124例疑难发热病的诊断

Pathological diagnosis of 124 cases with originally undeternmined fever

目的 提高内科医师对疑难发热病的诊断 ,避免误、漏诊 ,使病人得到及时治疗。方法回顾了 195 3～ 1997年《中华内科杂志》刊出的 12 4例发热病例的临床病理讨论。结果 疑难发热病病因以感染性、血液系统及肿瘤疾病为主 ,分别为 36 4%、30 2 %及 2 0 9%。感染性疾病中以细菌性及结核性感染为主 ,分别为 2 3 4%及 2 9 8% ,其次为病毒性、寄生虫性及霉菌性感染。 80～ 90年代与5 0～ 70年代比较 ,结核性及寄生虫感染无减少趋向。病毒及霉菌性感染报道增多 ,尤其艾滋病、卡氏肺囊虫肺炎及巨细胞病毒。结论 对我国疑难发热病例应警惕结核和细菌性感染 ,以及寄生虫、艾滋病、淋巴瘤、恶性组织细胞病及恶性肿瘤等。严禁滥用肾上腺皮质激素。

Objective To investigate the causes of undetermined fever after thorough clinical,radiological, functional and laboratory examinations and to facilitate the diagnosis and treatment Methods The reports of clinic pathological conference on undetermined fever were collected from Chinese Journal of Internal Medicine during the period from 1953 to 1997124 cases with originally undetermined fever were reviewedThe diagnosis in these cases was finally established with pathological examinationThe causes of the fever in these cases were analyzed in this study Results Infectious, hemotoloical and neoplastic diseases appeared to be the common causes of the fever in these patientsThey amounted to 364%, 302% and 209% respectively (of the cases presenting with fever) Very strikingly, tuberculosis accounted 298% of the cases with infectious fever, whereas other bacterial infections amounted to 234% A comparison of the occurrence of tuberculous fever between 1950s1970s and 1980s 1990s showed no differenceAmong the diseases of hemotology,more than half of cases with the fever were attributed to lymphoma and histocytosis AIDS associated infection and fever tended to increase Conclusion Increasing alertness on tuberculosis,lymphoma, histocytosis, AIDS and cancer often directs to further specific examinations and may finally make the correct diagnosis