上海市1998—1999年新登记肺结核病人误诊过诊情况分析

摘要/Abstract

摘要： 目的　分析上海市新登记肺结核病人中误诊(包括过诊)状况及探讨减少误诊的途径。方法研究1998—1999年新登记肺结核病人取消登记原因为误诊的病例,分析被误诊的疾病种类、造成误诊的诊疗单位分布、延误诊断和抗结核治疗时间、误诊对结核病控制的影响程度。结果总误诊率为4.2%,误诊组与确诊组在结核病诊断特征上无差异。误诊组各级医院误诊率为综合医院4.5%,三级专科医院4.0%,二级专科医院4.2%。被诊断为肺结核到取消结核病登记诊断为其它肺部疾病的时间是74.1d,期间也是抗结核治疗时间。结论在肺结核防治过程中正确诊断是发现和治愈肺结核病人的重要前提,主要是提高痰检阴性肺结核病人的诊断正确性。菌阴病人的诊断有待开发类似菌阳病人痰检涂片和培养找抗酸杆菌的诊断“金”标准的技术和方法。在目前组织和提高市和区县结核病防治化疗例会制度,各科医生集体对疑难病例的诊断,是减少误诊的必要措施。

关键词: 结核,肺, 误诊

Abstract: Objective To analyze the condition of misdiagnosis (over-diagnosis) in the new-registered pulmonary tuberculosis in Shanghai and to find the ways for reducing misdiagnosis.Methods All the new-registered tuberculosis (TB) cases that were withdrawn because of being misdiagnosed from 1998 to 1999 in Shanghai were included in the analysis.The indicators like kinds of diseases misdiagnosed,the distribution of hospital provided misdiagnosis,the duration of delay for diagnosis and the time for anti-tuberculosis treatment,and the impact on tuberculosis control.Results The total misdiagnosing rate was 4.2%.The first three diseases be misdiagnosis were lung cancer,pneumonia and pulmonary parasite.The misdiagnosis rates in general hospitals,municipal tuberculosis hospital and district (county) tuberculosis hospital was 4.5%,4.0%,4.2%,respectively.The doctor-delay was 74.1 days for misdiagnosis as TB and then is diagnosis as other diseases.Conclusion Accurate diagnosis is an important premise for finding and curing pulmonary tuberculosis patients,especially for the smear negative patients.It is necessary to develop gold standard to diagnose smear negative tuberculosis.It is essential that to establish and perfect the regular meeting on tuberculosis prevention and chemotherapy.For the difficult and complicated cases,doctors of several departments should provide final diagnosis.

Key words: Tuberculosis,pulmonary, Misdiagnosis

李永祥,沈鑫,梅建,沈梅,夏珍,. 上海市1998—1999年新登记肺结核病人误诊过诊情况分析[J]. 中国防痨杂志, 2003, 25(5): 295-298.

LI Yong-xiang,SHEN Xin,MEI Jian,et al.. Analysis on misdiagnosis and over-diagnosis situations of the new-registered pulmonary tuberculosis patients from 1998 to 1999 in Shanghai[J]. Chinese Journal of Antituberculosis, 2003, 25(5): 295-298.

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上海市1998—1999年新登记肺结核病人误诊过诊情况分析

Analysis on misdiagnosis and over-diagnosis situations of the new-registered pulmonary tuberculosis patients from 1998 to 1999 in Shanghai

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