老年人不明原因发热外周血炎性因子表达水平探究

Analysis of clinical characteristics on the elderly fever of unknown origin

目的探讨老年人不明原因发热的临床特点以及炎症因子表达水平,为临床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科与危重症科2014年1月至2016年11月期间收治的不明原因发热老年患者260例,详细记录患者性别、热程及病因,分析老年人不明原因发热的临床特点以及相关炎性因子表达水平。结果 260例FUO患者中,最终确诊236例,确诊率为90.77%,死亡7例,病死率为2.69%。感染性疾病是最主要的病因,占总例数59.62%,第二病因为结缔组织疾病(占16.15%),第三位是恶性肿瘤(占8.85%);IL-1在各个发热病因亚组间相比差异不具有统计学(P>0.05);IL-6在结缔组织疾病患者外周血中表达显著高于其他组,TNF-α在恶性肿瘤患者外周血中表达显著高于其他组,IL-25在感染性疾病患者中表达显著高于其他组,差异具有具有统计学意义(P<0.05);各组发热病程中≤1月热程患者中感染性疾病占35.77%,且不同发热病程时间病因分布具有有统计学差异(P<0.05)。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,临床医生应全面考虑免疫学因子,才能及时明确诊断和对症治疗。

Objective To investigate the clinical features of fever of unknown origin in the elderly,and provide guidance for clinical diagnosis and treatment. Methods Retrospective analysis of 260 cases of elderly patients with fever of unknown origin admitted from January,2014 to November,2016 in Henan Province People＇s Hospital,Department of Respiratory Medicine and Critical Care Department of Henan Province were analyzed retrospectively,the gender,heat history and etiology were recorded in detail,and the unexplained fever Of the clinical features. Results Of the 260 cases of FUO,236 cases were diagnosed,the diagnosis rate was 90. 77%,7 cases died and the mortality was 2. 69%. Infectious disease was the most important cause,accounting for 59. 62% of the total cases,the second was connective tissue disease（ 16. 15%）,the third was malignant tumor（ 8. 85%）. IL-1 in each fever subgroup（ P〉0. 05）. The expression of IL-6 in peripheral blood of patients with connective tissue disease was significantly higher than that of other groups,and the expression of TNF-α in peripheral blood of patients with malignant tumor was significantly higher than that of other groups（ P〈0. 05）. In the fever course of each group,the infection rate was 35. 77%,and the difference was significant（ P〈0. 05）. The difference was significant（ P〈0. 05） There were significant differences in the temporal distribution of cause（ P〈0. 05）. Conclusion FUO patients ＇ condition is complicated and complicated. The main cause of FUO is infectious diseases,connective tissue diseases and malignant tumors. Therefore,clinicians should fully consider the diagnosis and symptomatic treatment.