102例不明原因发热患者的病因分布及诊断策略研究

Study on the etiology distribution and diagnosis strategy of 102 cases with FUO

目的研究不明原因发热(fever of unknown origin,FUO)的病因分布及诊断策略。方法制定FUO诊断策略,纳入FUO患者102例,按照FUO诊断策略进行诊断,比较不同性别组、不同年龄组、不同热程组、有无合并症组FUO患者病因分布是否存在差异。同时评估该诊断策略的确诊率、平均确诊时间、平均住院费用及患者对该诊断策略的依从性。结果 102例FUO患者中感染性疾病最常见,感染性疾病排在前6位的为泌尿系感染、血流感染、未定位感染、布氏杆菌病、肺炎+泌尿系感染、肺炎,非感染性疾病常见的有结缔组织病、其他类疾病。未明确诊断15例(14.7%),确诊87例(85.3%),确诊时间中位值为6(3,10)d,住院费用中位值为1.6(1.1,2.3)万元,依从诊断策略者90例(88.2%)。不同性别组及不同热程组FUO患者的病因分布差异无统计学意义;老年组感染性疾病构成比高于青年组和中年组(P<0.05),非感染性疾病所占比例低于青年组和中年组(P<0.05),无合并症FUO患者非感染性疾病所占比例高于有合并症者(P<0.05)。结论 FUO首发病因为感染性疾病,其中以泌尿系感染为主,其次为结缔组织病及其他疾病。老年FUO患者感染性疾病更为多见。中青年及无合并症FUO患者非感染性疾病更常见。FUO诊断策略确诊率高、确诊时间短、平均费用低,患者对诊断策略的依从性好,可进一步临床推广。

Objective To discuss the etiology and diagnostic strategy of fever of unknown origin（FUO）.Methods To formulate a diagnostic strategy of FUO,one hundred and two patients with FUO treated in our hospital were analyzed to study if there were differences in the distribution of the etiology of FUO patients with different sex,duration of fever,age and complications.At the same time,the diagnostic rate,average diagnosis time,average hospitalization cost and compliance of the diagnostic strategy were evaluated.Results The most common cause were infectious diseases,urinary tract infections,blood stream infections,unlocalized infections,brucellosis,pneumonia combined with urinary tract infections,pneumonia were in the top six.In the non-infection diseases,connective tissue diseases and miscellaneous diseases were mostly seen.No definite diagnosis diseases were 15 cases（14.7%）.The 87 patients（85.3%）were confirmed,and the accurate rate was 85.3%,the diagnosis time was 6（3,10）days and the hospitalization cost was 1.6（1.1,2.3）million yuan,compliance rate was 88.2%（90/102）.There was no significant difference in the etiology distribution between different genders,duration of fever.The prevalence rate of infectious diseases in senior patients was higher than that in non-senior patients（P〈0.05）.The proportion of non-infection diseases in non-senior patients was higher than that in senior patients（P〈0.05）.The prevalence rate of non-infection diseases without complications was higher than that with complications patients（P〈0.05）.ConclusionThe first cause of FUO is infectious disease.Among them,urinary tract infection was the main factor.The second is connective tissue disease and other diseases.The prevalence of infectious diseases in elderly FUO patients is more common.Non infectious diseases are more common in young and middle-aged patients without FUO.The accurate rate of the diagnostic strategy of FUO is high,the diagnosis time is short,the average cost is low,the accurate rate of the patient′s compliance with the diagnostic strategy is good,so it can be further promoted in clinic.