| 摘要: |
| 目的：探讨腹型过敏性紫癜（HSP）患者合并蛋白丢失性肠病（PLE）的临床特征，并比较其与白蛋白正常腹型过敏性紫癜间的差异。方法：选取电子科技大学医学院附属妇女儿童医院2015年1月至2020年2月收治的腹型过敏性紫癜合并蛋白丢失性肠病患者19例，利用1:1倾向性得分匹配同期住院诊断为腹型过敏性紫癜白蛋白正常的19例患者为对照组，采用病例对照研究方法分析两组患者的临床表现、生化指标、影像学检查、内镜改变和病理结果。结果：合并蛋白丢失性肠病患者共19例，男性10例，女性9例，男女比例为1.1︰1；平均发病年龄为（6.2±2.0）岁，主要临床表现为腹痛、皮疹，部分伴便血、呕吐、低蛋白水肿和关节肿胀；白细胞、中性粒细胞、C反应蛋白、血小板、中性粒细胞/淋巴细胞（NLR）明显升高，白蛋白和IgG降低，与对照组比较差异有统计学意义（P<0.05）；影像学改变多提示肠管壁增厚及腹腔积液；胃镜结果提示胃和十二指肠黏膜充血、水肿，部分出现糜烂、溃疡；病理改变主要提示黏膜上皮细胞肿胀，黏膜下血管扩张，血管壁坏死，间质水肿，血管周围炎症变化，中性粒细胞、淋巴细胞和嗜酸粒细胞浸润。住院时间较对照组长，差异有统计学意义（P<0.05）。结论：腹型过敏性紫癜合并蛋白丢失性肠病在腹型过敏性紫癜基础上，表现为白细胞、中性粒细胞、CRP、NLR等炎症指标明显升高，肠道黏膜损伤重，住院时间长，需采取积极有效的治疗措施。 |
| 关键词: 腹型过敏性紫癜 蛋白丢失性肠病 炎症反应 儿童 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2022.12.012 |
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| 基金项目: |
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| Clinical Analysis of Abdominal Henoch-Schönlein Purpura Complicated with Protein-Losing Enteropathy in Children |
| Jiang Maolin, Xiang Mei, Li Jing, Yuan Lan, Xie Xiaoli |
| (Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610091, China) |
| Abstract: |
| Objective: To probe into the clinical characteristics of abdominal Henoch-Schönlein purpura (HSP) complicated with protein-losing enteropathy (PLE) in children, and to compare the differences with the abdominal HSP with normal albumin. Methods: Nineteen children diagnosed with abdominal HSP complicated with PLE admitted into Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China from Jan. 2015 to Feb. 2020 were extracted. Nineteen children with abdominal HSP and normal albumin who were hospitalized during the same period were selected as the control group by 1∶1 propensity score matching. Case-control study method was performed to analyze the clinical manifestations, biochemical indicators, imaging examination, endoscopic changes and pathological results of two groups. Results: There were 19 cases in the PLE group, including 10 males and 9 females, the male/female ratio was 1.1︰1.0. The average age of onset was (6.2±2.0) years. The main clinical manifestations were abdominal pain and rash, partly accompanied by hematochezia, vomiting, hypoprotein edema and joint swelling. In PLE group, significant increases were found in white blood cells, neutrophils, C-reactive protein (CRP), platelets, neutrophils/lymphocytes (NLR), and decreases were found in albumin and immunoglobulin G, statistically different from those in the control group (P<0.05). Imaging changes indicated intestinal wall thickening and ascites. Results of gastroscopy showed congestion and edema of gastric and duodenal mucosa, and some lesions such as erosion and ulcer. Pathological changes mainly suggested mucosal epithelial cell swelling, submucosal vasodilation, vascular wall necrosis, interstitial edema, perivascular inflammatory changes, neutrophil, lymphocyte and eosinophil infiltration. The length of stay in the PLE group were longer than that in the control group, with statistically significant difference (P<0.05). Conclusion: The clinical manifestations of abdominal HSP complicated with PLE are significantly increased inflammatory indicators such as white blood cells, neutrophils, CRP and NLR, severe intestinal mucosal injury and long length of stay. Therefore, active and effective treatment measures should be taken. |
| Key words: abdominal Henoch-Schönlein purpura protein-losing enteropathy inflammatory response children |
