对莱姆病的过度诊断
A C Steere1, E Taylor, G L McHugh
1Division of Rheumatology/Immunology, New England Medical Center, Boston, MA 02111.
JAMA
|April 14, 1993
概括
对788名因莱姆病转诊的患者进行的一项审查发现,只有23%的人患有活跃的莱姆病. 误诊是莱姆病患者抗生素治疗无效的主要原因.
科学领域:
- 医学诊断 医学诊断 医学诊断
- 传染病 传染病 传染病
- 神经学 神经学
背景情况:
- 莱姆病的诊断可能很复杂,导致误诊.
- 被转移到专门诊所的患者往往表现出多样化和重叠的症状.
- 准确的诊断对于有效的治疗和患者的治疗结果至关重要.
研究的目的:
- 分析在莱姆病诊所评估的患者的诊断准确性,血清学结果和治疗结果.
- 将转诊前的诊断和评估与当前发现进行比较.
- 确定怀疑莱姆病病例治疗失败的原因.
主要方法:
- 在4.5年内对788名转诊患者进行了回顾性病例调查.
- 纳入标准:被怀疑患有莱姆病的患者通过转诊医生或自我.
- 评估症状,迹象,免疫诊断测试和神经功能.
主要成果:
- 只有180名患者 (23%) 患有活跃的莱姆病 (关节炎,脑病,多神经病).
- 156名患者 (20%) 之前患有莱姆病加上其他疾病; 452人 (57%) 没有莱姆病.
- 在没有莱姆病的人中,有45%之前在其他地方有阳性血清学,但在这个诊所的实验室中是阴性的. 错误诊断是79%治疗患者抗生素反应不佳的原因.
结论:
- 被转诊诊所的少数患者符合莱姆病的诊断标准.
- 错误诊断是缺乏对抗生素治疗反应的最常见原因.
- 专业诊所在准确的莱姆病诊断和管理中发挥着重要作用.
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