1838例发热待查患者临床特征

Clinical characteristics of 1 838 patients with fever of unknown origin

目的了解1 838例发热待查(FUO)患者的病因分布特点,为临床诊治提供参考。方法回顾性分析2014年1月至2018年2月在徐州医科大学附属医院就诊的1 838例FUO住院患者的相关临床资料,将病因分为感染性疾病(1 256例)、非感染性疾病(391例)和诊断不明(191例)3类,分析其性别、年龄、住院天数、发热原因、预后等特点。结果FUO患者中男女比例为1∶1.15,年龄(49.01±19.72)岁。不同病因组间性别、住院天数等方面差异均无统计学意义(P>0.05),年龄比较差异有统计学意义(F=4.556,P<0.01),其中肿瘤性疾病患者年龄(56.92±17.53)岁,高于其他各组患者。感染性疾病中以细菌性感染最多见,其中呼吸系统感染416例(22.63%)。非感染性疾病中以结缔组织病最多见,其中成人斯蒂尔病55例(2.99%)。药物热(2.01%)等其他原因所致FUO也较多见。出院后随访3个月示1 604例患者好转,102例治愈,7例死亡。结论临床诊疗FUO患者应首先考虑呼吸系统感染等感染性疾病以及成人斯蒂尔病等非感染性疾病,根据患者临床表现、体征及实验室指标临床综合分析,尽量明确或缩小可能的诊断范围。

Objective To understand the aetiology of 1 838 patients with fever of unknown origin (FUO), so as to provide references for clinical diagnosis and treatment. Methods The clinical data of 1 838 hospitalized patients with FUO in the Affiliated Hospital of Xuzhou Medical University from January 2014 to February 2018 were retrospectively analyzed. The patients were divided into three groups of infectious diseases (1 256 cases), non-infectious diseases (391 cases) and unidentified diagnosis (191 cases). The characteristics of gender, age, days of hospitalization and prognosis were analyzed. Results The male to female ratio of FUO patients was 1:1.15, and the age were (49.01±19.72) years old. The differences of the gender and days of hospitalization had no statistically significance in three groups (P>0.05). However, the difference of average ages had statistical significance (F=4.556, P<0.01), and the age of tumor patients was (56.92±17.53) years old which was higher than that of other patients. In infectious disease group, bacterial infection was the most common cause, in which respiratory system infections were seen in 416 cases (22.63%). In non-infectious disease group, connective tissue disease was the most common cause, in which adult Still disease was seen in 55 cases (2.99%). Other diseases such as drug fever (2.01%) were also commonly seen in FUO patients. After a 3-month follow-up, 1 604 patients improved, 102 were cured and 7 died. Conclusions Infectious diseases such as respiratory system infection, and non-infectious diseases such as adult Still disease should be considered primarily for the diagnosis and treatment of FUO patients. Clinical manifestations, symptoms and laboratory indexes can be comprehensively analyzed to narrow the possible diagnosis range as much as possible.