冠心苏合丸相关肾损害9例误诊原因的临床分析

Clinical analysis of causes of misdiagnosis to Guanxinsuhe pills-related renal injury in 9 cases

目的:分析冠心苏合丸相关肾损害的误诊原因,有助于对其正确诊断和治疗。方法:回顾31例冠心苏合丸相关肾损害病例,对其中9例的误诊原因进行分析。结果:9例均为中老年患者,临床上均表现为慢性小管间质性肾病,均伴肾小管酸中毒、肾性糖尿、低渗尿和不同程度的肾功能减退。贫血程度与肾功能减退程度不平行。其中有7例按药典规定剂量用药,2例超过药典规定剂量。有5例误诊为高血压病肾损害,2例误诊为糖尿病肾病,2例误诊为慢性肾小球肾炎。9例中有7例住院时未询问有无冠心苏合丸服药史,另2例虽询问出有冠心苏合丸服药史,但未能诊断为冠心苏合丸相关肾损害。结论:冠心苏合丸相关肾损害多见于中老年患者。由于临床医师对冠心苏合丸肾毒性及肾损害的临床特征了解不深,常易将中老年糖尿病或高血压患者的冠心苏合丸相关肾损害误诊为糖尿病肾病或高血压肾病。因此,对肾损害患者,特别是中老年患者,应询问其冠心苏合丸用药史,以避免漏诊或误诊。

Objective： To analyse the causes of misdiagnosis to Guanxinsuhe pills-related renal injury in order to be benefial to its exact diagnosis and treatment. Methods. Thirty-one cases with Guanxinsuhe pills-related injury were reviewed, and the causes of misdiagnosis to 9 of them were analysed. Results： All of the 9 cases were middle-aged and elderly patients. They were diagnosed as chronic tubulointerstitial nephrothy with renal tubular acidosis, renal glueoseuria, hyposthenufia, and decreased renal function in varying degree. The severity of anemia was not parallel to decreased renal function. Of the 9 patients, 7 took Guanxisuhe pills according to the dosage of pharmacopoeia, and 2 took the dosage higher than that of pharmacopoeia. Of the cases, 5 were misdiagnosed as hypertensive nephropathy, 2 diabetic nephropathy, and 2 chronic glomerulonephfitis. Seven of the 9 patients were not asked about the history of Guanxinsuhe pills use, and 2 patients had the history of Guanxinsuhe pills use but they were not diagnosed as Guanxinsuhe pills-related renal injury. Conclusion： The most of cases with Guanxinsuhe pills-related renal injury are middle-aged and elderly patients. Since clinician are not well aware of renal toxicity and renal injury of Guanxinsuhe pills, the Guanxinsuhe pills-related renal injury of middle-aged and elderly patients with diabetic or hypertension are usually misdiagnosed as diabetic nephropathy or hypertensive nephropathy. Therefore, the patients with renal injury, especially in middle-aged and elderly patients, should be asked about the history of Guanxisuhe pills use in order to avoid the missed diagnosis or misdiagnosis.