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目的探讨超声联合胃镜对儿童腹型过敏性紫癜(HSP)的临床诊断价值。方法采用超声及胃镜对46例经临床诊断为HSP的患儿进行观察。结果 (1)超声表现:38例出现不同程度的节段性肠壁增厚,以十二指肠降部及水平部为主。肠壁增厚为4~10mm不等,其中肠壁厚4~7mm 9例,7~9 mm 17例,9~10 mm 12例,肠管管腔狭窄,呈均匀的低回声。增厚肠壁的近端肠管扩张。CDFI示增厚肠壁血流信号明显增多。(2)胃镜表现:41例患儿均有不同程度胃十二指肠黏膜改变,以十二指肠受累最为多见。(3)高频超声联合胃镜诊断阳性率为97.8%(45/46),单纯超声诊断阳性率为82.6%(38/46),差异具有统计学意义(χ~2=4.43,P<0.05)。(4)疗效评估:HSP患儿经临床治疗2周后,复查超声病情明显改善。结论超声联合胃镜可提高儿童HSP诊断的准确度,超声以无创、便捷、可重复检查等优势可作为常规首选检查方法用于诊断及疗效评估。
Objective To investigate the clinical value of ultrasound combined with endoscopy in the diagnosis of children with abdominal Henoch-Schonlein purpura (HSP). Methods Ultrasound and gastroscopy were used to observe 46 cases of clinically diagnosed HSP. Results (1) Ultrasonography: There were 38 cases of segmental intestinal thickening to varying degrees, mainly in the descending part and the horizontal part of the duodenum. Intestinal wall thickening ranged from 4 to 10 mm, including 4 to 7 mm of intestinal wall thickness in 9 cases, 7 to 9 mm in 17 cases and 9 to 10 mm in 12 cases. The intestinal lumen was stenotic and showed a uniform hypoechoicity. Thickening of the proximal bowel wall dilatation. CDFI showed thickening of the intestinal wall blood flow signal increased significantly. (2) gastroscopy performance: 41 cases of children with varying degrees of gastric mucosal changes to the most common duodenal involvement. (3) The positive rate of high-frequency ultrasound combined with gastroscopy was 97.8% (45/46), the positive rate of pure ultrasonography was 82.6% (38/46), the difference was statistically significant (χ ~ 2 = 4.43, P0.05) . (4) Efficacy Evaluation: Children with HSP after 2 weeks of clinical treatment, review the ultrasound condition was significantly improved. Conclusion Ultrasound combined with gastroscope can improve the diagnostic accuracy of HSP in children. The advantages of noninvasive, convenient and repeatable examination of ultrasound can be used as the first choice for diagnosis and evaluation of therapeutic effect in children.