国内15年误诊为间质性肺病的疾病分析

Analysis of Diseases Misdiagnosed as Interstitial Lung Disease in China in Past 15 Years

目的：提高对间质性肺病（ interstitial lung disease,ILD）更进一步的临床认识,减少对误诊。方法回顾近15年国内发表的误诊为ILD的疾病,分析其特点。结果国内15年报导的误诊为ILD 28例,男20例,女8例,男女之比为5：2；年龄25~72岁,平均（53±12）岁。28例误诊为ILD的疾病中,10例最终确诊为细支气管肺泡癌（35．71%）,5例肺结核（17．86%）,4例为 HIV/AIDS（14．29%）,1例先天性心脏病卵圆孔未闭（3．57%）,1例冠心病心功能不全（3．57%）,1例限制性心肌病（3．57%）,1例心肌病心功能不全（3．57%）,1例结直肠癌并肺淋巴管癌（3．57%）,1例慢性淋巴细胞白血病（3．57%）,1例恙虫病（3．57%）,1例肺硬化性血管瘤（3．57%）,1例Castleman病（3．57%）。误诊时间平均（34．5±61）周。除咳嗽、渐进性呼吸困难外,患者可有Velcro啰音、限制性通气功能障碍等间质性肺病特有临床表现。结论在ILD的诊疗过程中,需结合病史、体格检查,对影像学存在间质性改变的患者务必行HRCT检查、仔细辨别其中差异。在诊疗过程中重视病理活检,及时确诊,给予患者正确、有效的治疗。

Objective To improve clinical understanding of interstitial lung disease （ ILD ） and reduce misdiagnosis. Methods We retrospectively analyzed domestic papers published in the past 15 years reporting diseases misdiagnosed as intersti-tial lung disease. Results All papers analyzed reported a total of 28 patients misdiagnosed with ILD,20 males and 8 females. And the male to female ratio is 5 to 2. 28 patients aged 25 to 72 with a mean age of（53 ± 12）years. Among 28 cases misdiagnosed as ILD,10 were finally diagnosed as bronchioloalveolar carcinoma （ 35. 71%） , 5 as tuberculosis （ 17. 86%） , 4 as HIV / AIDS （14. 29%）,1 as congenital heart disease,hole ovale（3. 57%）,1 as coronary heart disease,heart failure（3. 57%）,1 as restrictive cardiomyopathy（ 3. 57%） , 1 as cardiomyopathy, heart failure （ 3. 57%） , 1 as colorectal cancer and lung lymphangitic cancer （3. 57%）,1 as chronic lymphocytic leukemia（3. 57%）,1 as scrub typhus（3. 57%）,1 as pulmonary sclerosing hemangioma （3. 57%）,1 as Castleman’s disease（3. 57%）. And the misdiagnosis time was（34. 5 ± 61） weeks on average. In addition to cough,progressive dyspnea,patients may have other specific clinical manifestations of ILD like Velcro rales,restrictive ventilatory dysfunction. Conclusion In the diagnosis and treatment process of ILD,clinicians should attach more importance to biopsy and make a cautious diagnosis combining detailed medical history with careful physical examination. And when the patients’ radiograph-ic examinations show the presence of interstitial changes,an HRCT examination must be prescribed to assist with the diagnosis.