以皮肤紫癜为临床表现儿童相关性疾病的鉴别诊断
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摘要
目的皮肤紫癜以血液溢于皮肤、黏膜之下,出现瘀点瘀斑,压之不退色为其临床特征,是小儿常见的出血性疾病之一。以皮肤紫癜为临床表现的儿童相关性疾病很多,临床上常见的有自身免疫性疾病、血液系统疾病、皮肤病等。皮肤紫癜的皮疹形式多种多样,常常伴有其他临床表现,在诊断疾病时易被忽视。部分以皮肤紫癜为首发表现的疾病,因其发病率低、起病隐匿且缺乏特异性临床表现,极易造成漏诊及误诊。对皮肤紫癜为临床表现儿童相关性疾病的鉴别,可以使部分疾病在早期得以明确诊断,指导治疗,改善预后。
The skin purpura is bloody under the skin and mucous membranes,and has ecchymosis,which is a clinical characteristic of the skin,and is one of the common hemorrhagic diseases in children. There are many children-related diseases with clinical manifestations of purpura,and autoimmune diseases,blood system diseases,and skin diseases are common in clinical practice. The rash of skin purpura is diverse and often accompanied by other clinical manifestations that are easily overlooked in the diagnosis of disease. Some of the diseases with skin purpura as the first manifestation,due to its low incidence,insidious onset and lack of specific clinical manifestations,can easily lead to missed diagnosis and misdiagnosis. The identification of skin-purpura as a clinical manifestation of childhood-related diseases can enable some diseases to be diagnosed early,guide treatment,and improve prognosis.
The skin purpura is bloody under the skin and mucous membranes,and has ecchymosis,which is a clinical characteristic of the skin,and is one of the common hemorrhagic diseases in children. There are many children-related diseases with clinical manifestations of purpura,and autoimmune diseases,blood system diseases,and skin diseases are common in clinical practice. The rash of skin purpura is diverse and often accompanied by other clinical manifestations that are easily overlooked in the diagnosis of disease. Some of the diseases with skin purpura as the first manifestation,due to its low incidence,insidious onset and lack of specific clinical manifestations,can easily lead to missed diagnosis and misdiagnosis. The identification of skin-purpura as a clinical manifestation of childhood-related diseases can enable some diseases to be diagnosed early,guide treatment,and improve prognosis.
引文
[1] CHOU T, LOUISSANT V R, ADAMS A, et al. Successful Treatment of Henoch-Schonlein Purpura With Recurrent Gastrointestinal Involvement With Mycophenolate Mofetil:A Brief Report[J]. Clinical Pediatrics,2015,54(9):900-903.
[2] CHEN O,ZHU X B,REN P,et al. Henoch Schonlein Purpura in children:clinical analysis of 120 cases[J]. African Health Sciences,2013,13(1):94-99.
[3]邓国民.应关注系统性红斑狼疮脑组织损害的发病机制[J].中国现代神经疾病杂志,2014,14(9):741-743.
[4]中华医学会儿科学分会免疫学组,《中华儿科杂志》编辑委员会.儿童系统性红斑狼疮诊疗建议[J].中华儿科杂志,2011,49(7):506-514.
[5]王俊英,杨蕊华,崔涛.小儿系统性红斑狼疮37例临床分析[J].山西医科大学学报,2013,44(1):61-63.
[6]中华医学会皮肤性病学分会免疫学组.皮肤型红斑狼疮诊疗指南(2012)[J].临床皮肤杂志,2012,41(6):390-392.
[7]唐倩,李志勇.原发性干燥综合征误诊原因分析[J].现代医药卫生,2015,31(S2):1-3,6.
[8]王景,宣磊,董振华.儿童原发性干燥综合征57例临床分析[J].中国临床医生志,2018,46(2):224-226.
[9]中华医学会学分会.干燥综合征诊断及治疗指南[J].中华风湿病学杂志,2010,14(11):766-768.
[10] REVELVILK S,YACOBOVICH J,FRANK S,et al. Age and duration of bleeding symptoms at diagnosis best predict resolution of childhood immune thrombocytopenia at 3,6,and 12 months.[J]. J Pediatr,2013,163(5):1335-1339. e2.
[11] NEUNERT C E,BUCHANAN G R,IMBACH P,et al. Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura.[J]. Blood,2008,112(10):4003.
[12] ZHOU Z,NGUYEN T C,GUCHHAIT P,et al. Von Willebrand Factor, ADAMTS-13, and Thrombotic Thrombocytopenic Purpura[J]. 2010,31(1):71-81.
[13]李志春,郭超,张振江,等.获得性低巨核细胞性血小板减少性紫癜48例临床分析[J].山东医药,2007,47(34):111.
[14]张玥,宋红梅.系统性血管炎分类介绍[J].中华实用儿科临床杂志,2013,28(21):1601-1603.
[15]张仙珍,胡岗,黄美春,等.抗中性粒细胞胞质抗体相关性小血管炎患者早期临床特点及预后分析[J].浙江医学,2017,39(21):1904-1906,1912.
