| Objective: To improve the understanding and reduce the misdiagnosis and mistreatment of abdominal type Henoch Schonlein purpura(HSP),the clinical characteristics of 34 cases with abdominal type Henoch Schonlein purpura were analyzed and summarized.Methods: 34 hospitalized cases with abdominal type HSP were included from July,2003 to November,2016 in the Second Hospital of Dalian Medical University,whose clinical datas including clinical characteristics,clinical manifestations,laboratory examination,auxiliary examination,treatment and prognosis were retrospectively analyzed.Results:1.Age and season of onset: 22 cases(64.71%)were less than 17 years old,4 cases(11.76%)were during 17-40 years old,8 cases(23.53%)were more than 40 years old;male to female ratio is 1.8:1.8 cases(23.53%)occurred in spring,7 cases(20.59%)occurred in summer,11 cases(32.35%)occurred in autumn,and 8 cases(23.53%)occurred in winter.2.Allergic history and incentives: 14 cases(41.18%)had allergic history.21 cases(61.76%)had obvious incentives,including 17 cases(50.00%)with a history of respiratory tract infection and 4 cases(11.76%)with food factors.And 13 cases(38.24%)did not have obvious incentives.3.Clinical manifestations:(1)symptoms of digestive tract: 32 cases(94.12%)had abdominal pain,14 cases(41.18%)had nausea,10 cases(29.41%)had vomiting,6 cases(17.65%)had diarrhea,and 16 cases(47.06%)had gastrointestinal bleeding.Characteristics of abdominal pain :(1)Property of abdominal pain:28 cases(82.35%)had paroxysmal colic;4 cases(11.76%)had persistent pain;2 cases(5.88%)had no abdominal pain.(2)Site of abdominal pain: periumbilical pain occured in 22 cases(64.71%);middle or upper abdominal pain occured in 6 cases(17.65%);lower abdominal pain occured in 1 case(2.94%);pain location uncertainty occured in 5 cases(14.71%);(3)abdominal signs: the abdomen of 34 cases were soft(100%),abdominal tenderness occured in 24 cases(70.59%),no abdominal positive signs occured in 10 cases(29.41%).(2)Skin rash: 30 cases(88.24%)had rash.Before the rash appeared,12 cases(35.29%)had abdominal manifestations,and rash was present with abdominal manifestations at the same time in 5 cases(14.71%).The abdominal manifestations of 13 cases(38.24%)occurred after rash,among which abdominal manifestations in 5 cases(14.71%)occurred 1 week after the rash.The remaining 4 cases(11.76%)had no rush throughout.4.Laboratory examinations:Blood leukocytes increased in 21 cases(61.76%)),which were mainly neutrophils.Urine protein in 11 cases(32.35%)was positive.Fecal occult blood test in 16 cases(47.06%)was positive.CRP increased in 7 cases(20.59%)and ESR increased in 3 cases(8.82%).Hemagglutination was normal.22 patients were tested for immunoglobulin,of which IgE was elevated in 11 cases(50.00%).5.Food Intolerance Test: Food intolerance was detected in 17 cases of all patients,among which there were 1-6 kinds of food allergens in 15 cases.The positive rate was 88.24%.6.HP detection: 16 cases were detected for HP,of which HP was positive in 9 cases(56.25%).7.Assistant examination:(1)Imaging examination: 19 cases got ultrasound examination,for which 1 case showed lower left abdominal effusion,and the positive rate was 5.26%.Others' results of ultrasound examination were normal.5 cases got CT examination,4 cases had positive changes(80%)that were intestinal wall thickening and edema,and with 2 cases accompanying around consolidation and 1 case accompanying intestinal cavity effusion.(2)Endoscopic findings and pathology: 7 cases got gastroscopy examination,the positive rate was 100%.Endoscopic findings included mucosal hyperemia,edema,erythema,bleeding,severe mucosal erosion and ulcer,for which duodenal lesions were severer than gastric lesions mostly.9 cases got colonoscopy examination,the positive rate was 100%.The congestion and swelling in intestinal mucosa were severe and extensive,with vascular fuzzy texture,ecchymosis,erosion and irregular patchy ulceration,also with scattered purpura of different sizes and mucosal bleeding points.The lesions in the terminal ileum was the most serious.5 patients got pathological examinations,all of which showed nonspecific inflammatory cell infiltration.The positive rate of endoscopic examination was significantly higher than that of abdominal ultrasound examination,and compared with the positive rate of CT examination,the difference was not statistically significant.8.Treatment and prognosis: 31 cases(91.18%)were treated with glucocorticoid,and abdominal pain could be alleviated after the first dose of glucocorticoid,then the reduction of glucocorticoid was began.Among the 31 cases,1 case(3.23%)replapsed after eating pork,and abdominal pain was relieved after combining with gamma globulin treatment;1 case(3.23%)relapsed during the reduction of glucocorticoid,and abdominal pain was relieved after combining with immunosuppressive agents treatment.The rest of 3 cases(8.82%)with slight abdominal type were not treated with glucocorticoid.All of the patients were relieved after the treatment of medical treatment.The aaverage hospitalization time was 12±5.87 days.Conclusions:1.Abdominal HSP mainly occurre in people who are less than 17 years old,and the season of easy onset is autumn,spring,winter,summer in order.People who have allergy history are at particular risk for the type of HSP,and upper respiratory infection is the common cause of this disease.Food intolerance may play an important role in the incidence of abdominal type HSP.2.Abdominal type HSP is a syndrome which have a variety of clinical manifestations,and the patients' illness evolves in various degrees.The main symptoms of abdominal HSP is paroxysmal colic,which is often accompanied by digestive tract symptoms,such as nausea,vomiting,bloody and so on.It is easily misdiagnosed when abdominal performance appears before the rash.The elevating of blood routine,CRP,IgE,and CT examination and abdominal ultrasound examination are helpful to diagnosis.And particularly,early endoscopy examination is an economic and effective method,which may be used in early stage of diagnosis and treatment so as to avoid complications and unnecessary surgery.3.The HP infection rate in patients with abdominal type of HSP is high,prompting that more attention should be paied to the HP infection in the diagnosis and treatment of abdominal type HSP.4.Glucocorticoid is the main drug for the treatment of abdominal type HSP,when there are glucocorticoid resistant and severe cases,the immunoglobulin can be used. |
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