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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (6): 450-454.

• 论著 • 上一篇    下一篇

十二指肠降部黏膜免疫荧光试验辅助诊断过敏性紫癜的价值及临床局限性

宋瑛1,4，石杰如2,4，唐子斐2，冯佳燕3，陈莲3，黄瑛2   

  1. 1 江苏省昆山市第一人民医院儿内科 昆山，215300；2 复旦大学附属儿科医院消化科 上海，201102；3 复旦大学附属儿科医院病理科 上海，201102；4 共同第一作者
  • 收稿日期:2016-12-22 修回日期:2016-12-19 出版日期:2016-12-25 发布日期:2016-12-25
  • 通讯作者: 黄瑛

The value and limitation of mucosal immunofluorescence of duodenal descending to assist diagnosis of Henoch-Schnlein purpura

SONG Ying1,4, SHI Jie- ru2,4, TANG Zi- fei2, FENG Jia-yan3, CHEN Lian3, HUANG Ying2   

  1. 1 Department of Pediatrics，First People 's Hospital of Kunshan, Kunshan 215300, China; 2 Department of Digestive, Children Hospital of Fudan University，Shanghai 201102, China; 3 Department of Pathology, Children Hospital of Fudan University, Shanghai 201102, China; 4  has equal contribution to the study
  • Received:2016-12-22 Revised:2016-12-19 Online:2016-12-25 Published:2016-12-25
  • Contact: HUANG Ying

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摘要：

目的 探讨十二指肠降部免疫荧光试验与黏膜病变程度在过敏性紫癜（HSP）辅助诊断中的价值和临床局限性。 方法 收集2014年4月至2015年12月复旦大学附属儿科医院消化科以腹痛为主要症状初诊的HSP或怀疑HSP，且辅助诊断至少有胃镜检查并行十二指肠降部黏膜免疫荧光试验的患儿，从病史中查阅紫癜的记录情况，采集HSP患儿行胃镜检查时十二指肠黏膜病变程度及其组织荧光试验结果；本文以胃镜直视下充血、水肿为轻度病变，糜烂和溃疡为中重度病变；本文以典型皮肤紫癜出现在胃镜检查前为早出紫癜，之后为晚出紫癜；根据免疫荧光试验结果分为阴性和阳性。 结果 符合本文纳入和排除标准的54例HSP患儿进入本文分析，男31例，女23例；平均（8.1±2.7）岁；门诊病例14例，住院病例40例；早出紫癜36例（76.7%），晚出紫癜18例。十二指肠降部黏膜均受累，免疫荧光阳性31例（57.4%），阴性23例（其中弱阳性6例）。十二指肠降部黏膜轻度病变14例（25.3%），重度病变40例（其中糜烂19例，溃疡21例）。免疫荧光阴性的HSP患儿中黏膜中重度病变的比例明显多于阳性，差异有统计学意义［91.3%（21/23） vs61.3%（19/31），P=0.013］；早出紫癜的HSP患儿黏膜轻度病变免疫荧光阳性比例(10/31,32.2%)多于阴性(2/23,8.7%)，差异有统计学意义(P=0.039)；不论免疫荧光结果阳性与否：早或晚出紫癜HSP患儿黏膜病变轻度与中重度比例差异均无统计学意义、晚出紫癜的HSP患儿黏膜轻度病变的比例差异无统计学意义、早出或晚出紫癜的HSP患儿黏膜中重病变的比例差异亦均无统计学意义。 结论 十二指肠降部黏膜较皮肤组织免疫荧光试验阳性率低，可能与取活检处黏膜的病变严重程度有关，不排除与取活检的部位、数量、深度及器械等多种因素有关。

Abstract:

Objective To study the value of immunofluorescence test and the severity of mucosal lesions of the duodenum descending portion in the diagnosis of Henoch-Schnlein purpura. Methods To collect the situation of purpura from the medical history and the degree of mucosal lesions and the immunofluorescence results of duodenum under endoscopic examination. The hyperemia and edema of mucosal were defined as mild lesions, the erosion and ulcer were defined as moderate to severe lesions observed under the endoscopy. The typical skin purpura appeared before the examination of gastroscopy was named as early onset purpura, and after that was named as later onset purpura. According to the results of immunofluorescence test was divided into negative and positive. Results The newly diagnosed Henoch- Schnlein purpura or suspected Henoch- Schnlein purpura patients with the main symptom of abdominal pain were collected who were treated in Department of Gastroenterology of Children's Hospital of Fudan University from April 2014 to December 2015. Fifity- four cases who finished the gastroscopic examination and immunofluorescence test of duodenum portion mucosal were enrolled in the study. Thirty- one cases were males and 23 cases were females; the average age was 8.1±2.7 years; 14 cases were outpatient patients, 40 cases were hospitalized patients; 36 patients (76.7%) were with early onset purpura, 18 cases were with later onset purpura. Duodenal mucosal lesions manifested as congestion and edema in 14 cases, manifested as erosion and ulcers in 40 cases (including erosion in 19 cases and ulcers in 21 cases). Thirty- one cases (57.4%) were immunofluorescence positive of duodenal mucosa and negative in 23 cases. The frequency of moderate to severe mucosal lesions was significantly higher in patients with duodenal mucosal immunofluorescence-negative Henoch- Schnlein purpura than that in positive ones (91.3% vs 61.3%, P=0.013). The frequency of mild mucosal lesions in patients with immunofluorescence positive of duodenal mucosa was higher than that with negative on the basis of all the patients with early onset purpura, the difference was statistically significant (χ2=4.241, P=0.039). There was no significant difference of the degree of mucosal lesions of duodenal portion between early or later onset purpura regardless of the result of immunofluorescence positive or negative of duodenal descending portion mucosal. There was no significant difference in the proportion of mucosal mild lesions with later onset purpura between immunofluorescence positive and negative of duodenal descending portion mucosal. There was no statistically significant difference in the proportion of moderate to severe lesions between patients with early onset purpura and patients with later onset purpura regardless of the result of immunofluorescence positive or negative of duodenal descending portion mucosal. Conclusion Clinical diagnosis of Henoch- Schnlein purpura with negative results of mucosal immunofluorescence should be cautious. It may be mainly associated with the severity of the lesion and can't rule out the biopsy factors, such as location, quantity, depth and equipment.