成人不明原因发热临床特点的回顾性分析

Clinical study on adult patients with fever of unkown origin

目的分析成人不明原因发热患者临床表现、诊断方法、病因、治疗措施及预后等方面的临床特点,探讨成人不明原因发热的病因规律及影响因素,为其临床及时诊断和治疗提供指导。方法回顾性分析河南省人民医院呼吸与危重症科2009年1月至2013年12月期间收治的住院成人不明原因发热患者260例,制作病例临床资料表,详细记录患者年龄、性别、热程及病因,探讨成人不明原因发热在临床表现、诊断方法、病因、治疗措施及预后等方面的特点,为成人不明原因发热临床诊治提供依据。结果 260例FUO患者中,男性较女性比例(61.15%vs.38.85%)显著升高。女性在结缔组织疾病中比例为高于男性患者(54.29%vs.45.71%)。FUO患者中病因按发病率排序依次为感染性疾病(162例,62.91%)、结缔组织疾病(35例,13.46%),恶性肿瘤(22例,8.46%)。FUO患者年龄分布和病因分类有统计学差异(χ2=87.56,P<0.01)。FUO患者按发病年龄分组最多见于41~60岁(37.31%)和21~40岁患者(25.77%)。感染性疾病多发于41~60岁患者(34.57%)和21~40岁患者(27.78%),而结缔组织疾病最常见于41~60岁中老年患者(51.43%)。各组发热病程中≤1月热程患者中感染性疾病占84.55%。随着发热病程时间的延长,感染性疾病所占比例有所下降,而结缔组织疾病和恶性肿瘤所占比例有所增加,不同发热病程时间病因分布有统计学差异(χ~2=123.07,P<0.001)。辅助检查中FUO患者出现异常率最高的依次为白细胞计数异常、谷丙转氨酶异常、免疫学检查异常、细菌学检查阳性、血清学抗体阳性、肿瘤标志物阳性。影像学检查异常者82例,占31.54%,体液骨髓穿刺检查和组织活检及病理诊断异常者各为39例(15.00%)和38例(14.62%)。结论 FUO患者病情较为复杂多变,其病因主要为感染性疾病、结缔组织疾病和恶性肿瘤,临床工作中应该全面考虑,才能及时明确诊断和对症治疗。

Objective In order to improve diagnosis and treatment level of FUO,we analyze the causes and clinical feature of adult patients with fever of unknown origin（ FUO）. Methods We collected 260 adult patients with FUO in the Department of Respiratory ICU of Henan Provincial People＇s Hospital from February 2009 to December 2013,retrospectively study the clinical data including the age,sex,fever duration,etiological Factor and prognosis of 260 adult patients with FUO. Results Male is higher than female in proportion of 260 FUO patients（ 61. 15% vs. 38. 85%）,and female is higher than male in proportion of connective tissue disease（ 54. 29% vs. 45. 71%）. FUO incidence in order is infectious diseases（ 162/62. 91%）,connective tissue disease（ 35/13. 46%）,tumor（ 22/8. 46%）. The distribution of age and etiological Factor of FUO patients remained statistically significant（ χ~2= 87. 56,P 〈0. 01）. FUO patients were seen most frequently between 41 and 60（ 37. 31%）,and secondly between 21 and 40（ 25. 77%）. Infectious diseases patients were seen most frequently between 41 and 60（ 34. 57%） and secondly between 21 and 40（ 27. 78%）. Connective tissue disease were seen most frequently between 41 and 60（ 51. 43%）. The causes of different fever durations remained statistically significant（ χ~2= 123. 07,P 〈0. 001）. The causes of less than 1 month fever duration was mainly infectious diseases（ 84. 55%）. With the extension of fever duration,the proportion of connective tissue disease and tumor were increased. The abnormal rate of assistant examination in order is leukocytosis and leukopenia,glutamic pyruvic transaminase,Immunologic test,bacteriologic assay,serological antibody test and tumor markers. Meanwhile the abnormal of imageological examination（ 82/31. 54%）,body fluids/bone marrow aspiration（ 39/15. 00%） and Biopsy and pathological examination（ 38/14. 62%） could be useful to diagnosis of FUO patients. Conclusion The clinical characteristics of FUO patients were complex. Infection is the main reason of FUO,followed by the order of connective tissue disease and tumor. Most of the FUO can be diagnosed by detailed medical history,thorough examination and experimental treatment when necessary.