临床误诊误治
臨床誤診誤治
림상오진오치
CLINICAL MISDIAGNOSIS & MISTHERAPY
2015年
6期
17-19
,共3页
血管炎%周围神经病%误诊%自身抗体%末梢神经炎%脑梗死
血管炎%週圍神經病%誤診%自身抗體%末梢神經炎%腦梗死
혈관염%주위신경병%오진%자신항체%말소신경염%뇌경사
Vasculitic%Peripheral neuropathy%Misdiagnosis%Autoantibody%Peripheral neuritis%Cerebral infarction
目的：探讨血管炎性周围神经病的诊治要点,并提出防范误诊的措施。方法对我院收治的5例误诊的血管炎性周围神经病的临床资料进行回顾性分析。结果本组均以单根（1例)或多根（4例)周围神经损害就诊,主要表现为肢体麻木、疼痛、肌无力以及步态不稳,均合并不同程度的其他脏器损害,误诊为末梢神经炎2例,脑梗死、脑炎、腰椎间盘突出症各1例。后经肌电图及自身抗体检测确诊。原发病因为干燥综合征2例,抗中性粒细胞胞浆抗体（ anti-Neutrophil Cytoplasmic Antibodies, ANCA)相关性血管炎-显微多血管炎、类风湿性关节炎、未分化结缔组织病各1例。给予糖皮质激素和免疫抑制剂治疗后好转4例,死亡1例。结论血管炎性周围神经病临床表现复杂且无特异性,提高对该病的认识并及时行自身抗体检测有助于早期诊断,避免或减少误诊误治。
目的：探討血管炎性週圍神經病的診治要點,併提齣防範誤診的措施。方法對我院收治的5例誤診的血管炎性週圍神經病的臨床資料進行迴顧性分析。結果本組均以單根（1例)或多根（4例)週圍神經損害就診,主要錶現為肢體痳木、疼痛、肌無力以及步態不穩,均閤併不同程度的其他髒器損害,誤診為末梢神經炎2例,腦梗死、腦炎、腰椎間盤突齣癥各1例。後經肌電圖及自身抗體檢測確診。原髮病因為榦燥綜閤徵2例,抗中性粒細胞胞漿抗體（ anti-Neutrophil Cytoplasmic Antibodies, ANCA)相關性血管炎-顯微多血管炎、類風濕性關節炎、未分化結締組織病各1例。給予糖皮質激素和免疫抑製劑治療後好轉4例,死亡1例。結論血管炎性週圍神經病臨床錶現複雜且無特異性,提高對該病的認識併及時行自身抗體檢測有助于早期診斷,避免或減少誤診誤治。
목적：탐토혈관염성주위신경병적진치요점,병제출방범오진적조시。방법대아원수치적5례오진적혈관염성주위신경병적림상자료진행회고성분석。결과본조균이단근（1례)혹다근（4례)주위신경손해취진,주요표현위지체마목、동통、기무력이급보태불은,균합병불동정도적기타장기손해,오진위말소신경염2례,뇌경사、뇌염、요추간반돌출증각1례。후경기전도급자신항체검측학진。원발병인위간조종합정2례,항중성립세포포장항체（ anti-Neutrophil Cytoplasmic Antibodies, ANCA)상관성혈관염-현미다혈관염、류풍습성관절염、미분화결체조직병각1례。급여당피질격소화면역억제제치료후호전4례,사망1례。결론혈관염성주위신경병림상표현복잡차무특이성,제고대해병적인식병급시행자신항체검측유조우조기진단,피면혹감소오진오치。
Objective To explore the key points of diagnosis and treatment of vasculitic peripheral neuropathies ( VPN) , put forward measures to prevent misdiagnosis of this disease and reduce misdiagnosis rate. Methods Clinical data of 5 misdiagnosed cases of VPN in our hospital were retrospectively analyzed. Results All the patients suffered from periph-eral neuropathy. Single nerve (1 case) or more nerves (4 cases) were damaged. The main symptoms consisted of numbness, pain, muscle weakness in legs and arms, walking instability, and concurrent damage to other organs. They were misdiagnosed as cerebral infarction (1 case), encephalitis (1 case), peripheral neuritis (2 cases), and lumbar disease (1 case). Finally this disorder was diagnosed by electromyography and auto-antibody detection. The primary diseases included Sjogren 's Syn-drome(SS) in 2 cases, ANCA associated vasculitis-microscopic polyangitis (MPA) in 1 case, rheumatoid arthritis(RA) 1 case, undifferentiated connective tissue diseases( UCTD) in 1 case. The prognosis of 4 cases was good after treatment of glu-cocorticoids and immunosuppressant. There was 1 case of death. Conclusion The clinical manifestations of vasculitic periph-eral neuropathies are usually complexed and not specified. To reduce the misdiagnosis rate, more knowledge of this disease should be learned, auto-antibody detection can help in early diagnosis.
