糖尿病患者细菌性肝脓肿的误诊原因

Misdiagnosis of pyogenic hepatic abscess in patients with diabetes mellitus

目的探讨糖尿病患者合并细菌性肝脓肿（PHADM）易误诊的原因，提高诊断正确率。方法回顾性分析2005年1月至2015年5月我院收治的86例PHADM患者的诊断过程，包括首诊主诉症状、并发症及合并症、实验室检查、首诊诊断、误诊结果、发现肝脓肿病灶的检查手段以及最终明确诊断的方式等。结果（1）86例PHADM患者中，首诊时主诉提及右上腹不适／疼痛的只有42例（48．8％），其余44例（51．2％）患者首诊主诉症状均为右上腹以外的其他症状，且呈现多样化。（2）PHADM患者常合并多系统并发症及合并症。（3）PHADM患者的实验室检查结果不具特异性。（4）PHADM患者首诊正确率只有57．0％，易被误诊为上呼吸道感染及胃炎等。（5）86例患者中，64例（74．4％）是通过超声发现肝脓肿病灶。结论PHADM易误诊的主要原因是首诊主诉症状多样化，且多为右上腹以外的其他症状。增强对PHADM的认识，对糖尿病患者发热时常规行肝脏超声检查是提高正确诊断率的重要措施。

Objective To analyze the causes of misdiagnosis of pyogenic hepatic abscess in patients with diabetes mellitus （PHADM） so as to improve diagnostic accuracy. Methods A retrospective study was conducted on 86 patients with pyogenic liver abscess and diabetes mellitus （PHADM） who were admitted to our hospital from Jan. 2005 to May. 2015. The chief complaints on presentation, complications, laboratory findings, diagnosis, misdiagnosis results, methods used to diagnose liver abscess and approaches to definite diagnosis were analyzed. Results （ 1 ） Of the 86 PHADM patients, only 42 patients （ 48.8% ） complained of right upper quadrant discomfort or pain. For the remaining 44 patients （51.2%） the chief complaints were not related to the right upper quadrant. （2） The PHADM patients often suffered from multiple complications. （3） The laboratory results were non-specific for diagnosis. （4） The correct diagnosis made at the first visit was only 57.0%. The patients with PHADM were often misdiagnosed to suffer from upper respiratory infection and gastritis. （5） In 64 of the 86 PHADM patients （74.4%）, liver abscesses were identified by ultrasonography. Conclusions The main reason why PHADM was frequently misdiag- nosed was because of non-specific symptoms at primary presentation. Hepatic ultrasound should he carried out in patients with diabetes mellitus who suffer from fever.