以发热为主要表现的孟乔森综合征两例并文献复习  

Munchausen syndrome manifested as fever: report of two cases and literature review

作　　者：梁锦坚[1] 莫颖倩[1] 李艳华[1] 韦秀宁[1] 李谦华[1] 郑东辉[1] 戴冽[1] Liang Jinjian;Mo Yingqian;Li Yanhua;Wei Xiuning;Li Qianhua;Zheng Donghui;Dai Lie

机构地区：[1]中山大学孙逸仙纪念医院风湿免疫科,广州510120

出　　处：《新医学》2017年第7期503-507,共5页Journal of New Medicine

摘　　要：目的总结孟乔森综合征的临床特点,提高临床医师对该病的认识。方法回顾2例不明原因发热住院的孟乔森综合征患者的临床资料,并以"孟乔森综合征"或"做作性障碍"、"Munchausen syndrome"或"Factitious disorder"为检索词,在中国期刊全文数据库、万方数据知识服务平台及Pubmed检索相关文献,总结孟乔森综合征的临床特点。结果 2例患者均为青年女性,以发热为主诉,不断接受各种检查,住院期间医护人员直接或间接发现了患者伪造发热的证据,从而诊断孟乔森综合征。国内共报道了4例孟乔森综合征,其中1例反复自残致病,其余3例扮演病人角色反复求医。复习文献显示孟乔森综合征患者女性多于男性,47.3%患者有医疗相关培训经历,与临床表现不相吻合的实验室检查结果是最常见的诊断依据,仅20.4%患者愿意接受精神治疗。结论孟乔森综合征的主要特点是患者描述的症状与体征、实验室及辅助检查结果不相符,临床医师应及早发现患者伪造症状的证据,避免过度检查及治疗带来的医源性损害。Objective To summarize the clinical characteristics of M unchausen syndrome and enhance the clinicians'understanding of M unchausen syndrome.Methods Clinical data of two patients withM unchausen Syndrome m anifested as fever of unknown origin were reviewed.Literature review was conducted from the China National Knowledge Infrastructure,Wanwang Database and PubM ed using the key words of“M unchausen syndrom e”or“Factitious disorder”in both English and Chinese.The clinical characteristics of M unchausen syndrome were analyzed.Results Two female patients reported chief complaints of fever.They received m ultiple examinations.During hospitalization,they were found to deliberately fabricate the symptoms and the diagnosis of M unchausen syndrome was subsequently made.Four cases have been reported in China.One case suffered from M unchausen syndrome due to repeated self-m utilation,and the rem aining3were repeatedly adm itted and treated by pretending as patients.Literature review found that the proportion of female was higher than that of male counterparts in M unchausen syndrome patients and47.3%of patients obtained m edical training experience.The diagnosis of M unchausen syndrome was mainly validated by inexplicable laboratory examination results which were inconsistent with clinical symptoms.Merely20.4%of patients were willing to accept psychiatric treatm ent.Conclusion M unchausen syndrome patients tend to fabricate symptoms and signs,which are inconsistent with laboratory and auxiliary examination results.Clinicians should pay early attention to averting iatrogenic damage induced by excessive examination and treatment.

关 键 词：孟乔森综合征 做作性障碍 不明原因发热 

分 类 号：R749[医药卫生—神经病学与精神病学]