CAJ | 학술논문

目的：分析腹型过敏性紫癜（AAP）的多层螺旋CT（MSCT）表现，探讨MSCT检查在AAP疗效评价中的作用。资料与方法回顾性分析13例经临床和实验室检查确诊为AAP患者的临床和CT检查资料，治疗前均行腹部CT平扫及薄层重建，8例行胃镜检查；治疗后10例行CT平扫复查，4例行胃镜复查。比较治疗前后临床表现和CT征象的差异。结果治疗前13例CT平扫中，2例一段肠管受累，10例多节段肠管受累，1例无阳性发现；8例累及十二指肠、空回肠，5例累及胃；受累肠管壁环形增厚，密度减低，肠腔均匀性狭窄，轮廓模糊不清，呈“双环”征；10例肠管周围见少量渗出，3例腹腔少量积液。CT平扫误诊为急性胰腺炎2例，急性胆囊炎、肠梗阻、腹膜炎各1例。13例患者中，治愈5例，有效8例。患者治疗后四肢皮疹、腹痛、大便潜血、白细胞升高、呕吐、黑便、尿潜血症状较治疗前均得到改善（χ2=5.59~18.33，P<0.05、P<0.01）；10例CT复查多节段肠管水肿、肠管周围渗出改变均显著改善（χ2=10.00、9.52，P<0.01），腹腔积液差异无统计学意义（χ2=1.14， P>0.05）。结论 AAP的CT表现无特异性，皮疹出现前MSCT诊断困难，结合多节段肠管水肿、渗出等基本CT征象和临床表现有利于本病的诊断，MSCT检查可以有效评价AAP的治疗效果。
목적：분석복형과민성자전（AAP）적다층라선CT（MSCT）표현，탐토MSCT검사재AAP료효평개중적작용。자료여방법회고성분석13례경림상화실험실검사학진위AAP환자적림상화CT검사자료，치료전균행복부CT평소급박층중건，8례행위경검사；치료후10례행CT평소복사，4례행위경복사。비교치료전후림상표현화CT정상적차이。결과치료전13례CT평소중，2례일단장관수루，10례다절단장관수루，1례무양성발현；8례루급십이지장、공회장，5례루급위；수루장관벽배형증후，밀도감저，장강균균성협착，륜곽모호불청，정“쌍배”정；10례장관주위견소량삼출，3례복강소량적액。CT평소오진위급성이선염2례，급성담낭염、장경조、복막염각1례。13례환자중，치유5례，유효8례。환자치료후사지피진、복통、대편잠혈、백세포승고、구토、흑편、뇨잠혈증상교치료전균득도개선（χ2=5.59~18.33，P<0.05、P<0.01）；10례CT복사다절단장관수종、장관주위삼출개변균현저개선（χ2=10.00、9.52，P<0.01），복강적액차이무통계학의의（χ2=1.14， P>0.05）。결론 AAP적CT표현무특이성，피진출현전MSCT진단곤난，결합다절단장관수종、삼출등기본CT정상화림상표현유리우본병적진단，MSCT검사가이유효평개AAP적치료효과。
PurposeTo evaluate multislice spiral CT (MSCT) in diagnosing abdominal anaphylactoid purpura (AAP), and to explore its role in treatment follow-up.Materials and Methods Clinical and MSCT data of 13 patients with confirmed AAP were retrospectively analyzed. All patients underwent abdominal CT scan and thin layer reconstruction. Upper endoscopy was performed in 8 patients prior to treatment. MSCT was performed in 10 patients and endoscopy in 4 patients posttreatment, then clinical and CT features were compared to pretreatment findings.Results In pretreatment CT scan, single segment bowel involvement was found in 2 cases, multisegmental bowel involvement in 10 cases, and no positive finding in 1 patient. The duodenum and jejunum were involved in 8 patients and stomach in 5 patients. The diseased bowel wall showed swelling and thickening with decreased attenuation and homogeneous luminal narrowing with equivocal lining and "double loop" sign. Infiltration was found in 10 patients, small ascites in 3 patients. Patients were misdiagnosed as acute pancreatitis in 2 cases, acute cholecystitis, small bowel obstruction and peritonitis in 1 case respectively. Of 13 patients, five patients were cured, and the other 8 patients were improved. The clinical symptoms including rash, abdominal pain, occult blood, leukocytosis, vomiting, melena, urine occult blood were improved (χ2=5.59-18.33,P<0.05 orP<0.01). Post treatment CT showed significant improvement of bowel edema and infiltration (P<0.01). There was no statistically significant difference in change of ascites (P>0.05).Conclusion MSCT findings of AAP are nonspecific. CT diagnosis is difficult before skin rash. Combining CT characteristics of multisegmental bowel edema and clinical manifestations is helpful. CT examination can effectively follow up treatment response.