【摘要】 目的探讨成人腹型过敏性紫癜的临床表现和内镜特点,提高其诊断水平。方法回顾性分析我院1994年1月~2014年9月收治的98例成人腹型过敏性紫癜的临床、内镜及病理学资料,其中58例接受胃镜检查,54例接受肠镜检查。结果 1症状主要为腹痛98例(100%)、皮肤紫癜98例(100%)、消化道出血51例(52%),伴关节肿痛23例(23%)。2实验室检查主要为外周血白细胞增高(55例,56%),C反应蛋白升高(20例,20%),白蛋白降低(10例,10%)。20%(20/98)B超提示腹腔积液,100%(32/32)CT提示肠壁增厚。3 58例胃镜下主要表现:53例(91%)为略高出黏膜的点状出血和淤斑或成片状,39例(67%)糜烂或多发溃疡伴出血,7例(12%)颗粒状或结节状增生,7例(12%)弥漫性出血。病变在十二指肠降部出现率最高且最严重(39例,67%),其次为十二指肠球部(35例,60%)、胃(23例,40%)。病理组织学呈毛细血管炎表现12例(21%),3例(5%)伴幽门螺杆菌感染,其余均为黏膜慢性炎,无特异性表现。4 54例肠镜下主要表现:42例(78%)为略高出黏膜的点状出血和淤斑或成片状,16例(30%)糜烂或多发溃疡伴出血,9例(17%)弥漫性出血。病变在回肠末端出现率最高且最严重(38例,70%),其次为直肠(16例,30%)、盲肠(11例,20%)、乙状结肠(4例,7%)、全结肠(4例,7%)、回盲瓣(2例,4%)。组织病理学均为黏膜慢性炎,无特异性表现。结论十二指肠降部、回肠末端病变在成人过敏性紫癜常见,内镜检查对成人以腹痛为主要表现的过敏性紫癜有较高的诊断价值。更多还原

【Abstract】 Objective To discuss the clinical manifestations and endoscopic and pathological features of abdominal type Henoch-Schnlein purpura( HSP) in adults. Methods A retrospective review was made on the clinical,endoscopic,and pathological features of 98 adult patients with abdominal type HSP who had been hospitalized from January 1994 to September 2014.Results The common symptoms were abdominal pain( 98 cases,100%),skin purpura( 98 cases,100%),gastrointestinal hemorrhage( 51 cases,52%),and arthralgia and joint swelling( 23 cases,23%). The major laboratory findings were increased peripheral white blood cells( 55 cases,56%),elevated C reactive protein( 20 cases,20%),and low serum albumin( 10 cases,10%). Ultrasonography showed ascites in 20 cases( 20%). Intestinal wall thickening was seen in all of the 32 cases who underwent CT examinations. Gastroscopy performed in 58 patients demonstrated the damages to the mucosa,which varied from congestion,edema,petechia,and ecchymosis( 53 cases,91%) to erosion and multiple ulcers with hemorrhage( 39 cases,67%),granulation of mucosa( 7 cases,12%),and diffuse hemorrhage( 7 cases,12%). The gastroscopy showed that the most common and severe position involved was the descending duodenum( 39 cases,67%),followed by duodenal bulb( 35 cases,60%),and stomach( 23 cases,40%). Pathology showed 12 cases( 21%) of capillary inflammatory manifestations and 3 cases( 5%) of Helicobacter pylori infection.Colonoscopy performed in 54 patients demonstrated the damages to the mucosa,which varied from congestion,edema,petechia,and ecchymosis( 42 cases,78%) to erosion and multiple ulcers with hemorrhage( 16 cases,30%),and diffuse hemorrhage( 9 cases,17%). The colonscopy showed that the most common and severe position involved was the terminal ileum( 38 cases,70%),followed by the rectum( 16 cases,30%),cecum( 11 cases,20%),sigmoid colon( 4 cases,7%),total colon( 4 cases,7%),and ileocecal valve( 2 cases, 4%). Pathological results showed chronic inflammation without specific appearance.Conclusions Descending duodenum and terminal ileum lesions are the most common and severe position involved in adult HSP.Endoscopy is very useful for the diagnosis of adult HSP presenting with abdominal pain.更多还原