目的 探讨成人腹型过敏性紫癜的临床特点和误诊情况,提高对该疾病的认识.方法 收集湘雅医院2002年1月～2007年12月成人过敏性紫癜住院患者102例,根据有无消化道症状分为腹型组及非腹型组,回顾性分析比较两组患者的临床特点.结果 成人腹型过敏性紫癜患者临床表现为皮疹(100％)、腹痛(100％)、消化道出血(72.7％)、呕吐(37.9％)和腹泻(34.8％),内镜结果主要表现为黏膜充血、水肿、糜烂及溃疡,病变可有融合,以十二指肠和回肠末端病变最为明显.两组在发病季节、上呼吸道感染史、发病年龄、合并肾脏及关节损害、蛋白尿、血尿方面差异均无显著性,但腹型过敏性紫癜患者白细胞升高、C反应蛋白升高及清蛋白降低更为明显.成人腹型过敏性紫癜误诊率达54.5％.结论 腹型过敏性紫癜患者消化道症状重,而体征轻微,内镜下黏膜病变以十二指肠及回肠末端为甚.腹型过敏性紫癜患者白细胞升高、C反应蛋白升高及清蛋白降低较非腹型组更为明显.以腹部症状为首发表现的成人腹型过敏性紫癜患者极易误诊,需注意鉴别.%[Objective] To observe the clinical manifestations and misdiagnosis of anaphylactoid purpura abdominalis in adults in order to get better understanding of the disease. [Methods] 102 patients admitted into Xiangya Hospital as anaphylactoid purpura from January 2002 to December 2007, were divided into two groups by abdominal symptoms, the abdominal group and the non -abdominal group. Retrospective analysis was conducted upon clinical manifestations. [Results] For the abdominal group, main clinical symptoms included skin rash (100%), abdominal pain (100%), gastrointestinal hemorrhage (72.7%), vomitl 37.9% land diarrhea (34.8%). Endoscopy demonstrated the damages to the mucosa fluctuated from congestion, edema, petechia to erosion and multiple ulcers predominantly in the duodenum and the terminal ileum. There was no statistical difference in onset season, upper respiratory infection, onset age, arthralgia and renal involvement, hematuria, proteinuria between two groups. However, patients with abdominal symptoms had higher white blood cell counts, higher serum C-reactive protein and lower albumin levels than the non-abdominal group. 54.5% patients with anaphylactoid purpura abdominalis could be misdiagnosed. [Conclusions] Patients with anaphylactoid purpura abdominalis may have severe gastrointestinal symptoms,while relatively minor signs. Endoscopy shows the lesions predominantly in the duodenum and terminal ileum. The abdominal group has higher white blood cell counts, higher serum C-reactive protein, but lower albumin levels than the non -abdominal group. Anaphylactoid purpura abdominalis patients, especially those with abdominal symptoms as onset clinical manifestation have a high risk of misdiagnosis.
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