风湿免疫科不明原因发热483例住院患者临床分析

Clinical analysis of 483 hospitalized patients with fever of unknown origin in the department of Rheumatology

目的探讨风湿免疫科不明原因发热(fever of unknown origin,FUO)住院患者的病因分布、临床特征及实验室特点。方法回顾性分析2000年1月至2010年1月我科收治的符合FUO诊断标准的483例患者的病因、诊断方法、临床特点以及实验室特点,并对出院时仍未诊断的进行随访。结果 483例中,男171例,女312例,年龄14～72岁,平均(36.5±13.4)岁。确诊459例,确诊率95%。风湿性疾病277例(57.3%),其中系统性红斑狼疮149例,成人斯蒂尔病60例;感染性疾病108例(22.3%),其中结核感染33例,均为肺外结核,败血症32例,主要为L型细菌感染;恶性肿瘤43例(8.4%),其中急性白血病13例;其他疾病31例(6.8%)。出院时仍未诊断疾病24例(5%)。发热时间超过1年的患者主要见于风湿性疾病。ESR≥100mm/h或CRP≥100mg/L的患者主要为风湿性疾病或感染性疾病或肿瘤。结论多数FUO的病因仍是常见病,风湿性疾病占FUO的比例逐渐增加,可能为其最主要的原因。

Objective To investigate the causes,clinical features and laboratory investigations of hospitalized patients with fever of unknown origin（FUO） in the department of Rheumatology.Methods Retrospectively analyzed the clinical data of 483 cases with FUO,who were hospitalized in the First Affiliated Hospital of Bengbu Medical College from January 2000 to January 2010.The data analyzed included etiology,diagnosis,laboratory investigations and clinical features.Results The 483 patients who met the criteria included 171 males and 312 females with a mean（SD） age of 36.5（13.4） years and ranged from 14 to 72 years old.459 cases out of 483 FUO cases with confirmed diagnosed,so the diagnostic ratio was 95%.The etiology of the FUO was rheumatic diseases（277/483,57.3%）,infectious diseases（108/483,22.3%）,malignant tumor（43/483,8.4%）,the miscellaneous causes（31/483,6.8%） and unknown diseases（24/483,5%）.The most frequent rheumatic diseases was systemic lupus erythmatosus（SLE）（149/483,30.8%）,followed by adult-onset Still＇s disease（60/483,21.6%）.The most prevalent infectious disease was tuberculosis（33/108,30.5.8%）,followed by septicemia in which bacteria septicemia was the most common cause.The most frequent neoplasm was acute leukemia（13/43,30.2%）.The most common miscellaneous cause was hemophagocytic syndromems14/31,45.1%）.The fever in most of the patients with disease duration of fever less than 1 year was caused by rheumatic diseases.Markedly elevated ESR（ESR≥100mm/h） or CRP（CRP≥100 mg/L）were mostly associated with rheumatic diseases or infectious diseases and malignant tumor.Conclusion For most patients,the causes of FUO can be clarified,but with rather atypical manifestations of common illnesses.The spectrum of diseases that cause FUO has been changed,and the rheumatic diseases has gradually increased in the proportion of causes of FUO and will probably replace infectious diseases as the most common cause of UFO in the future.