中老年系统性红斑狼疮54例误诊病例分析  

Misdiagnosed Analysis of 54 Middle-aged Patients with Systemic Lupus Erythematosus

作　　者：刘元税[1] 欧阳艳红[1] 宋维[1] 胡志高[1] 杜育刚[1] 

机构地区：[1]海南省人民医院急诊科,海口570311

出　　处：《临床误诊误治》2017年第4期24-28,共5页Clinical Misdiagnosis & Mistherapy

基　　金：2012年度海南省自然科学基金(812150)

摘　　要：目的探讨中老年系统性红斑狼疮(systemic lupus erythematosns,SLE)的临床特点和误诊原因。方法通过电子病案管理系统收集我院2006年1月—2016年10月收治并首诊误诊的54例中老年SLE临床资料。结果我院同期收治中老年SLE患者的误诊率为29.19%(54/185)。54例误诊患者首诊症状为水肿、胸闷、胸痛、咳嗽、发热、头晕、乏力、关节及肌肉疼痛、单侧肢体乏力、皮下出血等。分别误诊为肺炎8例,肾病综合征、冠心病各6例,类风湿性关节炎7例,肾小球肾炎4例,高血压性心脏病、白血病各3例,再生障碍性贫血、骨髓增生异常综合征、脑梗死各2例,肺结核、缺铁性贫血、周期性瘫痪、过敏性紫癜、特发性血小板减少性紫癜、湿疹、脊髓炎、胃炎、肠炎、血栓性静脉炎、颌下腺炎各1例。误诊发生于肾病风湿科14例,余分别发生于血液内科、心血管内科、急诊内科、神经内科、老年病科、呼吸内科、消化内科、皮肤科、保健中心等科室。误诊时间370.5(24.0,1100.0)d。入院后均经ds-DNA抗体、抗核抗体等特异性检查确诊,确诊时间6(5,8)d,住院时间19.5(13.0,27.25)d。结论中老年SLE患者临床表现错综复杂,首发症状不典型,易误诊;非风湿免疫科医师对中老年SLE认识不足和思维局限等是主要误诊原因,对可疑者及早行特异性免疫学检查有助于诊断。Objective To discuss clinical characteristics and misdiagnosed causes of middle-aged patients with systemic lupus erythematosus （SLE）.Methods Clinical data of 54 SLE patients who were misdiagnosed at the first diagnosis during January 2006 and October 2016 was collected by management system of electronic medical record.Results The misdiagnosis rate of middle-aged SLE patients admitted by our hospital in the corresponding period was 29.19% （54/185）.Symptoms of the misdiagnosed patients in primary diagnosis included edema, dyspnea, chest pain, cough, fever, dizziness, acratia, pain in joints and muscles, weakness in unilateral limb, subcutaneous hemorrhage, etc.Among the 54 patients, 8 patients were misdiagnosed as having pneumonia, 6 as having primary nephritic syndrome, 6 as having coronary heart disease, 7 as having rheumatoid arthritis, 4 as having glomerulonephritis, 3 as having hypertensive heart disease, 3 as having leukemia, 2 as having aplastic anemia, 2 as having myelodysplastic syndrome, 2 as having cerebral infarction, 1 as having pulmonary tuberculosis, 1 as having iron deficiency anemia, 1 as having periodic paralysis, 1 as having anaphylactoid purpura, 1 as having idiopathic thrombocytopenic purpura, 1 as having eczema, 1 as having myelitis, 1 as having gastritis, 1 as having enteritis, 1 as having thrombophlebitis and 1 as having submaxillitis.A total of 14 patients were misdiagnosed in nephropathy and rheumatology department, and others were misdiagnosed in hemopathology department, vasculocardiology department, emergency department, neurology department, gerontology department, respiratory medicine department, digestive system diseases department, dermatology department and health center respectively.The misdiagnosis period was 370.5（24.0,1100.0）d.The patients were finally confirmed after specific inspections such as ds-DNA and antinuclear antibody.The time of final diagnosis was 6（5,8）d, and the length of hospital stay was 19.5（13.0,27.25）d.Conclusion Clinical manifestations o

关 键 词：红斑狼疮 系统性 中老年人 误诊 肺炎 肾病综合征 冠心病 脑梗死 

分 类 号：R593.241[医药卫生—内科学]