1979—2012年中文文献报道的成人不明原因发热病因构成分布

Chinese literature review of etiology distribution of adult patients with fever of unknown origin from 1979 to 2012

目的分析1979--2012年中文文献报道的10201例不明原因发热（FUO）患者病因构成并比较南北地区的差异及不同时期的变化。方法通过中国知网以“不明原因发热”为主题词，对1979年至2012年期间中文文献进行检索，命中1362篇文献。剔除病例数小于100的文献，以1961年美国Petersdorf和Beeson医生提出的定义为纳入标准，纳入43篇临床研究文献，共计10201例患者。将该时段分早、中、后3期并根据文献所属地域分南、北方，对其临床资料进行统计学分析。结果42篇文献（9787例患者）阐明了性别，其中男性5063例，女性4724例。10201例患者病因依次为感染性疾病（53．5％）、风湿免疫病（20．1％）、肿瘤（12．0％）及其他病因（6．4％），确诊率约91．8％。感染性疾病以结核（23．8％）多见，风湿免疫病以成人Still病（7．0％）多见，恶性肿瘤中以淋巴瘤（3．4％）多见，其他病因以药物热（1．7％）多见。早、中、后3期，感染性疾病构成比逐渐减少，风湿免疫病和其他病因构成比呈增加态势，肿瘤构成比中期显著高于早期和后期，原因仍未明的比例增加（P〈0．05）。北方感染性疾病构成比显著低于南方，药物热等其他病因构成比显著高于南方（P〈0．05）。结论近30年来我国FUO病因的诊断仍然首先考虑感染性疾病，尤其是结核病的可能性。

Objective To review the etiology of 10 201 adult patients with fever of unknown origin （FUO） in China from 1979 to 2012, and to compare the reasons between the South and the North of China, and to illustrate the change in different periods. Methods Literatures containing key word ＂ fever of unknown origin＂ were selected in China National Knowledge Infrastructure （CNKI） database from 1979 to 2012. Articles were excluded if patient population were less than 100. Diagnostic criteria of FUO were confirmed by the standard of Petersdorf and Beeson in 1961. Totally 43 literatures including 10 201 patients were enrolled in this study. The period of the literatures were divided into the early, middle and later period, and the regions were partitioned into the South and the North. Results A total of 42 articles （ including 9787 patients） provided the gender information with 5063 men and 4724 women. The etiologies of 10 201 FUO patients included infectious diseases （53.5%）, rheumatic diseases （20. 1%o ） and tumor （12. 0% ）. The positive diagnostic rate was 91.8%. Tuberculosis （23.8%） was the most common reason in infectious diseases. Adult Still＇s disease （7.0%） was the most common cause of FUO among rheumatic diseases. Lymphoma （3.4%） was the most common tumor in FUO patients. Besides, drug-induced fever （1.7%） should also be considered. In the recent 30 years, the proportion of FUO caused by infectious diseases had decreased, rheumatic diseases and other reason had increased （ P 〈 O. 05 ） . The proportion of tumor in middle period was significantly higher than that in the early and later period （ P 〈 0. 05 ）. The negative diagnostic rate had increased （ all P 〈 O. 05 ） . The proportion of infectious diseases in North China was significantly lower than that in the South （ P 〈 0. 05 ）. The proportion of other reason was significantly higher in the North （ P 〈 0. 05 ）. Conclusion In the recent 30 years, the most common cause of FUO was still infectious diseases, especially tuberculosis.