摘要：
目的：探讨成人腹型过敏性紫癜的临床表现和内镜特点，提高其诊断水平。方法回顾性分析我院1994年1月～2014年9月收治的98例成人腹型过敏性紫癜的临床、内镜及病理学资料，其中58例接受胃镜检查，54例接受肠镜检查。结果①症状主要为腹痛98例（100％）、皮肤紫癜98例（100％）、消化道出血51例（52％），伴关节肿痛23例（23％）。②实验室检查主要为外周血白细胞增高（55例，56％），C反应蛋白升高（20例，20％），白蛋白降低（10例，10％）。20％（20／98）B超提示腹腔积液，100％（32／32）CT提示肠壁增厚。③58例胃镜下主要表现：53例（91％）为略高出黏膜的点状出血和淤斑或成片状，39例（67％）糜烂或多发溃疡伴出血，7例（12％）颗粒状或结节状增生，7例（12％）弥漫性出血。病变在十二指肠降部出现率最高且最严重（39例，67％），其次为十二指肠球部（35例，60％）、胃（23例，40％）。病理组织学呈毛细血管炎表现12例（21％），3例（5％）伴幽门螺杆菌感染，其余均为黏膜慢性炎，无特异性表现。④54例肠镜下主要表现：42例（78％）为略高出黏膜的点状出血和淤斑或成片状，16例（30％）糜烂或多发溃疡伴出血，9例（17％）弥漫性出血。病变在回肠末端出现率最高且最严重（38例，70％），其次为直肠（16例，30％）、盲肠（11例，20％）、乙状结肠（4例，7％）、全结肠（4例，7％）、回盲瓣（2例，4％）。组织病理学均为黏膜慢性炎，无特异性表现。结论十二指肠降部、回肠末端病变在成人过敏性紫癜常见，内镜检查对成人以腹痛为主要表现的过敏性紫癜有较高的诊断价值。%Objective To discuss the clinical manifestations and endoscopic and pathological features of abdominal type Henoch-Schönlein purpura ( HSP) in adults. Methods A retrospective review was made on the clinical , endoscopic, and pathological features of 98 adult patients with abdominal type HSP who had been hospitalized from January 1994 to September 2014. Results The common symptoms were abdominal pain ( 98 cases, 100%), skin purpura ( 98 cases, 100%), gastrointestinal hemorrhage (51 cases, 52%), and arthralgia and joint swelling (23 cases, 23%).The major laboratory findings were increased peripheral white blood cells (55 cases, 56%), elevated C reactive protein (20 cases, 20%), and low serum albumin (10 cases, 10%).Ultrasonography showed ascites in 20 cases (20%).Intestinal wall thickening was seen in all of the 32 cases who underwent CT examinations .Gastroscopy performed in 58 patients demonstrated the damages to the mucosa , which varied from congestion , edema, petechia, and ecchymosis (53 cases, 91%) to erosion and multiple ulcers with hemorrhage (39 cases, 67%), granulation of mucosa (7 cases, 12%), and diffuse hemorrhage (7 cases, 12%).The gastroscopy showed that the most common and severe position involved was the descending duodenum (39 cases, 67%), followed by duodenal bulb (35 cases, 60%), and stomach (23 cases, 40%).Pathology showed 12 cases (21%) of capillary inflammatory manifestations and 3 cases (5%) of Helicobacter pylori infection. Colonoscopy performed in 54 patients demonstrated the damages to the mucosa , which varied from congestion , edema, petechia, and ecchymosis (42 cases, 78%) to erosion and multiple ulcers with hemorrhage (16 cases, 30%), and diffuse hemorrhage (9 cases, 17%).The colonscopy showed that the most common and severe position involved was the terminal ileum (38 cases, 70%), followed by the rectum (16 cases, 30%), cecum (11 cases, 20%), sigmoid colon (4 cases, 7%), total colon (4 cases, 7%), and ileocecal valve ( 2 cases, 4%). Pathological results showed chronic inflammation without specific appearance . Conclusions Descending duodenum and terminal ileum lesions are the most common and severe position involved in adult HSP . Endoscopy is very useful for the diagnosis of adult HSP presenting with abdominal pain .
