特发性肺含铁血黄素沉着症的误诊及对策

目的：探讨特性肺含铁血黄素沉着症（IPH）的临床特点、误诊原因及对策。方法：对误诊的23例IPH病例进行回顾性分析。结果：本组病例临床表现上主要为面色苍白、乏力（91．30％）、咳喘（69．57％），咯血或呕血（52．17％），肝脾肿大（39．13％）及肺部罗音（34．78％）。23例中先后误诊为：缺铁性贫血、肺结核、肺炎、支气管扩张，误诊时间最短10d，最长6a。对IPH认识不足是误诊的主要原因，对反复性持续性或进行性加重的小细胞低色素性贫血以及反复咳喘、咯血、常规抗炎治疗效果不佳，均应考虑本病，耐心、多次检查小儿痰液及胃液中含铁血黄素巨噬细胞是提高确诊率的关键。

Misdiagnosis and Strategy of Idiopathic Pulmonary Hemosiderosis(IPH)

Objective　To explore the cause of misdiagnosis、clinical characterisitics and strategy of indiopathic pulmonary hemosiderosis(IPH).Methods　Twenty-three cases of misdiagnostic IPH were retrospectively analyzed.Results　The clinical features of the cases mainly were pale and asthnia(91.30%),cough and asthma(69.57%),hemoptysis or hematemesis(52.17%),hepatosplenomegaly(39.13%),pulmonary rales(34.78%).23 cases were misdiagnosed as iron-deficiency anemia,pulmonary tuberculosis,pneumonia and bronchiectasis.The duration of misdiagnosis was from 10 days to 6 years.Conclusions　The main reason for misdiagnosis is the lack knowledge of IPH.The patient,with repeated,persistent,progressive microcytic hypochromic anemia and those accompanied with repetitive cough,asthma,hemoptysis and adverse effects to routine auti-inflammatory therapy,should be on the alert for the disease.The repeated examination of siderocyte in sputum and gastric juice is key to improve diagnosis rate.