Clinical Characteristics And Risk Factors Of Gastrointestinal Hemorrhage Of Henoch Sch?nlein Purpura In Recent Six Years

Objective:To analyze the epidemiological and clinical characteristics,treatment and misdiagnosis of Henoch Sch?nlein purpura,and analyze the risk factors of gastrointestinal bleeding,so as to improve the early diagnosis and prevention level of Henoch Sch?nlein purpura.Methods:The clinical data of 557 patients with Henoch Sch?nlein purpura from 2013 to 2018 were analyzed retrospectively,including age,gender,clinical symptoms,experimental examination,treatment and misdiagnosis.SPSS 24.0 statistical software was used for statistical analysis.Results:1.From 2013 to 2018,the number of hospitalized patients with HSP in our hospital was 89,94,98,87,90 and 99 respectively,with no increasing trend.HSP is more common in the autumn and winter,especially in October,November,December and January,Men are more common than women,the ratio is 1.53: 1.and a high incidence age group of 6-15 years old.The average age of onset was higher in male than female(P <0.05);in terms of population distribution,the incidence rate of rural population in the juvenile group was higher than that in the urban population(P <0.05);Infection was the most common cause,accounting for 53.0%.2.There is no obvious difference in various types of HSP in the past six years, the most common type is the mixed type HSP,accounting for 31.6%.The clinical symptoms of the adult group are different from those of the juvenile group.The incidence of articular HSP in minors is more than that in adults,while the incidence of mixed HSP and HSPN is less than that in adults(P < 0.05).3.The incidence of HSP with gastrointestinal bleeding have no changed in the past six years,and the incidence of renal damage decreased,while the incidence of joint symptoms increased;4.61.0% of patients are accompanied by gastrointestinal symptoms,of which abdominal pain accounts for 59.4%,gastrointestinal bleeding 36.3%,nausea and vomiting 28.9%,diarrhea 4.5%,intestinal obstruction 1.6%,acute pancreatitis 0.4%,intestinal perforation 0.2%.HSP patients with gastrointestinal symptoms are easily misdiagnosed,with a misdiagnosis rate of 21.2%;the misdiagnosis rates in the past 6 years were 16.9%,22.3%,16.1%,14.3%,12.2%,11.1%,showing a downward trend;5.309 cases were examined for D-dimer,of which 235 patients had increased D-dimer,the positive rate was 76.1%.Abdominal CT and Gastrointestinal endoscopy are significant in patients with gastrointestinal symptoms,CT can show edema and thickening of gastrointestinal tract wall,disorder of intestinal structure,stenosis of lumen,and enlargement of mesenteric lymph nodes.Gastrointestinal endoscopy usually shows punctate or flaky bleeding spots of mucosa,or edema,erosion and ulcer of gastrointestinal mucosa,and the descendent duodenum and terminal ileum were the most common lesions;6.The number of males,patients younger than 18 years old,patients with vomiting,leukocytosis and joint symptoms in HSP patients with gastrointestinal hemorrhage was higher than that in the group without gastrointestinal hemorrhage(P < 0.05).Multivariate logistic regression analysis found that male,combined with vomiting and leukocytosis are independent risk factor for HSP with gastrointestinal bleeding.Conclusions:1.In the past six years,the incidence of joint symptoms increased,but the incidence of HSP renal damage decreased,and the misdiagnosis rate has also decreased;The clinical symptoms of the adult group are different from those of the juvenile group.The adult patients should pay more attention to the renal and gastrointestinal symptoms,while the juvenile patients should pay more attention to the joint symptoms.2.The rate of HSP patients with gastrointestinal symptoms is high,which is easy to be misdiagnosed.Abdominal CT and gastroenteroscopy are helpful for its diagnosis and differential diagnosis.3.Male,combined with vomiting and high white blood cell are independent risk factors for HSP with gastrointestinal bleeding.