婴儿无反应性结核病误诊1例并病理解剖后综合分析

Comprehensive analysis of one infant NRT misdiagnosis and after pathological dissection

目的:克服无反应性结核病(NRT)误诊率极高的危害,加深认识,提高诊断技能。方法:选读NRT国内外重要专题文献,对西安交通大学医学院第一附属医院收治的1例NRT疑难误诊病例,展开全面综合分析。结果:分析得出因NRT少见,对NRT治疗无经验,医务人员思维、检查受干扰,未及早抓住疾病的关键,错失了部分短暂的诊查机会,影响了诊断的确立。结论:NRT患者多数器官都有内含抗酸杆菌无炎性反应性病灶,病情凶险,症状繁杂,缺乏规律,仅部分有免疫功能低下的线索和都有急性感染征像。对有这样临床表现又不能完全确诊的患儿,建议抢夺机遇,尽早选做浅表肿大淋巴结、骨髓,甚至肝、脾穿刺送病理检查,可减少误诊达到快捷准确的诊断。

Objective To investigate the reasons for the misdiagnosis of non -reactive tuberculosis （INtfl＇） and improve dmgnos＇s lev- el. Method Studed international papers on this topics and comprehensively analyzed one case NRT of suspected and difficult mis diagnosis patient admitted in the first hospital affiliated Xi＇an Jiaotong University in 1997. Results On account of rare of NRT, less experience, and cogitation and inspection disturbed, key of the disease did not be mastered at early stage. So, short- lived partial diagnosis opportunity had been missed, and correct diagnosis had been influenced. Conclusion Most organs of NRT patients exist non - inflammation reactive lesions with acid -fast bacillus so patients condition is dangerous, symptom is complex, regular law is lack, and only partial patients have a clue of low immunity ability and all patients have signs of acute infection. For these infant patients with such a clinical behavior and not exactly di- agnosed, we suggest to carry out pathological inspection of selected superficial enlarged lymph nodes, marrow, even punctured liver or spleen. So,less misdiagnosis and fast and accurate diagnosis could be given.