不明原因发热患者中肺外结核与病毒感染的临床特征分析

Clinical Features of Extrapulmonary Tuberculosis and Virus Infection in Patients with Fever of Unkown Origin

目的回顾性分析不明原因发热(FUO)患者肺外结核与病毒感染的临床特征,为临床该疾病的诊疗提供帮助。方法选择2009年1月1日—2011年6月30日因FUO入院、诊断困难且最终确诊为肺外结核的35例患者(肺外结核组)和25例病毒感染患者(病毒感染组)。对患者的一般状况(性别、年龄、病程)、实验室检测结果〔外周血白细胞水平(WBC)、红细胞沉降率(ESR)、C-反应蛋白(CRP)、腺苷脱氨酶(ADA)、乳酸脱氢酶(LDH)、补体C3(C3)及降钙素原(PCT)〕进行比较,同时对肺外结核患者与病毒感染患者γ-干扰素释放试验结果及患者外周血T细胞亚群检测结果进行分析。结果肺外结核组患者与病毒感染组患者的性别与年龄差异无统计学意义(P>0.05),但病毒感染组病程小于8周的构成比高于肺外结核组〔88.6%(22/25)比60.0%(21/35),P=0.046〕,差异有统计学意义;外周血检测结果发现常规炎性指标如ESR、CRP、PCT及补体C3差异无统计学意义(P>0.05),但WBC〔(9±4)×109/L比(6±3)×109/L,P=0.014〕、ADA〔(22±13)U/L比(38±24)U/L,P=0.005〕、LDH〔(210±103)U/L比(347±180)U/L,P=0.002〕两组患者间差异有统计学意义;γ-干扰素释放试验在肺外结核组阳性率为75.0%(21/28),病毒感染组阳性率为14.3%(2/14),差异有统计学意义(P=0.000);淋巴细胞亚群计数发现两组患者B细胞、NK细胞、CD4+和CD8+T细胞水平差异无统计学意义(P>0.05),但病毒感染组CD4+/CD8+倒置率为63.2%(12/19),肺外结核组患者为28.6%(4/14),差异有统计学意义(P=0.049)。结论FUO患者中,肺外结核与病毒感染患者临床特征存在差异,可通过病程、外周血WBC、ADA和LDH水平、γ-干扰素释放试验及CD4+和CD8+等进行诊断和鉴别诊断。

Objective The clinical features of extrapulmonary tuberculosis and virus infection in patients with the fever of unkown origin （FUO） were retrospectively analyzed, in order to benefit clinical diagnosis and treatment. Methods From Jan- uary 1 of 2009 to June 30 of 2011, 35 patients finally diagnosed with extrapumonary tuberculosis （group A） and 25 with virus in- fection patients （group B）, who were admitted because of FUO in our hospital, were enrolled. The patients＇ general status in- cluding gender, age and the course of disease, laboratory measurements including periphery white blood ceils （WBC）, erythro- cyte sedimentation rate （ ESR）, C - reactive protein （ CRP）, adenosine deaminase （ ADA ）, lactic acid dehydrogenase （LDH）, complement （C3）, and procalcitonin （PCT） were between the two groups compared. The assayresults of interferon gamma release and T cells subgroups were also compared. Results No significant difference was found between the two groups a- bout the proportion of gender and age （P 〉 0.05 ）. But the constituent ratio of disease course less than 8 weeks for patients of group B was higher than that of group A [88.6% （22/25） vs. 60.0% （21/35）, P =0.0461. There were no significant difference between the two groups in ESR, CRP, PCT and C3 （P 〉0. 05） ; but there were in WBC [ （9 ±4） × 10^9/L vs. （6 ±3） ×10^9/L, P=0. 014], ADA [ （22±13） U/L vs. （38±24） U/L, P=0. 005], LDH [ （210±103） U/Lvs. （347 ± 180） U/L, P = 0. 002]. The positive rate of interferon gamma release assay was 75.0% （21/28） in group A and 14. 3% （2/14） in group B, with a significant difference （P = 0. 000）. No significant difference was found between the two groups about the levels of B cells, NK cells, CD4 ＋ and CD8＋ T - cells （ P 〉 0.05 ）. However, ratio of CD4＋/CD8＋ was 63.2% （12/19） in group B and 28. 6% （4/14） in group A, with a significant difference （ P = 0. 049 ）. Conclusion The clinical features of extrapulmonary tuberculosis and virus infection in FUO patients are different. The course of disease, levels of WBC, ADA and LDH, interferon gamma release assay and ratio of CD4 ＋/CD8＋ are useful in diagnosis and differential diagnosis.