摘要
目的 总结巨幼细胞贫血的临床特点,提高对该病的认识,减少误诊.方法 回顾性分析2001年1月至2015年9月北京协和医院普通内科以诊断未明疾病收治而最终确诊为巨幼细胞贫血患者17例的病历资料,总结其一般资料、临床表现、诊断、病因、实验室检查、误诊与治疗等特点.结果 17例巨幼细胞贫血患者男14例,女3例,中位年龄63岁;发病至就诊间隔22 d -60个月,中位时间7个月;曾经多次就诊而未确诊者9例（9/17）,初诊或在住院初期被误诊者13例（13/17）.神经（12例）、消化（10例）、心血管系统（8例）症状为主要临床表现.入院平均血红蛋白水平（64.9±18.7）g/L,平均红细胞体积（MCV） （112.2±10.5）fl,全血细胞减少者12例（12/17）.2例分别通过MCV升高与中性粒细胞多分叶现象确诊,15例检测血清维生素B12及叶酸水平均存在维生素B12缺乏,1例合并叶酸缺乏.17例患者均在接受维生素B12及叶酸治疗后痊愈,随诊状况良好.结论 巨幼细胞贫血因缺乏特异性表现易被误诊,提高对其的认识有助于早期确诊与治疗.
Objective To analyze the clinical features of patients with megaloblastic anemia diagnosed as diseases of unknown origin at admission.Methods Seventeen patients admitted during the period of January 2001 to September 2015,who were diagnosed as disease of unknown origin at admission and finally diagnosed as megaloblastic cell anemia,were included in the analysis.The clinical data of patients including age,gender,disease duration,clinical manifestations,laboratory testing,misdiagnosis and treatments were retrospectively analyzed.Results Of the 17 patients,14 were males and 3 were females,the median age is 63 years.The interval from disease onset to consultation was 22 days-60 months with a median time of 7 months.Nine cases had the history of repeated consultations without confirmed diagnoses,13 cases were misdiagnosed in the first visit or at the admission.Symptoms of neurological （12 cases）,digestive （10 cases）and cardiovascular （8 cases） systems were predominant clinical manifestations.The average hemoglobin concentration at admission was （64.9 ± 18.7） g/L,the mean corpuscular volume （MCV） was （112.2 ± 10.5） fl,and 12 cases had pancytopenia.Two cases were diagnosed based on the elevated MCV and hyper-segmented nucleus of neutrophils,respectively.Fifteen patients underwent serum vitamin B12 and folate examination;vitamin B12 levels decreased in all cases,while only 1 had folate under normal range.All 17 patients recovered successfully by vitamin B12 and folate supplement and were doing well during follow-ups.Conclusions Megaloblastic anemia is likely to be misdiagnosed,because the clinical manifestations are usually not specific.It is necessary to raise the awareness of the disease for early diagnosis and treatment.
出处
《中华全科医师杂志》
2016年第11期855-858,共4页
Chinese Journal of General Practitioners
