以胰腺损害为首发表现的成人过敏性紫癜临床分析

摘要

目的：分析以胰腺损害为首发表现的成人过敏性紫癜的临床特征，以提高对此病的认识。方法回顾性分析以胰腺损害为首发表现的成人过敏性紫癜5例患者的临床表现、实验室检查、影像学检查、内镜表现、治疗与转归。结果5例患者均以胰腺损害为首发及突出表现(腹痛及血淀粉酶升高)，分别于起病后2-12 d就诊，腹痛部位多变，腹部体征较症状轻，多合并消化道出血，皮肤紫癜、瘀斑于腹痛后5-13 d出现。内镜检查可见十二指肠降部、回盲部和升结肠黏膜损害最严重，单纯给予质子泵抑制剂、奥曲肽或生长抑素、解痉剂等治疗效果不佳，糖皮质激素治疗有效。结论以胰腺损害为首发表现的成人过敏性紫癜临床表现无特异性，易造成误诊，应仔细询问病史、密切观察皮肤有无紫癜、结合实验室检查、内镜及腹部CT检查，及时进行早期诊断和治疗。%Objective To summarize the clinical characteristics of Henoch-Schönlein purpura in adult patients with pancreatic gland damage as the initial clinic presentation,and to raise the awareness of disease. Methods From December 2003 to December 2012, five adult Henoch-Schönlein purpura patients with pancreatic gland damage as the initial clinic presentation were enrolled in this study. The clinical data were retrospectively analyzed,including clinic presentation, laboratory tests, imaging tests, endoscopic performance, treatment and prognosis of this disease. Results Pancreatic gland damage was the first and outstanding performance in five patients ( abdominal pain,blood amylase elevating) . The patients saw doctor in 2-12 d after the onset of ill. Severe abdominal pain in indefinite sites and mild abdominal signs were the important characteristic feature. Some patients complicated gastrointestinal bleeding. Skin pur-pura and petechiae appeared in 5-13 d after abdominal pain. Glucocorticoid was effective. Conclusion The adult Henoch-Schönlein purpura patients with pancreatic gland damage as the initial clinic presentation have no specificity, and are easy to be misdiagnosed. It is neccessary to ask careful history, observe the skin closely,combine the test results,and give early diagnosis and timely treatment.