综合性医院呼吸科443例发热患者临床诊断分析

Clinical analysis of 443 fever patients in respiratory department of general hospital

目的探讨呼吸科发热患者的病因构成和临床特点,为发热患者的病因诊断提供有价值的线索。方法回顾性分析2014年1月至2014年12月在安徽医科大学第一附属医院呼吸科住院且最终确诊的发热患者并按年龄分为〈45岁组,45~59岁组及≥60岁组三组,对临床资料进行回顾性分析。结果 443例发热患者中,感染性疾病321例（72.5%）,肺炎最常见168例（37.92%）;非感染性疾病122例（27.5%）,肺癌105例（23.7%）。〈45岁组：共有80例,其中感染性疾病71例（88.75%）,其中肺炎40例（50.00%）;急性气管支气管炎12例（15.00%）;结核性胸膜炎10例（12.50%）。非感染性疾病9例（11.25%）,其中肺癌7例（8.75%）;45~59岁组：共有93例,其中感染性疾病56例（60.21%）肺炎33例（35.48%）;肺脓肿、慢阻肺急性加重各5例（均5.38%）。非感染性疾病39例（41.94%）,其中肺癌35例（37.53%）。≥60岁组：共有270例,其中感染性疾病195例（72.22%）,其中肺炎95例（35.18%）;慢阻肺急性加重42例（15.56%）。非感染性疾病75例（27.78%）,其中肺癌63例（23.33%）;ANCA相关性血管炎8例（2.96%）。结论综合性医院呼吸科发热患者主要病因为感染性疾病,其中肺炎所占比例最高;在非感染性疾病中,各年龄组均以肺癌为首位,应该引起临床上重视。

Objective To investigate the etiology and clinical characters of fever patients in respiratory department and to provide the valuable clues for the diagnosis of fever patients. Methods All 443 cases of fever patients,admitted to the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2014,were divided into three groups by age： the group A（ 〈45 years old）,the group B（ 45 ~ 59 years old） and the group C（ ≥60 years old）. Their clinical data were retrospectively reviewed. Results Infectious diseases were identified in 321（ 72. 5%） of 443 cases,including pneumonia in 168 patients（ 37. 92）. Non-infectious diseases were diagnosed in 122 cases（ 27. 5%）,including lung cancers in 105（ 23. 7%）. 71 of 80 cases in the group A were defined as infectious diseases,including pneumonia in 40 cases（ 50%）,acute tracheobronchitis in 12（ 15%） and tuberculous pleuritis in 10 cases（ 12. 5%）. 9 of 80 cases had non-infectious disease,including 7 cases of lung cancer. 56 of 93 cases in the group B were recognized as infectious diseases（ 60. 21%,） including pneumonia in 33 cases（ 35. 48%）,lung abscess and AECOPD both in 5 cases. 39 cases（ 41. 94%） in the group B were non-infectious disease,35 of which were diagnosed as lung cancer（ 37. 53%）. 195 of 270（ 72. 22%） cases in the group C were infectious disease,including pneumonia in 95 cases（ 35. 18%）,and AECOPD in 42 cases（ 15. 56%）. 75 of 270cases（ 27. 78%） in the group C had non-infectious disease,including lung cancer in 63 cases（ 23. 33%）,and antineutrophil cytoplasmic antibody（ ANCA）-associated vasculitides in 8 cases. Conclusion The main cause of fever patients in respiratory department of general hospital is infectious diseases,of which pneumonia cases have the greatest proportion. Lung cancer is the most common cause of non-infectious diseases in all groups,which should be paid more attention.