288例不明原因发热患者的临床病因分析

Clinical etiology analysis of 288 patients with fever of unknown origin

目的分析不明原因发热(FUO)患者的病因分布及确诊方法,为临床诊断治疗提供参考。方法回顾性分析2015年10月—2018年4月在本院感染病科住院且符合FUO诊断标准的288例患者的病历资料,进行病因分析,探讨FUO患者的病因分布及其与性别、年龄、热程的关系。结果 288例FUO患者中最终确诊236例(81.9%),出院仍未确诊者52例(18.1%)。236例明确诊断患者病因分类为:感染性疾病146例(50.7%),其中肺部感染占23.3%(34/146),败血症占20.5%(30/146),结核病占17.1%(25/146);结缔组织病(CTD) 36例(12.5%),其中成人still病占38.9%(14/36);肿瘤性疾病22例(7.6%),以淋巴瘤为主31.8%(7/22);其他疾病32例(11.1%),以药物热最为多见56.2%(18/32)。女性结缔组织病CTD的比例明显高于男性,男性肿瘤性疾病的比例明显高于女性,差异具有统计学意义(P<0.05)。感染性疾病在各年龄阶段中均为首要病因,但以60～85岁年龄组较多见; CTD以30～59岁年龄组较多见,肿瘤性疾病以60～85岁组多见; FUO的病因构成在不同年龄组中差异具有统计学意义(χ~2=16. 449,P=0.036)。随着热程的延长,感染性疾病占的比例有所下降,结缔组织疾病(CTD)和肿瘤性疾病占的比例有所上升;不同热程组FUO病因分布有统计学差异(χ~2=23.938,P=0.002)。结论 FUO病因繁杂,感染性疾病是FUO首要病因,CTD和肿瘤性疾病在FUO病因中位居第二、第三。FUO患者经过详细的病史采集、全面系统的体格检查、合理利用各种诊查手段,大部分可以明确诊断。FUO患者病因分布在不同性别、年龄、热程间存在一定的差异。

Objective To analyze the etiology distribution and diagnosis methods of 288 patients with fever of unknown origin(FUO),and provide reference for clinical diagnosis and treatment.Methods A retrospective analysis of the medical records of 288 patients admitted to the first affiliated hospital of Bengbu Medical College from October 2015 to April 2018 and meeting the diagnostic criteria of FUO was conducted to analyze the etiology and to investigate the etiology of FUO patients,the relationship between the cause distribution and gender,age,and duration of fever.Results Of the 288 patients with FUO,236(81.9%)were definitively diagnosed,and 52(18.1%)were still undiagnosed after discharge.The causes were classified as:146 cases(50.7%)of infectious diseases,of which 23.3%(34/146)were pulmonary infections,20.5%(30/146)were sepsis,and 17.1%(25/146)were tuberculosis;connective tissue diseases(CTD)36 cases(12.5%),including adult still disease accounted for 38.9%(14/36);tumor disease 22 cases(7.6%),lymphoma mainly31.8%(7/22);other diseases 32 cases(11.1%),the most common drug fever was 56.2%(18/32).The proportion of CTD in female was significantly higher than that in male,the proportion of male neoplastic disease was significantly higher than that in female,the differences were statistically significant(P<0.05).Infectious diseases were the primary cause in all ages,but more common in the 60-85 age group,CTD was more common in the 30-59 age group,and tumor diseases are more common in the 60-85 age group.The etiology of the FUO was statistically significant among different age groups(χ~2=16.449,P=0.036).With the prolongation of duration of fever,the proportion of infectious diseases decreased,however,the proportion of connective tissue diseases(CTD)and neoplastic diseases increased.The distribution of FUO in different heat courses was statistically different(χ~2=23.938,P=0.002).Conclusions The cause of FUO is more complicated.Infectious diseases are the primary cause of FUO,CTD and neoplastic diseases rank second and third in the cause of FUO.FUO patients can be diagnosed with detailed medical history,comprehensive and systemic physical examination,and rational use of various diagnostic methods.There are some differences in the etiology of FUO patients among different genders,ages and duration of fever.