讨以腹痛为首发症状的儿童过敏性紫癜的临床表现及其胃镜下改变。方法：对119例以腹痛为首发症状的过敏性紫癜患儿的临床资料进行回顾性分析。结果：本组病例均以腹痛为首发症状，胃肠道症状表现多样，腹部查体无固定的压痛点及明显的腹肌紧张，腹痛的严重程度与腹部体征不一致，皮肤紫癜平均于腹痛后（5.7±2.3）d出现。胃镜检查14例，见胃肠粘膜表现为充血、水肿、出血糜烂或溃疡，食管粘膜无异常改变。结论：过敏性紫癜可以腹痛为首发症状，临床症状程度与胃肠粘膜病变程度密切相关，胃镜检查在儿童过敏性紫癜中具有诊断和治疗的参考意义。 【关键词】 儿童；过敏性紫癜；腹痛；胃镜检查 ［Abstract］ Objective:To investigate the clinical symptoms of HenochSchonlein Purpura (HSP) in children with bellyache as its first symptom and its changes under gastroscopy. Methods:A retrospective analysis was performed on the clinic data of 119 cases of HSP with bellyache as their first symptom. Results:Abdominal pain was the first appearance of those cases and the appearance of the gastrointestinal tract are multiplicity, there is no fixed tenderness point and obvious abdominal muscle intension, the degree of bellyache is disagree with the sign. The purpura of skin appeared (5.7±2.3)d after bellyache appeared. We can see congestion, hydroncus, bleeding or anabrosis in gastrointestinal tract mucosa but nothing in esophagus mucosa of the 14 patients from the gastroscope appearance. Conclusions:Abdominal pain may be the first appearance of HSP and its degree is parallel with the change of gastrointestinal tract mucosa. Gastroscopy is important in diagnosis and treatment of childrens allergic purpura. ［Key words］ Children; Anaphylactoid Purpura; Abdominal pain; Gastroscopy 过敏性紫癜是儿童较常见的血管变态反应性疾病，皮肤紫癜是最常见的临床表现，关节、胃肠道和肾脏也常受累，以腹痛为首发症状者由于皮疹出现延迟，不易早期确诊。为提高对本型过敏性紫癜的认识，我们对2006年1月至2007年9月在重庆医科大学附属儿童医院肾内科住院的119例以腹痛为首发症状的过敏性紫癜患儿的临床资料及胃镜检查结果进行回顾性分析，现报告如下。 1 临床资料 1.1 一般资料 119例中男72例，女47例，年龄2.1岁～14.5岁，平均年龄6.9岁，秋冬发病63例，春夏发病56例。 1.2 诱发因素 有明确或可能诱发因素49例（41.18 %），其中呼吸道感染36例，皮肤感染1例，药物过敏1例，进食特殊食物（鱼、虾、蟹、冷饮、牛奶）6例，肠蛔虫4例，接种乙肝疫苗1例。 1.3 临床表现 119例均以腹痛为主诉，表现为持续性钝痛38例（31.93%），发作性疼痛81例（68.07%）；恶心呕吐63例（52.94%），血便49例（41.18%），呕咖啡样物或血丝6例（5.04%），腹泻5例（4.20%），腹部压痛57例（47.90%），均无明显反跳痛、肌紧张及固定压痛点；29例伴有关节肿痛；37例尿常规异常。并发肠套叠4例、肠梗阻2例，失血性休克2例。118例于腹痛后0.5～20 d［平均（5.7±2.3）d］相继出现皮肤紫癜，1例全病程中未见皮疹为疑诊