摘要
目的回顾分析115例肌萎缩侧索硬化症患者院前误诊情况,加深对该病临床特点的认识,减少误诊,实现尽早诊断和尽早治疗。方法收集北京大学第三医院2003年1月-2005年3月全部诊断为运动神经元病住院患者的临床资料,按照肌萎缩侧索硬化症的诊断标准(修订版)对所有患者进行严格诊断,将其中“确诊为肌萎缩侧索硬化症”和“很可能肌萎缩侧索硬化症”(包括很可能和实验室支持的很可能)115例患者作为观察对象。结果115例患者中符合“确诊”标准者74例,“很可能”标准41例;平均诊断间期为14.80个月,平均误诊间期6.40个月。其中误诊者72例,未误诊28例,余15例为我院首诊患者,无一例误诊,院前误诊率为72.00%(72/100“确诊”和“很可能”患者的误诊率分别为)。72.31%和71.43%,二者相比差异无显著性意义(P>0.05)。症状首发部位分别为球部合并上肢(5例)、单侧上肢(49例)、单侧下肢(15例)以及偏侧上下肢者(2例),共71例,其误诊率达80.28%(57/71)。在误诊病种中,以颈椎病最为多见,其次为脑血管疾病。北京市与外埠患者的误诊率分别为50.00%(13/26)和79.73%(59/74),二者相比差异具有显著性意义(P<0.05)。80%以上误诊发生于基层医院,最终明确诊断局限于教学医院。结论引起肌萎缩侧索硬化症误诊的原因除疾病本身具有临床较少见的特点外,医生对其认识不足亦是发生误诊的重要因素之一,故提高医生对该病的了解并加强专业修养,是降低肌萎缩侧索硬化症误诊率的有效方法和必要手段。
Objective The pre-admission misdiagnosed patterns of 115 patients with amyotrophic lateral sclerosis （ALS） were retrospectively reviewed in order to strengthen the recognition of the clinical characteristics of this disease, minimize the misdiagnosis, and achieve the early diagnosis and treatment. Methods The clinical data of admitted patients diagnosed as motor neuron disease during January 2003 to March 2005 in The Third Hospital of Peking University were reviewed. All of the patients were strictly diagnosed according to the revised edition of the diagnostic criteria for ALS. A total of 115 patients with definitely diagnosed ALS and very possible ALS （including clinically and laboratory supported cases） were enrolled as study objects. Results There were 74 definite ALS cases and 41 very possible cases in all the 115 patients. Their mean diagnosis duration was 14.80 months, mean misdiagnosis duration was 6.40 months. Among these patients there were misdiagnosed 72 cases, not misdiagnosed 28 cases （15 of them were first diagnosed in this hospital, none was misdiagnosed）. The total misdiagnosis rate was 72.00% （72/100） pre-admission. In definite and very possible ALS patients the misdiagnosis rates were 72.31% and 71.43% respectively, there was no significant difference between them （P〉0.05）. The misdiagnosis rate was as high as 80.28% in patients of first occurred symptoms in bulbar and upper limbs （n=5）, single upper limb （n=49）, single lower limb （n=15）, lateral limbs （n=2）. Most of misdiagnosed cases were patients with cervical spondylopathy, and cerebral vascular diseases. The misdiagnosis rate was 50.00% in Beijing, and 79.73% in other places, their difference was significant （P〈0.05）. Most of the misdiagnosed cases （〉80%） were found in basic hospitals, the final correct diagnosis were achieved in the teaching hospitals. Conclusion The main cause of misdiagnosis in ALS were the infrequent clinical characteristics of the disease and insufficient knowledge of d
出处
《中国现代神经疾病杂志》
CAS
2005年第4期240-243,共4页
Chinese Journal of Contemporary Neurology and Neurosurgery
关键词
肌萎缩侧索硬化症
脑血管疾病
脊柱骨赘病
运动神经元
Amyotrophic lateral sclerosis Diagnostic errors Spinal osteophytosis Cerebrovascular disorders
