以低蛋白血症为主要表现的蛋白丢失性胃肠病病因和误诊分析  

Etiological analysis and the reasons of misdiagnosis of Protein-losing Gastroenteropathy with the manifestation of Hypoproteinemia

作　　者：徐美华[1] 贺帼英[1] 张桂英[1] 李新华[1] 刘霆[1] 李乾[1] 

机构地区：[1]中南大学湘雅医院消化科,湖南长沙410008

出　　处：《中国现代医学杂志》2010年第3期422-425,428,共5页China Journal of Modern Medicine

摘　　要：目的分析以低蛋白血症为主要表现的蛋白丢失性胃肠病的病因及其误诊原因,旨在加深对其病因的认识,提高其诊断率,减少误诊。方法收集2002年1月～2007年12月湘雅医院住院患者作为研究对象,选择以低蛋白血症为主要表现的蛋白丢失性胃肠病16例。结果①16例病例中蛋白丢失性胃肠病病因为不典型克罗恩氏病、小肠淋巴管扩张症、免疫增殖性小肠病、Menetrier’s病、多发性硬化及嗜酸性胃肠炎,其中以克罗恩氏病多见,占50.00%(8/16);②以低蛋白血症为主要表现的罕少见病误诊率高达62.50%(10/16)。③双气囊小肠镜对以低蛋白血症为主要表现的小肠罕少见病检出率100%(9/9)。结论①以低蛋白血症为主要表现的蛋白丢失性胃肠病误诊率高;其病因以不典型克罗恩氏病最常见且容易误诊;②双气囊小肠镜检查对该病的诊断有重要诊断价值。【Objective】To make an a etiological analysis and to approach the reasons of misdiagnosis of protein-losing gastroenteropathy with the manifestation of hypo-proteine-mia,improving the diagnosis rate and reducing the misdiagnosis.【Methods】Selecting in-patients＇ medical records in Xiangya Hospital from January 2002 to December 2007,who has the clinical manifestations of hypoalbuminemia,16 cases meet the requirements.【Results】The etiologies of the protein-losing gastroenteropathy with the manifestation of hpoproteinemia exist in untypical Crohn＇s disease,primary intestinal lymphangiectas,immunoproliferative enteropathy,Menetrier＇s disease and multiple sclerosis.Crohn＇s disease are 50.00%（8/16）,62.50% of all the cases have the history of misdiagnosis,100% of the double-ballon enteroscopy exam find the pathological changes in intestinal protein-losing gastroenteropathy with the manifestation of hypoalbuminemia.【Conclusions】There are high rate of misdiagnosis in the protein-losing gastroenteropathy with hypoalbuminemia.The cases are diagnosed untypical Crohn＇s disease is in the protein-losing gastroenteropathy with the manifestation of hypoalbuminemia and is easily misdiagnosed.The double-ballon enteroscopy is valuable to the diagnosis for the protein-losing gastroenteropathy with the hypoalbuminemia.

关 键 词：低蛋白血症 蛋白丢失性胃肠病 误诊率 病因 

分 类 号：R57[医药卫生—消化系统] R447[医药卫生—内科学]