临床误诊误治2017，Vol.30Issue(4)：24-28,5.DOI:10.3969/j.issn.1002-3429.2017.04.009
中老年系统性红斑狼疮54例误诊病例分析
Misdiagnosed Analysis of 54 Middle-aged Patients with Systemic Lupus Erythematosus
摘要
Abstract
Objective To discuss clinical characteristics and misdiagnosed causes of middle-aged patients with systemic lupus erythematosus (SLE).Methods Clinical data of 54 SLE patients who were misdiagnosed at the first diagnosis during January 2006 and October 2016 was collected by management system of electronic medical record.Results The misdiagnosis rate of middle-aged SLE patients admitted by our hospital in the corresponding period was 29.19% (54/185).Symptoms of the misdiagnosed patients in primary diagnosis included edema, dyspnea, chest pain, cough, fever, dizziness, acratia, pain in joints and muscles, weakness in unilateral limb, subcutaneous hemorrhage, etc.Among the 54 patients, 8 patients were misdiagnosed as having pneumonia, 6 as having primary nephritic syndrome, 6 as having coronary heart disease, 7 as having rheumatoid arthritis, 4 as having glomerulonephritis, 3 as having hypertensive heart disease, 3 as having leukemia, 2 as having aplastic anemia, 2 as having myelodysplastic syndrome, 2 as having cerebral infarction, 1 as having pulmonary tuberculosis, 1 as having iron deficiency anemia, 1 as having periodic paralysis, 1 as having anaphylactoid purpura, 1 as having idiopathic thrombocytopenic purpura, 1 as having eczema, 1 as having myelitis, 1 as having gastritis, 1 as having enteritis, 1 as having thrombophlebitis and 1 as having submaxillitis.A total of 14 patients were misdiagnosed in nephropathy and rheumatology department, and others were misdiagnosed in hemopathology department, vasculocardiology department, emergency department, neurology department, gerontology department, respiratory medicine department, digestive system diseases department, dermatology department and health center respectively.The misdiagnosis period was 370.5(24.0,1100.0)d.The patients were finally confirmed after specific inspections such as ds-DNA and antinuclear antibody.The time of final diagnosis was 6(5,8)d, and the length of hospital stay was 19.5(13.0,27.25)d.Conclusion Clinical manifestations of middle-aged patients with SLE are complicated with atypical initial symptom, and therefore it is easily misdiagnosed.Mainly misdiagnosed causes are shortage of SLE understanding and thinking limitation of clinicians in non-rheumatism and immune departments, and specificity immunologic test should be performed as early as possible for doubtful patients to help early diagnosis of SLE.关键词
红斑狼疮/系统性/中老年人/误诊/肺炎/肾病综合征/冠心病/脑梗死Key words
Lupus erythematosus/systemic/Middle-aged and elderly/Misdiagnosis/Pneumonia/Nephrotic syndrome/Coronary disease/Brain infarction分类
医药卫生引用本文复制引用
刘元税,欧阳艳红,宋维,胡志高,杜育刚..中老年系统性红斑狼疮54例误诊病例分析[J].临床误诊误治,2017,30(4):24-28,5.基金项目
2012年度海南省自然科学基金(812150) （812150）
