| Objective:Anaphylactoid purpura also known as Henoch-Sch?nlein purpura(HSP),which is a common systemic vascular inflammatory disease.At present,the diagnosis and treatment of HSP has reached a consensus.The immune group of Pediatrics branch of Chinese medical association has formed children allergic purpura evidence-based treatment recommendations in 2013.However,at present,there has not diagnostic criteria and treatment principle for Henoch-Schonlein purpura with digestive tract symptoms,so the early diagnosis and treatment of these HSP were difficult.This paper aimed to analyze the clinical data of these HSP,and to explore their clinical characteristics,misdiagnosis,treatment and pron-gosis,and to provide reference of diagnosis,treatment and prevention of these HSP.Methods:1.To collect the clinical data of 480 cases(illness score>3)of Henoch-Sch?-nlein purpura with digestive tract symptoms admitted to department of digestion,dermatology and pediatrics of our hospital from June 2013 to May 2015,but a total of 316 patients were incorporated in the retrospective analysis and followup study.All patients of HSP with digestive tract symptoms were scored by HSP scoring criteria,and underwent three big conventions,high-sensitivity C-reactive protein,biochemistry,blood lipids,and blood clotting inspection.In which,290 patients received allergen test,172 patients underwent medical imaging,and 50 patients performed endoscopy admitted to Gastroenterology for their gastrointesti-nal symptoms of HSP.The clinical data include of 316 patients age,gender,onset season,pathogenesis,clinical signs and symptoms,misdiagnosis,illness score,abdo-minal pain and purpura disappearance time,laboratory test,imaging and endosco-pic test,relationship between rash and digestive tract symptoms,treatment,progn-osis and 6-month follow-up,etc.were analyzed.2.The 316 cases were divided into glucocorticoid group and non-glucocor-ticoid group according to whether the use of glucocorticoids.The glucocorticoid group had 221 patients,whose illness score was 5.75±1.201 and the dose was methyl prednisone 1~2 mg/kg.d intravenous infusion;92 patients were were off glucocorticoid within 1 week as the digestive tract ymptoms and purpura disapp-earance;129 patients continued to use methyl prednisone 0.4~0.8mg/kg.d as a maintaining therapy,69 of whom were treated for less than 2 weeks and 60 for 2 to 4 weeks.The non-glucocorticoid group had 95 patients,whose illness score was 5.57±1.068.Analysing the relationship between glucocorticoid maintaining time and recurrence rate of rash and digestive tract symptoms;comparing diges-tive tract symptoms,purpura disappearance time,hospitalization treatment time and relapse after discharge between both groups.3.The incidence of renal involvement between the glucocorticoid treatment patients and the non-glucocorticoid were compared in patients admitted to the hospital without renal involvement after follow-up 6 months.At the same time,the turned negative rate of urine between the glucocorticoid treatment patients and the non-glucocorticoid were compared in patients admitted to the hospital with renal involvement after follow-up 6 months.Results:1.316 patients with HSP accompanied digestive tract symptoms(76 cases had initial symptoms of abdominal pain and gastrointestinal bleeding)included 190 males and 126 females.The onset age was 3~76 years old,13.54±13.491 on average.In children,teenage and adult,there were 194,75 and 47 patients respe-ctively.In the number of incidence patients,the children was higher than the teenage and adult(P< 0.05).232 patients had abdominal pain,79 patients had abdominal pain associated with gastrointestinal bleeding and only 5 patients had gastrointestinal bleeding.Abdominal pain mainly occurred in peripheral umbilic-us and upper abdomen.There were 200 patients in peripheral umbilicus and 69 cases in upper abdomen.There were 85.34% abdominal pain of children in peripheral umbilicus and 52.17% adult in upper abdomen.77.22%(244/316),15.51%(49/316)and 7.28%(23/316)patients had digestive tract symptoms within 1 week,between 1 and 2 weeks and more than 2 weeks