儿童过敏性紫癜57例临床剖析.docVIP

儿童过敏性紫癜57例临床剖析 　　doi：10.3969/j.issn.1007-614x.2014.17.16 　　摘要目的：探讨儿童过敏性紫癜（HSP）的临床特点，提高诊治水平，减少误诊误治。方法：对2008年1月-2014年1月收治57例HSP患儿的发病季节、诱因、临床表现、辅助检查结果及预后等方面进行回顾性分析。结果：57例儿童过敏性紫癜中发病平均（6.5±1.2）岁，一年四季均有发病，以秋冬季节发病居多。85.96%的患儿起病前有明确诱因，其中78.94%的患儿发病前1～4周内有明确的呼吸道感染或胃肠道感染、泌尿系感染史。临床表现以皮肤紫癜为首发症状28例，以关节症状为首发10例，以腹部症状为首发19例。误诊8例，以腹部症状为首发症状。57例HSP患儿中D-二聚体升高31例，阳性率54.4%；血小板升高34例，异常率59.65%，显示HSP患儿体内存在高凝状态。57例患儿中发生肾损害5例（8.77%）。治疗后痊愈出院无复发52例，复发再住院1次3例，复发再住院2次2例。结论：儿童过敏性紫癜发病诱因仍是以感染为第1位。以腹痛为首发症状时，易导致误诊。本病一般预后良好，肾脏损害程度是影响HSP病程和预后的关键因素。 　　关键词儿童过敏性紫癜临床表现肾损害 　　Clinical analysis of 57 children with allergic purpura 　　Huang Shaoling，Yu Bo 　　Department of Pediatrics，the First People’s Hospital of Nanning City Affiliated to Guangxi Medical University（Nanning City， Guangxi），530022 　　AbstractObjective：To investigate the clinical features of children’s henoch schonlein purpura（HSP），in order to improve the level of diagnosis and treatment，to reduce the misdiagnosis and mistreatment.Methods：57 children with HSP were selected from January 2008 to January 2014.Retrospective analyze the season of incidence，causes，clinical manifestation，auxiliary examination results and prognosis.Results：The average age of 57 cases with allergic purpura was 6.5±1.2 years old.This disease occurs throughout the year，and higher in autumn and winter.85.96% cases had definite causes before the onset of the disease，and 78.94% of them had clear respiratory，gastrointestinal or urinary system infection in 1～4 weeks before.Clinical manifestation：28 cases with skin purpura as initial symptoms，10 cases with joint symptoms as initial symptoms，19 cases with abdominal symptoms as initial symptoms.8 cases with abdominal symptom as initial symptoms were misdiagnosed.D-two dimer increased in 31 cases among 57 children with HSP，and the positive rate was 54.4%.34 cases with thrombocytosis，and the abnormal rate was 59.65%， which showed that hypercoagulable state presence in children with HSP.5 cases with renal damage in 57 cases（8.77