系统性红斑狼疮早期漏误诊原因分析  

Hie Analysis of Misdiagnostic Causes of Eariy Systemic Lupus Erytfaematosus

作　　者：张汝忠[1] 顾同进[1] 王群献[1] 

机构地区：[1]上海华东医院,上海200040

出　　处：《中国医药导刊》2002年第6期400-402,共3页Chinese Journal of Medicinal Guide

摘　　要：目的:探讨系统性红斑狼疮(SLE)患者早期误漏诊原因,提高SLE诊断水平。方法:对我院住院诊断的63例SLE患者临床资料进行回顾性分析。结果:(1)63例确诊为SLE患者的病程为(4.38±3.13)年;(2)早期误诊率高达68.3％,误诊的病种有:上呼吸道感染、急性阑尾炎、类风湿性关节炎、风湿性关节炎、急性肾炎、心包炎、胸膜炎、慢性肝炎、淋巴结炎、淋巴瘤等。发热、关节痛,皮疹是SLE早期最常见的症状,面部盘状红斑、颧部红斑是最具特征的表现;(3)特异性指标的阳性率低:狼疮细胞(LE)17.6％,抗ds-DNA抗体20％,抗核抗体(ANA)26.6％;(4)发热和白细胞明显升高者占误诊的74.4％(32/43);血沉增快和尿检蛋白阳性在未误诊者与误诊者间存在明显差异(P<O.05)。结论:早期SLE误诊主要原因缺乏系统表现,实验室特异性检查阳性率低,发热、白细胞升高是早期SLE容易误诊的因素,血沉明显升高和尿检异常是SLE早期诊断有价值的指标。Objective: To analyze the misdiagnostic causes of early systemic lupus erythematosus(SLE) , Methods: 63 cases of SLE patients from 1982 - 2001 years were studied retrospectively. Results: The mean disease duration before distinct diagnosing SLE was (4.38* 3.13) years , misdiagnostic rate was 68.3% .Etiology was confused among upper respiratory tract infection, acute appendicitis, rheumatoid arthritis, acute glomerulonephritis, lymphoma, lymphnoditis, pericarditis, pleuropneumonia, chronic hepatitis. Fever , rash and arthralgia were the commonest clinical features, malar rash and discoid rash were the special characters that physician paid attention to. Positivity of ANA and/ or anti - dsDNA was low in early SLE. Fever and elevation of white cell were associated with increased misdiagnostic rate. Elevation of erythrocyte sedimentation rate (ESR) and abnormality of urine routine examination were associated with increased diagnostic rate. Conclusion: Lack of systemic manifestations and characteristic laboratory findings were associated with increased misdiagnostic rate, so were fever and elevation of white cell. Elevation of ESR and abnonnality of urine routine examination were the predict factors on diagnosing early SLE.

关 键 词：原因 系统性红斑狼疮 误诊率 SLE 诊断 漏诊 误诊 

分 类 号：R593.241[医药卫生—内科学]