224例不明原因发热患者病因分析

Etiologies of 224 patients with fever of unknown origin

目的了解某院不明原因发热(FUO)患者病因,及其明确诊断的方法,为临床诊断和治疗FUO提供参考。方法应用血清学、细菌学、分子生物学、骨髓穿刺、组织活检,以及诊断性治疗等方法,对该院2008年1月—2014年7月收治的FUO住院患者进行临床诊断,回顾性分析224例FUO患者病因和最终诊断。结果最终明确病因者189例,占84.38%;未明确者35例,占15.62%。其中感染性疾病、结缔组织病、恶性肿瘤、其他类疾病分别占50.45%、18.75%、9.82%、5.36%。在感染性疾病中,细菌为主要病原体,其次为病毒;结缔组织病以系统性红斑狼疮和结节性多动脉炎为主;恶性肿瘤以血液系统肿瘤为主,而淋巴瘤最常见。189例确诊患者采用病原学检查者占30.16%,病理学检查者占24.34%,其他方法(综合分析)占20.11%。结论感染性疾病、结缔组织病、肿瘤为FUO的主要病因。

Objective To explore the etiologies of fever of unknown origin（FUO）and methods for confirming diagnosis in patients at a hospital,and provide reference for clinical diagnosis and treatment of FUO.Methods Patients with FUO admitted to a hospital between January 2008 and July 2014 were performed clinical diagnosis with methods of serology,bacteriology,molecular biology,bone marrow aspiration,tissue biopsy,and diagnostic therapy,the etiologies and final diagnosis of 224 patients were analyzed retrospectively.Results Of 224 FUO cases,189（84.38%）eventually got confirmed diagnosis,35（15.62%）were not confirmed.The percentage of infectious diseases,connective tissue diseases,malignant tumor,and other diseases were 50.45%,18.75%,9.82%,and5.36%respectively.Among infectious diseases,the major pathogens were bacteria,followed by virus.The major connective tissue diseases were systemic lupus erythematosus and polyarteritis nodosa;the main malignant tumor was hematological tumor,lymphoma was the main form.Among 189 patients with confirmed diagnosis,30.16% and24.34% were performed pathogenic and pathologic detection respectively,and20.11% were performed the other（comprehensive）methods.Conclusion Infectious diseases,connective tissue diseases,and tumor are major etiologies of FUO.