原发性硬化性胆管炎四例误诊讨论

Analysis of Misdiagnosis on 4 Cases of Primary Sclerosing Cholangitis

目的分析原发性硬化性胆管炎(primary sclerosing cholangitis,PSC)的误诊原因并提出防范对策。方法对我院2003年7月～2010年12月收治4例PSC的临床资料进行回顾性分析。结果本组均有碱性磷酸酶、γ-谷氨酰转移酶、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素不同程度的升高。4例均误诊,误诊为淤胆性肝炎2例、肝豆状核变性及胆结石各1例,误诊时间1～7年。均经血清自身抗体检测和内镜下逆行胰胆管造影术(ERCP)或核磁共振胆胰管造影(MRCP)检查确诊,予熊去氧胆酸等治疗均好转出院。结论对疑诊PSC的病例应及时行肝病自身抗体检测、ERCP和(或)MRCP检查,尽早明确诊断,避免或减少误诊。

Objective To analyze the causes of misdiagnosis of primary biliary cirrhosis （PBC）. Methods A retrospective analysis was performed on clinical data of 4 patients diagnosed as having PBC during July 2003 and December 2010. Results The ALP, T-GT, ALT, AST and TBIL of all the patients were higher than normal value at different degrees. 4 patients were misdiagnosed. The time needed for correct diagnosis was 12-84 months. The misdiagnosis of the disease was categorized as cholestatic hepatitis, hepatolenticular degeneration and cholelithiasis. Conclusion In order to make a definite diagnosis and avoid or reduce the misdiagnosis rate, the suspected patients with PBC should undertake liverish autoantibody test, and ERCP/MRCP detection.