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目的分析流行性乙型脑炎(乙脑)临床漏诊情况及漏诊原因,为指导临床诊断提供依据。方法对济南市部分医院乙脑漏诊情况及其原因,以及临床诊断、临床漏诊的乙脑确诊病例的流行病学特征、临床特征、临床检验等进行比较分析。结果在128例实验室确诊病例中,漏诊77例(60.16%),其中53例被诊断为病毒性脑炎、病毒性脑膜炎或病毒性脑膜脑炎。传染病专科医院漏诊率低,不开展乙脑IgM抗体检测的医院漏诊率较高。按照入院诊断时漏诊和入院诊断为乙脑分组分析其流行病学特征显示,在病例来源、性别上,两组病例差异无统计学意义;而在发病时间上,7～9月之外乙脑的非发病高峰期漏诊率较高;在病例年龄分布上,<5岁病例漏诊较高。分析其临床特征发现,两组病例在有发热、头痛、精神萎靡等症状的差异无统计学意义,但在恶心、呕吐、嗜睡、意识障碍、颈项强直、脑膜刺激征等方面,入院诊断乙脑组均显著高于漏诊组。分析两组病例临床常规实验室检验发现,无论是血象还是脑脊液(Cerebrospinal Fluid,CSF)常规,两组病例检测结果差异无统计学意义。结论医疗机构,尤其是非传染病专科医院乙脑病例漏诊严重,漏诊的主要原因是部分病例临床症状不典型,而非传染病专科医院在流行季节不开展乙脑特异性IgM抗体检测,将乙脑病例诊断为其他病毒性感染神经系统疾病。应在医疗机构推广使用血清或CSF特异性乙脑IgM抗体检测,提高医疗机构的诊断水平,减少乙脑危害。
Objective To analyze the clinical misdiagnosis and causes of missed diagnosis of Japanese encephalitis (JE) and provide evidence for clinical diagnosis. Methods The etiological characteristics, clinical characteristics, clinical tests and so on of the cases of missed diagnosis of JE in some hospitals in Jinan and the clinical diagnosis and missed diagnosis of JE were comparatively analyzed. Results Of the 128 laboratory confirmed cases, 77 were missed (60.16%), of which 53 were diagnosed as viral encephalitis, viral meningitis or viral meningoencephalitis. The rate of misdiagnosis in infectious disease specialist hospitals is low, and the rate of misdiagnosis in hospitals that do not carry out the detection of IgM antibodies to Japanese encephalitis is high. According to the misdiagnosis and admission diagnosis of adrenalin, the epidemiological characteristics of encephalitis B group showed that there was no significant difference between the two groups in the source and gender of the cases, while in the time of onset, The rate of misdiagnosis at the peak of non-morbidity was high. In the age distribution of cases, the number of missed cases at <5 years old was higher. Analysis of its clinical characteristics found no significant difference between the two groups in the symptoms of fever, headache, sluggishness, etc. However, in the nausea, vomiting, lethargy, disturbance of consciousness, neck stiffness, meningeal irritation and other symptoms, Group were significantly higher than the missed diagnosis group. Analysis of two groups of clinical routine laboratory tests found that, whether blood or cerebrospinal fluid (Cerebrospinal Fluid, CSF) routine, the two groups showed no significant difference in test results. Conclusions The main reason for the missed diagnosis of JE in medical institutions, especially non-communicable diseases hospitals, is that the clinical symptoms are not typical in some cases. However, non-infectious diseases hospitals do not carry out JE-specific IgM detection during the epidemic season. Cases diagnosed as other viral infections of nervous system diseases. Should promote the use of serum or CSF specific IgM IgM antibodies in medical institutions to improve the diagnostic level of medical institutions and reduce the harm of JE.