纤维肌痛综合征的就诊现状及误诊漏诊分析

The current situation of the diagnosis of fibromyalgia syndrome

目的调查纤维肌痛综合征(FMS)患者的就诊现状及诊断情况,并对相关因素进行分析,旨在提高临床医生对本病的诊断水平。方法采用横断面调查研究方法,制定"FMS诊断情况表",记录患者人口学指标及既往就医经历,统计误诊和漏诊的比例和被误诊为的疾病,并根据患者既往诊断情况,将患者分为误诊组(调查前被误诊者),漏诊组(调查前未诊断者)及既往诊断组(调查前已确诊者),统计误诊组和漏诊组的人口学特点、就诊情况及病情严重程度,并与既往正确诊断组进行比较,探讨患者被漏诊或误诊的原因。计量资料采用t检验或秩和检验,计数资料采用χ^(2)检验。结果共277例患者参与调查。仅53例(19.1%)患者既往被正确诊断,63例(22.7%)患者曾被误诊,161例(58.1%)患者曾被漏诊。从首次症状出现到确诊平均病程约(51.0±81.2)个月。常被误诊为OA(21例,33.3%)、RA(13例,20.6%)、腰椎病(12例,19.0%)、焦虑抑郁状态(11例,17.4%)等。在人口学特点方面,既往正确诊断组平均年龄较低为(44±13)岁(t=8.64/9.20,P<0.05);在职比例较高,为56.6%(χ^(2)=3.96/4.95,P<0.05),月收入较高,>10000元的比例为47.2%(χ^(2)=7.10/6.87,P<0.05),学历也较高,高学历(大学或大专以上)比例(62.3%)(χ^(2)=7.12,P<0.05)。在就诊情况方面,漏诊组其他医疗机构的就诊率更高,为6.3%;就诊医生人数也更少。在病情方面,漏诊组的弥漫疼痛指数(WPI)评分、FMS症状严重程度评分(SSS)评分更低(χ^(2)=8.94/5.28,P<0.05)。结论目前国内FMS的诊断情况不容乐观,诊断时尤要注意与OA、RA、颈腰椎疾病和心理科疾病进行鉴别。加强科普力度,提高基层患者对本病的认识程度以及各科医生,尤其是骨科、针灸科和疼痛科等专业医生对本病的认识,重视向风湿科转诊等都是降低本病误诊和漏诊的关键。

Objective To investigate the currentstatus of the diagnosis of fibromyalgia syndrome(FMS),and analyze the related factors in order to improve the diagnostic level of the disease.Methods A survey was carried out,A"FMS diagnosis table"was developed.The demographic data and past medical experience of patients were recorded.The rates of misdiagnosis and missed diagnosis were calculated.The specific misdiagnosed cases were recorded and analyzed.According to the previous diagnosis history,patients were divided into misdiagnosed group,missed diagnosis group and correct diagnosis group.The demographic characteristics,medical history and disease severity in the misdiagnosis group and missed diagnosis group were statistically analyzed,and compared with the correct diagnosis group.The reasons for missed diagnosis or misdiagnosis were explored.Results A total of 277 patients were included in the survey.Only 19.1%(53 cases)of patients were correctly diagnosed,22.7%(63 cases)of patients were misdiagnosed,58.1%of patients were missed.The mean time from first symptom to disease diagnosis was(51.0±81.2)months.They were often misdiagnosed as osteoarthritis(n=21,33.3%),rheumatoid arthritis(n=13,20.6%),lumbar disease(n=12,19.0%),and anxiety and depression(n=11,17.4%).Patients'social and economic status such as age,income,educational level and the diagnosis level of pain related clinicians in medical institutions at all levels were factors that might influence misdiagnosis and missed diagnosis rate.In terms of demographic characteristics,the correctly diagnosed group had a lower average age of(44±13)years(t=8.64/9.20,P<0.05),a higher proportion of employees,a higher monthly income(χ^(2)=7.10/6.87,P<0.05),and a higher education level(χ^(2)=7.12,P<0.05).In terms of visits,the rate of visits to other medical institutions(private hospitals)in the missed diagnosis group was higher,and the number of doctors visited was also lower.In terms of illness,the diffuse pain index(WPI)score and FMS symptom severity(SSS)score were lower in the missed diagnosis group.Conclusion The current situation of the diagnosis of FMS in China is not optimistic,and the diagnosis should be differentiated from osteoarthritis,rheumatoid arthritis,cervical and lumbar diseases,and cardiac diseases.In order to reduce the misdiagnosis and missed diagnosis of this disease,it is necessary to strengthen the public education,improve the understanding of this disease in primary care doctors,and physicians in orthopedics,acupuncture and pain departments.