非特异性间质性肺炎四例误诊分析

Misdiagnosis Analysis of 4 Patients with Non-specific Interstitial Pneumonia

目的 探讨非特异性间质性肺炎（non-specific interstitial pneumonia,NSIP）的临床特点、误诊原因及防范误诊措施。方法 对我院收治的4例NSIP误诊患者资料进行回顾性分析。结果 4例因咳嗽、气促、痰中带血起病,有上呼吸道感染病史及类风湿性关节炎病史各1例,就诊多家医疗机构先后误诊为社区获得性肺炎和（或）支气管扩张伴感染、肺结核,给予相应治疗,病情反复,后经胸部CT检查示肺部片状或斑片状磨玻璃样改变,肺组织病理检查见炎性细胞浸润和（或）纤维化,综合分析修正诊断为NSIP,给予糖皮质激素治疗,均好转出院。随诊8~12周,病情稳定。结论 NSIP缺乏典型临床表现,易误诊;提高临床医师对本病的认识、综合分析病情,及早行CT、病理检查可有效减少本病误诊。

Objective To investigate clinical features, misdiagnosis causes and preventive measures of non-specific interstitial pneumonia （NSIP）. Methods Clinical data of 4 misdiagnosed patients with NSIP was retrospectively analyzed. Results Onste symptoms of the 4 patients were cough, shortness of breath and blood in the sputum, and 1 patient had a history of upper respiratory tract infection and other patient had a history of rheumatoid arthritis. The 4 patients were misdiagnosed as having community-acquired infections and （or） bronehiectasis with infection and pulmonary tuberculosis by a number of medical institutions, but diseases recurrent attacked after corresponding treatment. NSIP was diagnosed by comprehensive analysis after finding schistic or plaque and ground glass-like changes by chest CT examination, and inflammatory cell infiltration and （or） fibrosis by pathological examination. All patients turned better and discharged after glucocorticoid treatment. With follow-up for 8-12 weeks, conditions of the patients were stable. Conclusion NSIP is lack of typical clinical manifestations and easily misdiagnosed, and misdiagnosis rate can be reduced by improving clinician＇s understanding of the disease, comprehensive analysis of the disease by performing CT and pathological examination as early as possible.