2007—2018年我国报告155例铅中毒误诊分析

Misdiagnosis analysis of 155 cases of lead poisoning reported in China from 2007 to 2018

[目的]分析临床工作中铅中毒误诊的原因,为采取有效的预防措施提供依据。[方法]查询中国知网、万方数据库、维普数据库2007-2018年铅中毒误诊相关文章,总结病例特点并进行综合分析。[结果] 155例铅中毒误诊病例中生活性铅中毒115例(占74.84%),职业性铅中毒39例(占25.16%);误诊为消化系统疾病127例(占81.9%),误诊为血液系统疾病15例(占10%),误诊为神经系统疾病12例(占7%),误诊为副肿瘤性天疱疮1例(占1%)。误诊为消化系统疾病的患者中,造成有创损伤26例(占20.5%);误诊为其他系统疾病的患者中,造成有创损伤5例(占17.9%)。误诊为不同系统疾病给患者造成有创诊治的概率差异无统计学意义(P> 0.05)。[结论]对不典型的铅中毒病例,经过全面检查才能得到正确诊断。临床医师需加强有关铅中毒知识的学习,对怀疑发生重金属中毒的患者,应尽早做相关检查,与其他疾病相鉴别,以免贻误治疗时机。

[Objective] The causes of misdiagnosis of lead poisoning in clinical work were analyzed to provide basis for taking effective preventive measures. [Methods] Inquiring the article on the misdiagnosis of lead poisoning in the past 10 years in CNKI,Wanfang database and Wipp database,the case characteristics were summarized and a comprehensive analysis was conducted. [Results] Among 155 misdiagnosed cases of lead poisoning,115(74.84%) were living lead poisoning,39(25.16%)were occupational lead poisoning,127(81.9%) were misdiagnosed as digestive system diseases,15(10%)as hematological system diseases,12(7%) as nervous system diseases,and 1 case was misdiagnosed as paraneoplastic pemphigus. Among the patients misdiagnosed as digestive system diseases,26(20.5%) cases were performed invasive diagnosis and treatment,and 5(17.9%)cases among other system diseases. There was no significant difference in invasive diagnosis and treatment of patients misdiagnosed as different system diseases(P > 0.05). [Conclusion] For atypical cases of lead poisoning,a thorough examination should be done to obtain a correct diagnosis. Clinicians need to strengthen their knowledge about lead poisoning. For patients suspected with heavy metal poisoning,they should be checked as soon as possible to avoid delay in treatment.