误诊为炎症性肠病、阑尾炎的肠白塞病临床分析  

Clinical Analysis of Intestinal Behcet's Disease Misdiagnosed as Inflammato⁃ry Bowel Disease and Appendicitis

作　　者：韩峰 吕黄勇 夏季 牟大礼 林玲 HAN Feng;LYU Huangyong;XIA Ji;MU Dali;LIN Ling(Department of Gastroenterology,the 926th Hospital of Joint Logistics Support Force of the PLA,Kaiyuan,Yunnan 661600,China)

机构地区：[1]联勤保障部队第九二六医院消化内科,云南开远661600

出　　处：《临床误诊误治》2024年第14期5-9,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨肠白塞病的临床特点、诊断及鉴别诊断要点,总结分析误诊原因和防范措施。方法对2014年1月至2024年5月收治的病初曾误诊为炎症性肠病和阑尾炎的肠白塞病7例的临床资料进行回顾性分析。结果7例以腹痛、腹泻、消化道出血、发热和腹部压痛、反跳痛为主要临床表现。4例白细胞、中性粒细胞升高;6例红细胞沉降率增快;5例C反应蛋白升高;全部患者抗中性粒细胞胞浆抗体、抗核抗体、抗双链DNA抗体及抗ENA抗体阴性;IgG升高4例,补体C3、C4降低5例,核周型抗中性粒细胞胞浆抗体阳性2例,抗心磷脂抗体阳性1例、类风湿因子阳性1例、便潜血试验阳性4例。胃镜示反流性食管炎1例。结肠镜检查示结直肠多发溃疡形成,伴有不同程度黏膜充血、糜烂、肠腔狭窄变形、结肠多发性息肉等。7例肠黏膜活检病理示回盲部/结肠黏膜急性和(或)慢性炎。于基层医院误诊为炎症性肠病4例,阑尾炎3例。入住我院后根据临床表现、实验室检查、胃肠镜检查及相关诊疗指南确诊为肠白塞病,误诊时间23 d~12年。确诊后7例给予糖皮质激素和(或)联合免疫抑制剂治疗,合并胃溃疡、反流性食管炎患者同时予抑酸剂及黏膜保护剂治疗,并发肠道穿孔或大出血者予手术治疗,7例均病情控制好转出院。结论肠白塞病易误诊,临床医师应提高对该病的警惕性,遇及疑似患者应及时行肠镜和病理检查,并根据临床表现及其他医技检查结果综合分析,以及早明确诊断并治疗。Objective To explore the clinical features,diagnosis and differential diagnosis of intestinal Behcet's dis-ease,and to summarize and analyze the causes of misdiagnosis and preventive measures.Methods From January 2014 to May 2024,the clinical data of 7 patients with intestinal Behcet's disease,which were initially misdiagnosed as inflammatory bowel disease and appendicitis,were retrospectively analyzed.Results The main clinical manifestations of 7 patients were abdominal pain,diarrhea,gastrointestinal bleeding,fever,abdominal tenderness and rebound pain.Blood routine examina-tion of 4 patients showed increased leukocytes and neutrophils.Erythrocyte sedimentation rate increased in 6 patients,and C reactive protein increased in 5 patients.All patients were negative for anti-neutrophil cytoplasmic antibody,anti-nuclear an-tibody,anti-double-stranded DNA antibody and anti-ENA antibody.IgG increased in 4 patients,while complement C3 and C4 decreased in 5 patients.Perinuclear anti-neutrophil cytoplasmic antibody was positive in 2 patients,anti-cardiolipin antibody was positive in 1 patient,rheumatoid factor was positive in 1 patient,and stool occult blood test was positive in 4 patients.Gastroscopy showed reflux esophagitis in 1 patient.Colonoscopy showed the formation of multiple ulcers in the colon and rec-tum,accompanied by different degrees of mucosal congestion,erosion,intestinal stenosis and deformation,and multiple pol-yps in the colon.Acute and/or chronic inflammation of ileocecal/colonic mucosa was found in 7 patients as pathological mani-festations by intestinal mucosal biopsy.In primary hospitals,4 patients were misdiagnosed with inflammatory bowel disease and 3 patients with appendicitis.After admission to our hospital,the patients were diagnosed with intestinal Behcet's disease according to clinical manifestations,laboratory examination,gastroenteroscopy and related diagnosis and treatment guidelines,and the misdiagnosis lasted 23 d to 12 years.After diagnosis,7 patients were treated with glucocorticoids a

关 键 词：白塞病 肠型 误诊 炎症性肠病 阑尾炎 鉴别诊断 

分 类 号：R597[医药卫生—内科学]