五种中华系列期刊18年间风湿病误诊报道的回顾性分析

The analysis of misdiagnosed rheumatism cases reported in Chinese journal in 16 years: a retro-spective study

目的分析近年来报道的风湿病的误诊状况。方法回顾1998年1月至2015年12月在《中华风湿病学杂志》《中华医学杂志》《中华内科杂志》《中华全科医师杂志》《中华临床免疫和变态反应杂志》发表的误诊文章,统计分析相关报道中风湿病误诊的状况。采用χ2检验和Fisher确切概率法进行统计分析。结果近18年上述5种期刊共发表误诊相关文章705篇,其中风湿病相关215篇,剔除仍不能明确诊断的病例报道28篇,最终共纳入187篇195例病例,占上述杂志区间内全部报道误诊病例的25.5%,是最常被误诊的疾病种类,其中风湿病误诊为其他疾病的例数为127例,其他疾病误诊为风湿病的为68例。风湿病误诊病例报道主要来源于三级医院。容易发生误诊的风湿病包括原发性血管炎(72例)、RA(25例)、SpA(17例)、PM(14例)、SLE(13例)和SS(12例)。1998—2006年与2007—2015年相比,风湿病总体诊断率比例及误诊延迟时间无变化。单病种比较,报道的PM、SpA及IgG4相关性疾病误诊率情况增加(P=0.004,0.034,0.008),PM及除AS之外的其他风湿病诊断延迟时间缩短(P=0.012,0.029)。结论风湿病误诊在临床常见,加强风湿病的继续教育势在必行。提高对风湿疾病的认识、建立正确的诊断思维方法,是降低误诊率的重要途径。

Objective To investigate the causes of misdiagnosis related to rheumatism diseasecases. MethodsA search was performed in database WanFang to identify the misdiagnosed clinical cases reports which were published in Chinese Journal and a retrospective analysis was conducted. All data were analyzed by chi-square test and Fisher′s exact test. ResultsWe screened 705 citations and identified 215 articles on the rheumatic diseases, finally, 187 reports and 195 cases in total with definite diagnosis were included, accounting for 25.5% of the total number of misdiagnosed cases. Primary vasculitis (72 cases), rheumatoid arthritis (25 cases), spondyloarthropathy (17 cases), polymyositis (14 cases), systemic lupus erythematosus (13 cases) and Sjogren′s syndrome (SS) (12 cases) were amongst the top misdiagnosed rheumatic diseases. There was no difference between 1998-2006 and 2007-2015 in the overall misdiagnosis cases. Single disease comparison, polymyositis, spondyloarthropathy and IgG4 related disease were increased (P=0.002;P=0.034;P=0.060;respectively), while polymyositis was delayed (P=0.002). Rheumatism misdiagnosed cases reported mainly came from tertiary hospitals and the department of rheumatology. ConclusionMisdiagnosed rheumatism are common in clinic. Strengthen the physicians′ continuous education, the validity of clinical thinking mode and rational use of diagnostic criteria are important to make correct diagnosis.