苏州市布鲁菌病临床误诊情况调查分析

Investigation on misdiagnosis of brucellosis cases in Suzhou City and a questionnaire survey

目的分析苏州市临床布鲁菌病的误诊情况,及其主观、客观原因。方法收集苏州大学附属第一医院感染病科2016-2018年布鲁菌病住院患者临床资料,分析主要起病方式、首诊科室、诊疗过程和主要诊断方向等。对苏州市部分医生进行电子问卷调查,了解医生对布鲁菌病的认识和诊疗情况,分析调查结果。结果共纳入24例布鲁菌病患者,主要的起病方式为发热(13例,54.17%)和腰痛或关节痛(6例,25.00%),或者二者皆有(3例,12.50%);其余为发热伴关节痛、睾丸炎(1例,4.17%)和紫癜(1例,4.17%)。首诊科室分布在10个不同科室,主要为感染科(6例,25.00%)和骨科(5例,20.83%)。病程中考虑布鲁菌病者仅2例(8.33%),主要诊断方向为血液病或淋巴瘤(7例,29.17%)、败血症(5例,20.83%)、结核(4例,16.67%)。共124名医生参与问卷调查,其中感(传)染科52名和其他科室72名,分别占41.94%和58.06%。知晓苏州市有布鲁菌病流行、临床工作中有考虑布鲁菌病、有询问流行病学史和清楚送检流程的比例分别为38.71%(48/124)、32.26%(40/124)、53.23%(66/124)和29.84%(37/124),感(传)染科考虑布鲁菌病比例(24/52,46.15%)高于其他科室(16/72,22.22%,χ2=7.913,P<0.05)。受访医生认为,影响病原体送检因素主要为不清楚或不熟悉送检流程、流程繁琐(93/124,75.00%)和没考虑到该病(85/124,68.55%);减少误诊有效措施主要包括医院设置相关检查或简化送检流程(96/124,77.42%),卫生部门、单位、科室组织学习(95/124,76.61%),个人搜集文献或书籍学习(72/124,58.06%)。结论苏州市布鲁菌病存在明显临床误诊现象,原因可能是苏州市医生对布鲁菌病不够重视,对送检流程不熟悉及流程繁琐等造成的。

Objective To analyze the subjective and objective misdiagnostic reasons of brucellosis in Suzhou City.Methods The clinical data of inpatients with brucellosis from the department of infectious diseases,the First Affiliated Hospital of Soochow University from 2016 to 2018 were collected.The main onset methods,the first consultation department,the diagnosis and treatment process,and the main diagnosis were analyzed.Simultaneously,a questionnaire survey was conducted among doctors from different departments in Suzhou City.To investigate the knowledge and diagnosis of brucellosis by electronic questionnaire,and analyze the results.Results Totally 24 brucellosis cases were collected.Fever(13 cases,54.17%),lumbago/arthralgia(6 cases,25.00%)or both(3 cases,12.50%)were the main initial symptoms,while a patient with fever,arthralgia and orchitis(1 case,4.17%)and another with purpura(1 case,4.17%)were also admitted.The 24 patients were distributed among 10 different departments,in which the department of infectious diseases(6 cases,25.00%)and orthopedics(5 cases,20.83%)dominated.Brucellosis was considered in only 2 patients(8.33%)before pathogen results,and the main suspected diagnosis were malignant hematopathy/lymphoma(7 cases,29.17%),sepsis(5 cases,20.83%),and tuberculosis(4 cases,16.67%).Totally 124 questionnaires were collected and analyzed.We divided them into 2 groups:department of infectious diseases(52/124,41.94%)and other departments(72/124,58.06%).The proportion of answer"yes"for the question Suzhou is the epidemic area of brucellosis,question whether brucellosis is considered in suspected patients,question whether the epidemiology is collected and question how and where to conduct the serological test was 38.71%(48/124),32.26%(40/124),53.23%(66/124)and 29.84%(37/124),respectively.The positive answer in the department of infectious diseases(24/52,46.15%)was significantly higher than those of others(16/72,22.22%,χ2=7.913,P<0.05).The respondents thought the serological test could not be conducted,because of that the non-pasture doctors were not familiar with the test procedure,which was complex(93/124,75.00%)and the disease was not considered(85/124,68.55%).And the respondents thought measures helpful to reduce misdiagnosis should include setting up serological test or simplifying the procedure(96/124,77.42%),massed learning organized by related administrations(95/124,76.61%)and learning by books,papers and classes(72/124,58.06%).Conclusion There is obvious clinical misdiagnosis of brucellosis in Suzhou City,which may be caused by Suzhou doctors not paying enough attention to brucellosis,being unfamiliar with the inspection process and complicated inspection process.