成人不典型哮喘误诊漏诊原因分析  

Analysis for the cause of misdiagnosis or missed diagnosis of adults with atypical asthma

作　　者：楚辉[1] 高玮 CHU Hui;GAO Wei(Department of Respiratory Medicine,Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China;不详)

机构地区：[1]首都医科大学附属北京天坛医院呼吸内科,北京市100070 [2]河北省石家庄市人民医院

出　　处：《河北医药》2021年第17期2618-2620,2624,共4页Hebei Medical Journal

基　　金：北京市临床重点专科项目经费资助[京卫医(2020)129号]。

摘　　要：目的对不典型哮喘误诊与漏诊的原因进行分析,提高临床医生对不典型哮喘的认识,减少误诊与漏诊的发生。方法回顾性分析2016年1月至2019年12月就诊的47例不典型哮喘患者,分析其临床特点、实验室检查等,对误诊及漏诊原因进行分析。结果47例患者中,男21例,女26例;年龄14~72岁,平均年龄(40.22±15.03)岁;有症状的患者病程1~24个月。咳嗽变异性哮喘37例(78.72%);胸闷变异性哮喘8例(17.02%);隐匿性哮喘2例(4.26%)。47例患者中除2例隐匿性哮喘因其他疾病入住手术科室经常规术前肺功能检查被诊断外,其余45例患者均曾被误诊的病史。47例患者中有哮喘家族史13例(27.66%)。有过敏性疾病史22例(46.81%)。47例患者中具有典型气道高反应的临床表现28例,具有阳性体征2例。47例患者中行激发试验呈阳性确诊19例,经舒张试验检查呈阳性确诊26例,呼气峰流量(PEF)监测日昼夜变异率>10%确诊2例。行呼出气一氧化氮(FeNO)检查26例,结果25~50 ppb 8例(8/26,30.77%);结果>50 ppb 8例(8/26,30.77%),结果正常<25 ppb 10例(10/26,38.46%)。47例患者中完全控制36例,部分控制11例,未控制者为0例。总有效率100%。结论不典型哮喘临床表现不典型,医生对不典型哮喘认识不足、病史收集不充分、实验室检查复杂都是引起不典型哮喘误诊与漏诊的原因。但仔细询问病史、合理选择肺功能及FeNO检查可帮助临床医生加强对不典型哮喘的诊断。Objective To investigate the cause of misdiagnosis or missed diagnosis of atypical asthma,and improve the cognition of clinicians for atypical asthma,so a to decrease the occurrence of misdiagnosis and missed diagnosis.Methods The clinical characteristics,laboratory inspection and the cause of misdiagnosis or missed diagnosis of 47 patients with atypical asthma from January 2016 to December 2019 were retrospective analysed.Results Among the 47 patients,there were 21 males and 26 females,aging from 14~72 years old,with mean age being(40.22±15.03)years.There were 37 cases of cough variant asthma(78.72%),8 cases of chest distress variant asthma(17.02%),2 cases of concealed asthma(4.26%).Exceop for 2 cases with concealed asthmathe other 45 cases had the history of misdiagnosis.Moreover 13 patients had a family history of asthma(13/47,27.66%),of whom,22 patients had a history of allergic disease(46.81%),and 28 patients had the clinical manifestation of typical airway hyperresponsiveness,and 2 patients had positive sign.Of the 47 patients,19 patients were diagnosed as positive cases by provocation test,26 patients were diagnosed as positive cases by relaxation experiment examination.And there were 2 cases whose PEF mutation rate was more than 10%.There were 26 cases carried out FeNO examination,and there were 8 cases(32%)whose FeNO value was between 25ppb and 50ppb,and 8 cases(32%)whose FeNO value was more than 50ppb,10 patients(40%)were less than 25 ppb.Conclusion The clinical manifestation of atypical asthma is atypical,the cognition deficiency of doctors and the collection insufficiency of medical history as well as the complex laboratory examination are the causes for misdiagnosed and missed diagnosis of atypical asthma.And to inquiry the medical history carefully,reasonable selection the examination of lung function and FeNO are helpful for clinicians to improve the diagnosis of atypical asthma.

关 键 词：不典型哮喘 咳嗽变异性哮喘 胸闷变异性哮喘 隐匿性哮喘 

分 类 号：R562.25[医药卫生—呼吸系统]