常规实验室检查对不明原因发热的诊断价值

Diagnostic value of routine laboratory test in patients with fever of unknown origin

目的探讨6项常规实验室检查项目在不明原因发热(fever of unknown origin,FUO)诊断中的价值,为提高发热待查患者的确诊率提供参考。方法回顾性分析我院2002年1月—2009年12月确诊的132例FUO患者入院时白细胞、中性粒细胞、淋巴细胞、红细胞沉降率、C-反应蛋白及免疫球蛋白(IgG、IgM、IgA)的实验室检查结果,并总结其与不同病因之间的关系。结果 132例中,白细胞计数升高55例,病因以细菌感染为主,占60.0%(33/55);中性粒细胞升高29例,其中细菌感染占79.3%(23/29);淋巴细胞升高32例,其中病毒感染占46.9%(15/32),血液病及实体肿瘤占18.8%(6/32),风湿免疫病占34.4%(11/32);红细胞沉降率增加61例,其中风湿免疫病占55.7%(34/61),血液病及实体肿瘤占24.6%(15/61),感染性疾病占19.7%(12/61);C-反应蛋白升高48例,病因以感染性疾病为主,占83.3%(40/48);免疫球蛋白(IgG、IgM、IgA)3项同时升高8例,均为风湿免疫性疾病,1～2项升高26例,其中感染性疾病占46.2%(12/26),风湿免疫病占53.8%(14/26)。结论常规实验室检查在FUO诊断中具有重要意义,仔细分析检查结果,常可为诊断提供线索。

Objective To investigate the diagnostic value of six routine laboratory test items so as to improve confirmative di-agnosis in patients with fever of unknown origin （FUO）. Methods A retrospective study was conducted in 132 confirmed FUO pa- tients, who were treated in our hospital from Jan. 2002 to Dec. 2009. White blood cell count, neutrophils, lymphocytes, erytbrocyte sedimentation rate, C-reactive protein and immunoglobulin （IgG, IgM and IgA） were tested upon admission and their relationship with different disease causes were analyzed. Results Of 132 FUO patients, white blood cell count elevated in 55 patients, 33 （60.0%） of whom had bacterial infection; neutrophil count increased in 29 patients, 23 （79.3%） of whom had bacterial infection; lymphocytes elevated in 32 patients, 15 （46.9%） of whom had viral infection, 6 （18.8%） had hematopathy and solid tumors and 11 （34.4%） had rheumatic disease; faster erythrocyte sedimentation rate was found in 61 patients, 34 （55.7%） of whom had rheumatic disease, 15 （24.6%） had hematopathy and solid tumors, and 12 （19.7%） had infectious diseases; higher C-reactive protein was found in 48 patients, 40 （83.3%） of whom had infectious disease; immunoglobulin （Ig） G, IgM and IgA increased in 8 patients, who had rheumatic diseases, and 1 or 2 items of lgG, IgM and IgA increased in 26 patients, 12 （46.2%） of whom had infectious diseases and 14 （53.8%） had rheumatic diseases. Conclusions Routine laboratory tests play an important role in the diagnosis of FUO. Careful analysis of laboratory test results can provide evidence for the diagnosis of FUO.