血栓性血小板减少性紫癜临床诊断及误诊分析  

To analyze the early clinical diagnosis and misdiagnosis of thrombotic thrombocytopenic purpura

作　　者：刘芳[1] 冯胜强[2] 杨清明[1] 彭朝津[1] 杜瑜[1] 刘默[1] 周宏伟[1] 欧阳璨[1] 曹志刚[1] 

机构地区：[1]解放军总医院第一附属医院干三科,北京100037 [2]总参警卫局保健处

出　　处：《中华保健医学杂志》2011年第2期130-132,共3页Chinese Journal of Health Care and Medicine

摘　　要：目的分析血栓性血小板减少性紫癜(TTP)诱因、早期临床表现及误诊疾病,提高临床工作者对TTP的认识。方法回顾性分析9例TTP患者的早期临床表现、误诊疾病、实验室检查及相关病因。结果 9例患者早期临床表现迥异,出现时间无明显规律性,早期诊断中8例误诊,误诊的疾病分别为病毒性感冒、急性肾小球肾炎和泌尿系感染、特发性血小板减少性紫癜、骨髓异常增生综合征、脑梗死、自发性溶血性贫血,误诊率为88.9(8/9)。8例给予新鲜冰冻血浆置换和(或)甲泼尼龙、丙种球蛋白等药物治疗,6例治愈。3例因延迟诊断治疗死亡。结论 TTP病情凶险,病因复杂;早期临床症状迥异,若未及时明确诊断,可增加病死率。Objective To analyze the predisposing factors,early clinical symptoms and clinical misdiagnosis of thrombotic thrombocytopenic purpura（TTP）,and to raise awareness of this disease among clinical practitioners.Methods Data of nine cases diagnosed of TTP in our hospital were reviewed retrospectively,and four indexes were studied including early clinical symptoms,clinical misdiagnosis,laboratory examination and the etiology of the cases.Results In our study,the early clinical symptoms of the nine cases of TTP were various and the time of onset of symptoms varied significantly.Eight cases were misdiagnosed as virus flu,acute glomerulonephritis,urinary system infection,idiopathic thrombocytopenic purpura（ITP）,myelodysplastic syndrome,cerebral infarction and spontaneous hemolytic anemia,the rate of misdiagnosis was 88.9%（8/9）.Three cases died because of delayed diagnosis and treatment.Plasma exchange improved TTP prognosis dramatically,decreasing the mortality from 90% to less than 20%.Conclusions TTP is a life-threatening disease with complex etiologies.The early clinical symptoms of TTP are diversified,and the misdiagnosis rate is high.Misdiagnosis of the disease in its early stage may increase the mortality rate of TTP.

关 键 词：血栓性血小板减少性紫癜 误诊 早期诊断 

分 类 号：R558[医药卫生—血液循环系统疾病]