重症肌无力临床表现及误诊原因分析  

Analysis of Clinical Manifestations and Causes of Misdiagnosis of Myasthenia Gravis

作　　者：颜聪亚 赵帅 顾珊珊 乞国艳 YAN Congya;ZHAO Shuai;GU Shanshan;Qi Guoyan(Myasthenia Gravis Treatment Center of Hebei Province,Shijiazhuang People's Hospital,Shijiazhuang 050030,China;Department of Acupuncture and Moxibustion,Shijiazhuang People's Hospital,Shijiazhuang 050030,China)

机构地区：[1]石家庄市人民医院河北省重症肌无力诊疗中心,石家庄050030 [2]石家庄市人民医院针灸科,石家庄050030

出　　处：《临床误诊误治》2024年第21期11-14,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省石家庄市科学技术研究与发展指导计划(181461143)。

摘　　要：目的探讨重症肌无力的临床特点、误诊原因及防范措施。方法回顾性分析2022年1月至2023年1月收治的48例被误诊为其他疾病的重症肌无力患者的临床资料。结果本组26例因眼睑下垂、复视、眼球运动受限就诊,误诊为动眼神经麻痹;12例因轻度吞咽费力、言语不清、饮水呛咳就诊,误诊为脑血管病;3例因四肢无力就诊,误诊为Lambert-Eaton综合征;2例以腰部无力为首发症状就诊,误诊为腰肌劳损、腰椎间盘突出各1例;3例以单纯吞咽困难就诊,误诊为咽喉炎;1例因胸闷气短为首发症状,误诊为冠心病;1例因双下肢无力且伴有上呼吸道感染病史,误诊为吉兰-巴雷综合征。入院后经详细询问病史、行新斯的明试验、检测乙酰胆碱受体抗体、抗肌肉特异性酪氨酸激酶抗体、胸部CT及肌电图后明确诊断为重症肌无力。误诊时间为3~35 d。确诊后给予相应治疗,所有患者症状得到明显改善,随访6个月,无复发,预后良好。结论重症肌无力为罕见的自身免疫性疾病,临床表现多样且不典型,易误诊,需要引起临床重视,在诊疗过程中重视重症肌无力的疾病特点,全面分析病情,重视针对性检查,可减少或避免误诊误治。Objective To investigate the clinical characteristics,causes of misdiagnosis and preventive measures of myasthenia gravis(MG).Methods We performed a retrospective analysis of the clinical data of 48 patients with MG misdiagnosed as other diseases from January 2022 to January 2023.Results In this group,26 patients presented with ptosis,diplopia and limited eye movement,and were misdiagnosed with oculomotor nerve palsy,and 12 patients were misdiagnosed as cerebrovascular disease due to mild dysphagia,slurred speech and coughing after drinking water.Three patients were misdiagnosed as Lambert-Eaton syndrome due to weakness of limbs,and 2 patients presented with lumbar weakness as the initial symptom,and were misdiagnosed with lumbar muscle strain and lumbar disc herniation respectively.Three patients presented with simple dysphagia and were misdiagnosed as pharyngitis.One patient was misdiagnosed as coronary heart disease due to chest tightness and shortness of breath,and 1 patient was misdiagnosed as Guillain-Barre syndrome due to weakness of both lower limbs and a history of upper respiratory infection.After admission,MG was confirmed by detailed medical history,neostigmine test,detection of acetylcholine receptor antibodies,anti-muscle-specific tyrosine kinase antibodies,chest CT and electromyography.The misdiagnosis lasted 3-35 d.After diagnosis,the corresponding treatment was given,and the symptoms of all patients were significantly improved.At 6-month follow-up,there was no recurrence,and the prognosis was good.Conclusion MG is a rare autoimmune disease with diverse and atypical clinical manifestations,which is more likely to be misdiagnosed.Clinical attention should be paid to the characteristics of MG in the course of diagnosis and treatment,comprehensive analysis of the disease,and targeted examination,which can reduce or avoid misdiagnosis and mistreatment.

关 键 词：重症肌无力 误诊 动眼神经疾病 脑血管障碍 LAMBERT-EATON综合征 新斯的明试验 乙酰胆碱受体抗体 抗肌肉特异性酪氨酸激酶抗体 肌电图 

分 类 号：R746.1[医药卫生—神经病学与精神病学]