2型糖尿病漏误诊原因分析

摘要

Objective To summarize missed diagnosis and misdiagnosed causes of patients with type 2 diabetes mellitus.Methods clinical data of 13 missed diagnosis or misdiagnosed patients with type 2 diabetes mellitus during January 2015 and April 2016 was retrospectively analyzed.Results Missed diagnosis and misdiagnosed rate in this group was 15.12%.Among the 4 misdiagnosed patients, 3 patients visited doctors for waist pain associated by both lower extremities numbness, and were misdiagnosed as having lumbar intervertebral disc protrusion;1 visited doctor for foot ulcers without incentives, and was misdiagnosed as having vasculitis, The misdiagnosed time was 2-7 d.Among the 9 missed diagnosis patients, 4 patients were misdiagnosed as having cholecystitis because of fever, abdominal pain associated by nausea and vomiting;3 patients were misdiagnosed as having urinary infection because of urinary frequency, urgency and urodynia;2 patients were misdiagnosed as having eczema complicated with infection because of skin rash, itching and flare in both lower extremities.The missed diagnosis time was 2 d-6 months.All patients were confirmed the diagnosis of type 2 diabetes mellitus after fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin examinations, and were treated with controlling blood glucose and corresponding support treatment.Misdiagnosed patients' conditions significantly improved, while missed diagnosis patients had no recrudescence.Conclusion Diabetes mellitus is easily missed diagnosis or misdiagnosed because of atypical symptoms induced by complex complications, and therefore clinicians should comprehensively understand the related knowledge and its complications, carefully ask disease history and perform comprehensive examination so as to confirm diabetes mellitus as early as possible to avoid occurrence of missed diagnosis and misdiagnosis.%目的 总结2型糖尿病漏误诊原因,提高诊治水平.方法 对2015年1月-2016年4月宝鸡市人民医院收治的曾漏误诊的13例2型糖尿病的临床资料进行回顾性分析.结果 本组漏误诊率15.12%.误诊4例,其中3例因腰部疼痛伴双下肢麻木就诊误诊为腰椎间盘突出症,1例因足底无诱因溃疡就诊误诊为脉管炎.误诊时间2~7 d.漏诊9例,其中4例因发热,腹部憋胀不适伴恶心、呕吐就诊诊断为胆囊炎,3例因尿频、尿急、尿痛就诊诊断为泌尿系感染,2例因双下肢皮疹伴红肿、瘙痒就诊诊断为湿疹并感染.漏诊时间2 d~6个月.13例均经空腹血糖、餐后2 h血糖及糖化血红蛋白检查确诊2型糖尿病,给予控制血糖及相应对症支持治疗后,误诊患者病情较前均明显好转,漏诊患者疾病均未再发作.结论 糖尿病复杂多样的并发症常造成发病时临床症状不典型,从而导致误漏诊,故接诊医生应全面了解糖尿病及其并发症相关知识,接诊类似本文患者时应详细询问病史、全面细致体格及医技检查,以尽早明确或筛除糖尿病,减少或避免漏误诊发生.