before and after purpura.Obviously,there were more patients who had digestive tract symptoms within 1 week before and after purpura than more than 1 week later(P<0.05).2.It was easy to be misdiagnosed HSP accompanied digestive tract symptoms.The misdiagnosis rate was 19.94%.The misdiagnosis rate of patients with initial symptoms of abdominal pain and gastrointestinal bleeding was as high as 61.84%.4 patients were misdiagnosed as appendicitis and received appendix resection.1 patient was misdiagnosed as biliary tract disease and received laparoscopic bile duct exploration.3.50 patients received endoscopy.Microscopic findings mainly included mucosal hyperemia edema,ulcers,multiple bleeding spots,as well as scattered and irregular multiple ulcers.1 patient received laparoscopy.Intestinal wall thickening and hyperemia edema were visible.172 patients received abdominal imaging test.The main manifestations were intestinal wall swelling/thickening and lymphadenovarix.4.The digestive tract symptom disappearance,purpura fadeaway and hospitalization treatment time were 3.24±1.684,6.49±2.844 and 8.54±2.898 days in glucocorticoid group and 6.39±2.044,7.22±2.415 and 11.19±5.509 days in non-glucocorticoid group respectively.The digestive tract symptom disappearance,purpura fadeaway and hospitalization treatment time in glucocort-icoid group were significantly shortened than those of non-glucocorticoid group(P< 0.05).5.Follow-up 6 months,It had no significant difference about the rash relapse rate(81.45%)in glucocorticoid group and in non-glucocorticoid group(84.21%)(P> 0.05).However,digestive tract symptom relapse rate(33.03%)was obviously lower than non-hormone group(47.37%)(P<0.05).Rash(71.32%)and digestive tract symptom(26.33%)relapse rate of glucocorticoid maintainers in glucocorticoid group were obviously lower than those of non-maintainers(95.65% and 42.39% respectively)(P<0.05).For the rash and digestive tract symptom relapse rate in glucocorticoid group,2~4 weeks’ maintaining time could get better effect(48.33% and 16.17%,respectively)than those not reach 2 weeks(91.30% and 39.13% respectively)(P<0.05).6.Follow-up 6 months,It had no significant difference about the rate of renal involvement between the glucocorticoid treatment patients(31.62%)and the non-glucocorticoid(32.84%)in patients admitted to the hospital without renal involvement.But the rate of renal involvement of 2 to 4 weeks glucocorticoid maintainers(16.67%)were obviously lower than those of less than 2 weeks maintainers(40.00%)(P<0.05).The turned negative rate of urine of the gluco-corticoid treatment patients(78.82%)were obviously higher than those of the non-glucocorticoid(53.57%)in patients admitted to the hospital with renal involvement after follow-up 6 months.Conclusions:1.HSP accompanied digestive tract symptoms is epidemic among children.Major digestive tract symptoms was abdominal pain,and followed by abdominal pain associated with gastrointestinal bleeding.There are few gastrointestinal bleedings alone.Digestive tract symptoms mainly occur within 1 week before and after purpura and the abdominal pain is sharp.2.It is easy to misdiagnose HSP accompanied digestive tract symptoms as acute abdominal disease.The misdiagnosis rate of patients with initial symptoms of abdominal pain and gastrointestinal bleeding is as high as 61.84%.3.It had no specificity about the laboratory examination results of HSP with digestive tract symptoms,and the early diagnosis was difficult,but endoscopic features were similar with skin purpura,and medical imaging had the features of non specific inflammatory edema.So,It was beneficial for this kind patients to the early diagnosis and treatment with endoscopic and imaging screening.4.The use of glucocorticoid can alleviate digestive tract symptoms,promote deflorescence,and shorten hospitalization treatment time.Using glucocorticoid,reducing amount regularly and maintenance therapy for 2 to 4 weeks is beneficial for reducing rash and digestive tract symptom relapse,renal involvement and pro-moting the urine turning negative rate of urine. |
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