以皮肤瘙痒为首发症状的原发性胆汁性肝硬化临床误诊分析  

Clinical Misdiagnosis of Primary Biliary Cirrhosis with Pruritus as the Initial Symptom

作　　者：徐广超 安松[3] 唐小惠 孙倩 孙雪珊[1] 孙立娜[1] 吴静 XU Guangchao;AN Song;TANG Xiaohui;SUN Qian;SUN Xueshan;SUN Lina;WU Jing(Department of Clinical Laboratory,the First Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Gastroenterology,the First Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Clinical Laboratory,Wangdu Hospital of Traditional Chinese Medicine,Wangdu,Hebei 072450,China)

机构地区：[1]保定市第一医院检验科,河北保定071000 [2]保定市第一医院消化科,河北保定071000 [3]望都县中医院检验科,河北望都072450

出　　处：《临床误诊误治》2024年第10期11-15,共5页Clinical Misdiagnosis & Mistherapy

基　　金：保定市科技计划项目(2141ZF227)。

摘　　要：目的分析以皮肤瘙痒为首发症状的原发性胆汁性肝硬化(PBC)患者早期误诊的原因及防范措施。方法选取2022年5月至2023年11月收治早期误诊为皮肤瘙痒症的以皮肤瘙痒为首发症状的PBC患者,分析其临床资料。结果3例中2例为中老年女性,1例为中年男性,均以皮肤瘙痒为首发症状就诊,并伴全身乏力,均未查肝功能,初诊为皮肤瘙痒症,予对症治疗未见明显好转。后经详细查体、多次查肝功能、腹部彩超和(或)肝脏CT,并行血清抗线粒体抗体(AMA)检测阳性,确诊为PBC。误诊时间13 d~4年半。确诊后予以熊去氧胆酸等药物治疗,肝功能恢复正常,症状好转或消失。结论PBC早期症状常不典型,当接诊以皮肤瘙痒为主要症状伴乏力、黄疸和肝功能损伤无或较轻患者时,应多次动态观察肝功能指标变化,行血清AMA检测,必要时行肝穿刺病理学检查,多可确诊。此外,接诊医生应加强对本病的认识,熟知引起肝功能损伤的病因,仔细鉴别,认真查体,尤其应重视男性患者发病的可能,提高警惕性。Objective To analyze the causes and preventive measures of early misdiagnosis in patients with primary biliary cirrhosis(PBC)with pruritus as the initial symptom.Methods From May 2022 to November 2023,PBC patients who had been initially misdiagnosed as pruritus with pruritus as the initial symptom were selected,and their clinical data were analyzed.Results Among the 3 patients,2 were middle-aged and elderly women and 1 was middle-aged man.All of them presented with pruritus as the initial symptom,accompanied by general fatigue.Liver function was not detected in all of them.The initial diagnosis was skin pruritus,which did not show significant improvement after symptomatic treatment.After detailed physical examination,multiple liver function tests,abdominal color ultrasound and/or liver CT,and serum anti-mitochondrial antibody(AMA)positive test,PBC was confirmed.The misdiagnosis lasted from 13 d to 4.5 years.After diagnosis,they were treated with Ursodeoxycholic Acid and other drugs,liver function returned to normal,and symptoms improved or disappeared.Conclusion The early symptoms of PBC are often atypical.When the patients present with pruritus as the main symptom accompanied by fatigue,jaundice and no or mild liver function injury,the changes of liver function indexes should be dynamically observed repeatedly,and serum AMA detection should be performed,as well as liver puncture pathology when necessary,to confirm the diagnosis.In addition,the attending doctors should strengthen the understanding of the disease,be familiar with the cause of liver function injury,perform careful identification and physical examination,especially should pay attention to the possibility of male patients developing the disease,and improve vigilance.

关 键 词：原发性胆汁性肝硬化 皮肤系统表现 误诊 皮肤瘙痒症 抗线粒体抗体 肝功能 肝穿刺病理学检查 鉴别诊断 

分 类 号：R575.22[医药卫生—消化系统]