以多系统表现的多发性骨髓瘤临床误诊分析
Analysis of Clinical Misdiagnosis of Multiple Myeloma Manifested as Multi-ple System Involvement
樊雪杰 1刘晗 2杨学农 1张钡 1吴华 1何兴娟1
作者信息
- 1. 050051 石家庄,河北医科大学第三医院检验科
- 2. 050051 石家庄,河北医科大学第三医院血液科
- 折叠
摘要
目的 探讨多发性骨髓瘤(MM)的临床特点及误诊原因、防范措施.方法 回顾性分析2020 年4 月—2022 年1 月收治的曾误诊为多种疾病的MM 14 例的临床资料.结果 本组因反复发热、咳嗽、炎性指标升高及胸部X线检查结果初步诊断为肺部感染3 例,因食欲减退、腰痛、贫血、蛋白尿、夜尿增多、颜面下肢水肿和尿常规异常初步诊断为慢性肾炎3 例,因腰背痛及腰椎X线检查结果初步诊断为腰肌劳损及骨质疏松症各2 例,因长期面色发黄、乏力、心悸和血红蛋白降低初步诊断为营养性贫血2 例,因头晕、恶心、上肢无力麻木及颈部X线检查结果初步诊断为颈椎病2 例.误诊时间10d～3 个月.14 例按初诊疾病予相应治疗后症状无明显好转,后经完善血清蛋白电泳、免疫固定电泳及骨髓穿刺细胞学检查确诊MM.14 例均在并发症治疗基础上联合化学治疗,随访6 个月病情稳定,皆未复发及死亡.结论 MM早期表现复杂多样,实验室检查特异性不高,若接诊医师对其缺乏认识,诊断思维局限,未早期行特异性检查,易误诊.临床遇及疑似本病患者应提高警惕性,要全面分析病情,及时行特异性检查,以提高确诊率.
Abstract
Objective To investigate the clinical features,causes of misdiagnosis and preventive measures of multi-ple myeloma(MM).Methods The clinical data of 14 MM patients who had been misdiagnosed with multiple diseases from April 2020 to January 2022 were retrospectively analyzed.Results In this group,3 cases were initially diagnosed as pulmo-nary infection due to repeated fever,cough,elevated inflammatory indexes and chest X-ray examination results;3 cases were initially diagnosed as chronic nephritis due to anorexia,lumbago pain,anemia,proteinuria,increased nocturia,facial and lower limb edema and abnormal urine routine;2 cases were initially diagnosed as lumbar muscle strain and osteoporosis due to lumbago and lumbar X-ray examination results.Nutritional anemia was initially diagnosed in 2 cases due to long-term sallow face,fatigue,palpitation and decreased hemoglobin,and cervical spondylosis was initially diagnosed in 2 cases due to dizzi-ness,nausea,upper limb weakness and numbness and X-ray examination of the neck.The duration of misdiagnosis was 10 d-3 months.The symptoms of 14 cases were not significantly improved after treatment according to the newly diagnosed disease,and MM was confirmed by serum protein electrophoresis,immunofixation electrophoresis and bone marrow puncture cytology.All the 14 cases were treated with chemotherapy on the basis of complication treatment,and their condition was stable after 6 months of follow-up;none of them relapsed or died.Conclusion The early manifestations of MM are complex and varied,and the specificity of laboratory examination is not high.If the doctor lacks understanding of the disease,the diagnostic think-ing is limited,and the specific examination is not performed early,it is more likely to cause misdiagnosis.Clinicians should be vigilant when patients are suspected with this disease,and perform comprehensive analysis of the condition and timely spe-cific examination,in order to improve the diagnosis rate.
关键词
多发性骨髓瘤/误诊/肺部感染/肾炎/腰肌劳损/骨质疏松/贫血/颈椎病Key words
Multiple myeloma/Misdiagnosis/Pulmonary infection/Nephritis/Lumbar muscle strain/Osteoporosis/Anemia/Cervical spondylosis引用本文复制引用
出版年
2023
国家科技期刊平台
NSTL
万方数据