以消化道出血为首发症状的过敏性紫癜临床诊治分析

摘要

Objective To analyse the clinical features,diagnosis and treatment of anaphylactoid purpura(AP)with gastrointestinal bleeding(GIB)as the first symptom. Methods The clinical data(including history,clinical manifestations, endoscopic characteristics and treatments)of 23 AP patients with GIB as the first symptom from January 2008 to December 2012 were analyzed retrospectively. Results All patients had GIB combined with abdominal pains,the sites of which were non - spe-cific. Skin purpura was seen within 2 ~ 18 d after onset. Endoscopic examinations showed mucosal congestion,edema and ex-tensive bleeding points or ulcers. Glucocorticoid treatment was effective. Conclusion Skin purpura is a major clinical diagnosis basis for AP patients. For those presenting with skin purpura following GIB may be diagnosed as AP. AP is commonly accompa-nied by severe abdominal pains inconsistent with abdominal signs,the sites were changeable. Endoscopy shows extensive bleed-ing points and flake - like multiple ulcer characteristic changes. Early full dosage of glucocorticoid makes a good prognosis.%目的：分析以消化道出血为首发症状的过敏性紫癜的临床特点、诊断及其治疗。方法回顾性分析华山医院及华山医院宝山分院2008年1月-2012年12月确诊的23例以消化道出血为首发症状的过敏性紫癜住院患者的病历资料，对其病史、临床表现、内镜特点、治疗进行分析。结果23例患者均有消化道出血表现，均伴有腹痛，腹痛部位非特异性，发病后2~18 d 内可见皮肤紫癜，内镜检查可见胃肠黏膜充血、水肿，有广泛出血点或溃疡，糖皮质激素治疗有效。结论过敏性紫癜患者以皮肤紫癜为重要临床诊断依据，对于以消化道出血为首发症状随后出现皮肤紫癜的患者应考虑过敏性紫癜的可能；过敏性紫癜常伴有与腹部体征不符的剧烈腹痛，疼痛部位多变，内镜下可见广泛出血点及雪花状多发溃疡的特征性改变，糖皮质激素需早期足量应用，预后多良好。