[16]李学刚,关广聚,柳刚,等.过敏性血管炎[J].山东医药,2003,43(22):59-60.
[17]于力,马媛媛.原发性小血管炎及其肾损害的研究进展[J].实用儿科临床杂志,2010,25(17):1296-1300.
[18]舒华娥,袁玲霞,王贯华.小儿早期慢性再生障碍性贫血误诊为血小板减少性紫癜10例分析[J].临床医学,2009,29(11):111-112.
[19] WILKINS R,JANES S. Aleukaemic leukaemia cutis:case report and review of the literature[J]. Clinical&Laboratory Haematology,2010,26(1):73-75.
[20]张书兰,赵德育,王全,等.儿童渗出性多形性红斑32例临床分析[J].安徽医药,2014,18(3):513-515.
[21] RAMOS-CASALS M, STONE J H, CID M C, et al. The cryoglobulinaemias[J]. Lancet,2012,379(9813):348-360.
[22] RAMOSCASALS M,MUOZ S, MEDINA F, et al. Systemic autoimmune diseases in patients with hepatitis C virus infection:characterization of 1020 cases(The HISPAMEC Registry)[J].Journal of Rheumatology,2009,36(7):1442.
[2] CHEN O,ZHU X B,REN P,et al. Henoch Schonlein Purpura in children:clinical analysis of 120 cases[J]. African Health Sciences,2013,13(1):94-99.
[3]邓国民.应关注系统性红斑狼疮脑组织损害的发病机制[J].中国现代神经疾病杂志,2014,14(9):741-743.
[4]中华医学会儿科学分会免疫学组,《中华儿科杂志》编辑委员会.儿童系统性红斑狼疮诊疗建议[J].中华儿科杂志,2011,49(7):506-514.
[5]王俊英,杨蕊华,崔涛.小儿系统性红斑狼疮37例临床分析[J].山西医科大学学报,2013,44(1):61-63.
[6]中华医学会皮肤性病学分会免疫学组.皮肤型红斑狼疮诊疗指南(2012)[J].临床皮肤杂志,2012,41(6):390-392.
[7]唐倩,李志勇.原发性干燥综合征误诊原因分析[J].现代医药卫生,2015,31(S2):1-3,6.
[8]王景,宣磊,董振华.儿童原发性干燥综合征57例临床分析[J].中国临床医生志,2018,46(2):224-226.
[9]中华医学会学分会.干燥综合征诊断及治疗指南[J].中华风湿病学杂志,2010,14(11):766-768.
[10] REVELVILK S,YACOBOVICH J,FRANK S,et al. Age and duration of bleeding symptoms at diagnosis best predict resolution of childhood immune thrombocytopenia at 3,6,and 12 months.[J]. J Pediatr,2013,163(5):1335-1339. e2.
[11] NEUNERT C E,BUCHANAN G R,IMBACH P,et al. Severe hemorrhage in children with newly diagnosed immune thrombocytopenic purpura.[J]. Blood,2008,112(10):4003.
[12] ZHOU Z,NGUYEN T C,GUCHHAIT P,et al. Von Willebrand Factor, ADAMTS-13, and Thrombotic Thrombocytopenic Purpura[J]. 2010,31(1):71-81.
[13]李志春,郭超,张振江,等.获得性低巨核细胞性血小板减少性紫癜48例临床分析[J].山东医药,2007,47(34):111.
[14]张玥,宋红梅.系统性血管炎分类介绍[J].中华实用儿科临床杂志,2013,28(21):1601-1603.
[15]张仙珍,胡岗,黄美春,等.抗中性粒细胞胞质抗体相关性小血管炎患者早期临床特点及预后分析[J].浙江医学,2017,39(21):1904-1906,1912.
[16]李学刚,关广聚,柳刚,等.过敏性血管炎[J].山东医药,2003,43(22):59-60.
[17]于力,马媛媛.原发性小血管炎及其肾损害的研究进展[J].实用儿科临床杂志,2010,25(17):1296-1300.
[18]舒华娥,袁玲霞,王贯华.小儿早期慢性再生障碍性贫血误诊为血小板减少性紫癜10例分析[J].临床医学,2009,29(11):111-112.
[19] WILKINS R,JANES S. Aleukaemic leukaemia cutis:case report and review of the literature[J]. Clinical&Laboratory Haematology,2010,26(1):73-75.
[20]张书兰,赵德育,王全,等.儿童渗出性多形性红斑32例临床分析[J].安徽医药,2014,18(3):513-515.
[21] RAMOS-CASALS M, STONE J H, CID M C, et al. The cryoglobulinaemias[J]. Lancet,2012,379(9813):348-360.
[22] RAMOSCASALS M,MUOZ S, MEDINA F, et al. Systemic autoimmune diseases in patients with hepatitis C virus infection:characterization of 1020 cases(The HISPAMEC Registry)[J].Journal of Rheumatology,2009,36(7):1442.