Behcet病临床特征及漏诊误诊原因分析

The clinical feature of Behcet's disease and the causes of missed diagnosis and misdiagnosis

目的探讨Behcet病全身性临床表现及漏诊和误诊的可能原因。方法回顾分析1997年1月～2007年1月诊治的Behcet病患者52例的临床资料。对所有患者详细询问病史,双眼作裂隙灯显微镜检查,并详细记录角膜后沉着物(KP)的性质与分布,前房细胞的数量以及前房闪辉的程度,观察口腔粘膜以及皮肤损害的程度,查阅以往的病史记录,分析诊断的一致性及漏诊、误诊原因。结果患者年龄20～75岁,双眼受累者48例,单眼受累者4例,所有病例均有睫状充血,角膜KP,前房细胞以及前房闪辉,19例22只眼有前房积脓,50例有口腔溃疡、48例有皮肤损害、26例有生殖器溃疡、32例有膝关节肿痛、6例有下肢血栓性静脉炎。结论Behcet病是一种侵犯眼、口腔、皮肤、生殖器、关节、神经系统、血管、消化系统等全身性疾病,缺乏对临床特征的认识及对全身病的重视是漏诊、误诊的重要原因。

Objective To survey the clinical feature and the possible causes of missed diagnosis and misdiagnosis of Behcet＇s disease. Methods The clinical data of 52 patients with Behcet＇ s disease diagnosed and treated from January in 1997 to January in 2007 were retrospectively analyzed. The medical history of each patient was carefully recorded and slit - lamp microscopy was performed. The character and the distribution of keratic precipitates （KP）, the cell number and the flare degree in anterior chamber were noted in detail. The lesion degree of oral mucosa and skin was observed. The past medical record was read. The concordance of diagnosis and the causes of missed diagnosis and misdiagnosis were analyzed. Results The age of the patients ranged from 20 to 75 years old, and binocular involvement was noted in 48 patients and single eye involvement in 4 patients. All patients showed ciliary congestion, KP, anterior chamber cells and anterior chamber flare. Hypopyon was observed in 22 eyes of 19 patients, oral ulcer in 50, dermal lesion in 48, genital ulcer in 26, swollen and pain of knee joint in 32 and thrombophlebitis of lower extremities in 6. Conclusion Behcet＇s disease is a systemic disorder affecting the eyes, oral cavity, skin, genitals, joints, vascular system and digestion system. The main missed diagnosis and misdiagnosis cause of Behcet＇ s disease is that some ophthalmologists do not understand well the clinical feature of Behcet＇s disease and pay no attention to the systemic diseases.