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題名 | Hepatobiliary Involvement of Henoch-Schonlein Purpura in Children=兒童類過敏性紫斑症與肝膽系統相關的表徵 |
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作者 | 趙舜卿; 江文山; 林思偕; Chao, Hsun-chin; Kong, Man-shan; Lin, Syh-jae; |
期刊 | 臺灣兒科醫學會雜誌 |
出版日期 | 20000300、20000400 |
卷期 | 41:2 民89.03-04 |
頁次 | 頁63-68+109 |
分類號 | 417.5637 |
語文 | eng |
關鍵詞 | 類過敏性紫斑症; 肝膽相關表徵; Henoch-schonlein purpura; Hepatobiliary involvement; |
中文摘要 | 兒童類過敏性紫斑症的肝膽表徵與臨床病程在過去文獻中少被提過。本研究由病曆中回塑性分析本院10年以上225位類過敏性紫斑症病童的臨床記錄,病童具肝膽表徵者爲本文研究對象。在定義上,凡是有氨基丙氨基轉移酶(ALT)昇高(>40IU/L),或穀胺酸轉移酶(GGT)大於正常值,或超音波有肝膽系統異常者,視爲有相關肝膽疾病。研究結果共有20位病童符合上述臨床診斷要項而進入本研究。在性別方面,女性比男性多(比率爲女:男=1.2:1.0),其平均年齡爲6.3±5.4歲。7位病童(35%)有前軀上呼吸道感染的症狀。這20位病童的臨床表征主要爲右上腹痛(80%),惡心(45%),嗜睡(20%)與嘔吐(16%),在肝功能血液檢查中,ALT上昇者有15位(75%),GGT上昇者有6位(30%),鹸性磷酸(ALK-P)上昇者有3位(15%),腹部超音波表征中膽腫大者有15位(75%),膽囊壁肥厚(≥3mm)者有5位(20%)。14位病童(70%)曾接受爲期1-2週的類固醇治療,大多數病童的症狀與異常超音波結堅果在3-7天內改善,肝膽功能(ALT,GGT值)也大多在2週內恢複正常。所有病童接受2年以上的臨床追蹤,其中只有一位病童在3個月後有併發膽囊肥厚,經短期治療也獲得完全康複。結論,肝膽表征在兒童類過敏性紫斑症中並不常見,大部分病童均有良好的預後。 |
英文摘要 | Hepatobiliary manifestation and its evolution in children with Henoch-Schönlein purpura (HSP) had been scarcely reported. Over a ten-year period between June 1988 and November 1998, medical charts of 225 children with the diagnosis of HSP encountered at Chang Gung Children’s Hospital were reviewed. Those with the evidence of hepatobiliary involvement were enrolled in the study. The patients with hepatobiliary involvement were defined by having an elevated serum alanine transaminase (ALT) or ganzma-glutamyl transferase (GGT), and the presence of abnormal sono graphic findings involving liver, biliary system, and gallbladder. The patients included 9 boys and 11 girls with range of age from 3 to 11 years. The mean age of these patients was 6.5±3.7 years. Preceding upper respiratory tract infection was common in these patients (35%). The main clinical manifestation were distinct from typical abdominal symptoms of HSP, and included right upper quadrant pain (80%), nausea (45%), lethargy (20%), and vomiting (15%). Elevated serum ALT was noted in 15 cases (75%) and GGT in 6 cases (30%). Abdominal ultrasonography revealed hepatomegaly (15/20, 75%), and gallbladder wall thickening (5/20, 25%). No specific laboratory parameters were correlated with the hepatobiliary manifestation of HSP. Fourteen children (70%) received steroid therapy and disappearance of symptoms and sonographic resolution of hepatobiliary lesion was noted within 3-7 days of steroid therapy. All patients recovered completely except for one patient with hepatobiliary recurrence manifested as purpuric rash, abdominal pain, elevated GGT, and gallbladder wall thickening during 2-year follow-up. |
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