肺炎支原体感染282例误诊文献分析

目的探讨肺炎支原体（mycoplasma pneumonia，MP）感染的误诊原因，以提高诊断率。方法检索2007年1月-2011年12月中国期刊全文数据库、维普数据库、万方医学数据库中MP感染误诊相关文献，对命中的11篇282例MP感染误诊病例的临床资料进行复习，分析误诊原因。结果282例均以发热、呼吸道症状为主要表现，部分患者有循环、消化、神经、泌尿及血液系统等多种表现。误诊疾病达20余种，从多到少依次为细菌或病毒性肺炎、上呼吸道感染、病毒性心肌炎、病毒性脑炎、支气管炎、急性胃肠炎、肺结核、败血症、贫血、肾炎、伤寒、腹泻原因待查、病毒性肝炎、类风湿关节炎、肾病综合征、自身免疫性溶血性贫血、过敏性紫癜、荨麻疹、急性淋巴结炎、胆囊炎及猩红热，误诊时间3d～6个月，中位误诊时间11d。所有病例按误诊疾病治疗效果差，完善相关实验室检查或行诊断性治疗后确诊为MP感染，经大环内酯类药物治疗痊愈。11篇文献中5篇报道误诊率。为20．0％-64．3％，平均误诊率为24．9％。结论MP感染既可能被误诊为由细菌、病毒、结核菌等病原体引发的感染，也可能被误诊为某些免疫性疾病。掌握正确诊断思维方法、重视实验室检查、施以规范诊断性治疗，有助于减少误诊。

Misdiagnosis Literature and Analysis of 282 Cases with Mycoplasma Pneumoniae Infection

Objective To investigate the misdiagnosis causes of mycoplasma pneumoniae(MP) infection in order to improve the diagnostic rate.Methods Misdiagnosis literatures of mycoplasma pneumoniae infection during January 2007 and December 2011 in China Journal Full text Database(CJFD),CQVIP Database and Wanfang Medicine Database were searched.We sifted 11 pieces of related clinical data for review,which included 282 cases with MP infection,and analyzed the misdiagnosis cause.Results Fever and respiratory symptoms were the main clinical manifestations in the 282 cases,some of which had clinical manifestations in circulation system,digestive system,nervous system,urinary system and hematological system.There were more than 20 species of misdiagnosed diseases,in the order of bacterial or viral pneumonia,upper respiratory tract infection,viral myocarditis,viral encephalitis,bronchiolitis,acute gastroenteritis,tuberculosis,sepsis,anemia,nephritis,typhoid fever,diarrhea of unknown origin,viral hepatitis,rheumatoid arthritis,nephrotic syndrome,autoimmune hemolytic anemia,allergic purpura,urticaria,acute lymphadenitis,cholecystitis and scarlet fever.The misdiagnosis time was from 3 days to 6 months,and the meta-misdiagnosis time was 11 days.The treatments for all misdiagnosed cases were poor,and all the patients were finally diagnosed as having MP infection after improving the relevant laboratory tests or diagnostic treatments,and the patients were cured after the macrolide treatment.Five of the eleven literatures reported that the misdiagnosis rate was 20.0%~64.3%,and was 24.9% on average.Conclusion MP infection may be misdiagnosed as infections caused by bacteria,viruses,tubercle bacillus and other pathogens,and also may be misdiagnosed as immune diseases.Misdiagnosis of the disease can be avoided if correct methods are used,more caution is paid to the laboratory tests and standardized diagnostic treatment is imposed.