摘要
目的 了解结缔组织病合并肺栓塞的临床特征,分析其误诊原因.方法 回顾性分析2006年2月至2014年3月阜外心血管病医院住院收治的22例结缔组织病合并肺栓塞患者的临床资料,包括其临床症状、发病特点、实验室检查特征和影像学检查资料并分析漏误诊原因.结果 22例患者中,男12例,女10例;年龄14～ 65岁,平均（36.2±14.2）岁;同时合并下肢深静脉血栓形成12例（54.5％）,结缔组织病以抗磷脂抗体综合征14例（63.6％）和贝赫切特综合征4例（18.2％）所占比例较多.胸闷、心悸20例（90.9％）,肢体肿胀10例（45.5％）等血栓表现为常见首发症状.实验室检查示红细胞沉降率增快11例（50.0％）,C反应蛋白升高8例（36.4％）和自身抗体异常15例（68.2％）.肺动脉病变可表现为狭窄闭塞和瘤样扩张.18例（81.8％）合并肺动脉高压,估测肺动脉收缩压（72±20）mmHg（1 mmHg =0.133 kPa）,其中3例肺动脉高压严重程度与肺动脉血栓血管受累范围不匹配.18例因缺乏典型的结缔组织病临床症状和临床医师缺乏诊断意识致入院前漏诊结缔组织病,漏诊率81.8％;3例（13.6％）因临床医师对疾病认识不足而误诊为特发性肺动脉高压.确诊时间中位数是12个月.结论 结缔组织病可以血栓表现为首发症状,部分患者因缺乏典型结缔组织病临床症状而误诊,应引起临床医师重视.
Objective To evaluate the clinical features and reasons of misdiagnosis of connective tissue disease plus pulmonary embolism （PE）.Methods The clinical data were reviewed retrospectively for 22 hospitalized patients with connective tissue disease and PE from February 2006 to March 2014.And the features of onset,clinical and laboratory characteristics,imaging tests and causes of misdiagnosis were analyzed.Results There were 12 males and 10 females with an average age of （36.2 ± 14.2） years.And 12 （54.5%） PE patients had concurrent deep venous thrombosis.Antiphospholipid syndrome and Behcet＇s disease were the major causes of connective tissue disease.Chest distress,palpitation and extremity swelling were initial symptoms.There were elevated erythrocyte sedimentation rate （n =11,50.0%）,elevated C-reactive protein （n =8,36.4%） and abnormal autoantibody （n =15,68.2%） respectively.Computed tomography showed pulmonary arteries stenosis,occlusion and aneurismal dilation.Eighteen （81.8%） patients had pulmonary hypertension with a systolic pulmonary pressure of （72 ± 20） mmHg （1 mmHg =0.133 kPa）.And 3 of them presented severity of pulmonary pressure non-matched to the degree of pulmonary vascular involvement.And 18 （81.8%） patients with connective tissue disease were missed due to a lack of typical symptoms and physician understanding of disease before admission.Three （13.6%） patients had a misdiagnosis of idiopathic pulmonary arterial hypertension.The median time of diagnosis was 12 months.Conclusions Connective tissue disease may develop PE as the initial symptom.And some patients lack typical clinical manifestations of connective tissue disease.It should raise an alert with the physicians.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第2期120-122,共3页
National Medical Journal of China
基金
国家科技支撑计划（2011BAI11B17）
关键词
肺栓塞
结缔组织病
疾病特征
误诊
Pulmonary embolism
Connective tissue disease
Disease attributes
Diagnostic errors
