小儿白血病临床表现及疾病类型等因素与误诊的关系

Relationships between Misdiagnosis of Children Leukemia and Its Clinical Manifestations,Types and Other Factors

目的 探讨小儿白血病误诊原因。方法 对 1992 - 0 1～ 2 0 0 2 - 0 6间在本校两所附属医院住院后确诊的 4 2 9例初发白血病患儿的性别、年龄、就诊年代、白血病类型、临床表现及误诊病种等因素进行了分析。结果 1小儿白血病的误诊原因与白血病的类型有关 ,其中以 AL L 误诊率最高 (5 7.8% ) ,CML 次之 (5 0 % ) ,ANL L 误诊率最低 (40 .2 % ) (P<0 .0 5 ) ,与性别、年龄、就诊年代无关 (P>0 .0 5 ) ;2本文误诊病种达 2 4种 ,其中误诊为风湿类疾病最多 (15 .9% ) ;3临床表现中有关节痛病史者其误诊率较高 (P<0 .0 0 1) ,有出血症状者其误诊率较低 (P<0 .0 5 ) ;4有无关节痛者误诊为风湿类疾病分别为 5 7.4 %与 2 .9% (P<0 .0 0 1) ,有无出血症状者误诊为不同分型分别为 12 .9%与 4 .5 % (P<0 .0 5 )。结论 小儿白血病误诊与类型及临床表现的变化多样有关 ,关节痛症状的出现易导致误诊 ,出血症状的出现则较易确诊。

Objective To improve the early diagnosis of leukemia in children.Methods Relationships between misdiagnosis and gender,age,diagnosis time,type of leukemia,and main clinical manifestations among 429 children(aged 0～14.9 years) with incipient leukemia from January 1992 to June 2002 in two affiliated hospitals of Sun Yat sen University were made.Results It showed that:①the type of leukemia was colsely associated with the misdiagnosis(P<0.05).Acute lymphoblatic leukemia (ALL) had a highest rate of misdiagnosis(57.8%),followed by CML (50%),and acute non lymphoblatic leukemia(ANLL) shared the lowest rate (40.2%).②regarding the manifestations,patients with a hirtory of arthralgic had a significant higher misdiagnosis rate(P<0.001),and were easily misdiagnosed as rheumatic diseases(57.4% vs 2.9%);while children presenting bleeding had a lower misdiagnosis rate(P<0.05).③no significant associations were found between the misdiagnosis and gender,age and diagnosis time.Conclusion All children had significant higher rate of misdiagnosis than those with ANLL;a history of arthralgia associated with higher misdiagnosis,while the presentation of bleeding seem to be helpful for a correct diagnosis.