成人过敏性紫癜（腹型）15例误诊原因分析

摘要

ObjectiveTo analysis of the reasons for misdiagnosis of adult with asabdominal type Henoch Schonlein purpura (HPS) which first performance of gastrointestinal symptoms. Methods 15 cases misdiagnosed adult HPS patients in our hospital were selected as the object of study, and they were retrospectively analyzed.Results15 patients had abdominal pain, 3 cases with nausea, 4 cases with vomiting, 4 cases with diarrhea, bloody stool in 3 cases, 1 cases of fever, 3 cases of joint pain, 1 cases of muscle soreness. With fecal occult blood positive in 6 cases, 7 cases with elevated WBC, proteinuria in 3 cases, 1 cases of hematuria, 1 cases with elevated serum amylase, CRP elevated in 6 cases, 2 cases of gastrointestinal endoscopy showed mucosal hyperemia and edema, visible erosion and ulcer. 15 patients respectively in skin purpura occured 3-10 days after admission, effective glucocorticoid treatment after diagnosis.ConclusionThe clinical manifestations of HPS in abdominal type is complicated, easy to be misdiagnosed, should ask detailed history, dynamic observe the changes in condition, supplemented by endoscopic examination can improve the diagnosis rate.%目的：分析成人以消化系统症状为首发表现的腹型过敏性紫癜（HPS）的误诊原因。方法选取我院15例误诊的成人腹型HPS作为研究对象，进行回顾性分析。结果15例患者均有腹痛，伴恶心3例、呕吐4例、腹泻4例、血便3例、发热1例、关节疼痛3例、肌肉酸痛1例。伴大便潜血阳性6例，WBC升高7例，蛋白尿3例、血尿1例，血清淀粉酶升高1例，CRP升高6例，2例胃肠镜检查均提示黏膜充血水肿，可见糜烂及溃疡。15例患者分别在入院后3~10d出现皮肤紫癜，确诊后糖皮质激素治疗有效。结论腹型HPS临床表现复杂多样，容易误诊，需详细询问病史，动态观察病情变化，辅以内镜检查可提高诊断率。