Allen Jeffrey A
Department of Neurology, University of Minnesota, Minneapolis, USA.
Neurol Ther. 2020 Jun;9(1):43-54. doi: 10.1007/s40120-020-00184-6. Epub 2020 Mar 26.
There is a growing realization that many patients are incorrectly diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP), with at least half of patients that carry a diagnosis of CIDP in the USA possibly having a different explanation for their neuropathy or having no neuropathy at all. Many misdiagnosed patients go on to receive costly and potentially harmful treatments for a disease that they do not have, while at the same time missing an opportunity to treat their true ailment. The cost of misdiagnosis on patients and society is not trivial. Many factors contribute to misdiagnosis. Particular points of vulnerability include the evaluation of "atypical" CIDP, interpretation of equivocal nerve conduction studies, over-reliance on elevations in cerebrospinal fluid protein concentration in indeterminate ranges, and placing excessive diagnostic weight on subjective changes following the initiation of immunotherapy. In addition to heighted awareness of the challenges, adherence to CIDP diagnostic guidelines, utilization of objective metrics to document clinical change, and referrals to CIDP centers of excellence are strategies that may improve diagnostic accuracy.
人们越来越意识到，许多患者被错误地诊断为慢性炎症性脱髓鞘性多发性神经病（CIDP），在美国，至少有一半被诊断为CIDP的患者，其神经病变可能另有原因，或者根本没有神经病变。许多被误诊的患者会继续接受针对他们并未患有的疾病的昂贵且可能有害的治疗，与此同时，他们错失了治疗自身真正疾病的机会。误诊给患者和社会带来的代价不容小觑。许多因素导致误诊。特别容易出现问题的方面包括对“非典型”CIDP的评估、对模棱两可的神经传导研究结果的解读、过度依赖脑脊液蛋白浓度在不确定范围内的升高，以及在免疫治疗开始后对主观变化给予过多的诊断权重。除了提高对这些挑战的认识外，遵循CIDP诊断指南、使用客观指标记录临床变化，以及转诊至卓越的CIDP中心，都是可能提高诊断准确性的策略。
