不明原因发热的临床病因分析和研究
发布时间：2018-08-04 10:07
【摘要】：目的：探讨近十年来不明原因发热(FUO)患者的临床病因分布构成和变化,提高临床医生对FUO的认识和了解,提高FUO的确诊率方法：回顾分析2003年12月至2014年6月在中国人民解放军空军总医院住院的500例FUO患者的临床资料,统计分析其病因分布、常见疾病和诊断方法,比较不同性别、年龄组和疾病热程FUO患者在病因分布和构成上的差异,并根据发病时间不同,将2003年12月～2008年12月、2009年1月～2014年6月划分为前后5年并比较两个时期的病因分布和构成。复习国内2000年以来相关文献,比较分析国内FUO患者临床病因分布和构成情况,了解国内其它地区FUO患者的临床特点。结果：1.500例FUO患者中,452例(90.4%)最终确诊,包括感染性疾病231例(46.2%),结缔组织病99例(19.8%)；肿瘤性疾病58例(11.6%)；其他疾病64例(12.8%)；未明确诊断48例(9.6%),疾病分布83种,常见疾病依次为结核感染、成人斯蒂尔病、肺部感染、淋巴瘤、血流感染等。2.在感染性疾病中,细菌感染176例,分别占全部病例和感染性疾病病例的35.2%(176/500)和76.2%(176/231),其中结核感染76例,分别占全部病例和感染性疾病病例的15.2%(76/500)和32.9%(76/231)；病毒感染35例,分别占全部病例和感染性疾病病例的7.0%(35/500)和15.2%(35/231)；其他感染20例,分别占全部病例和感染性疾病病例的4.0%(20/500)和8.7%(20/231)。感染性疾病分布30种,常见疾病依次为结核感染、肺部感染、血流感染、泌尿系感染、脓肿及布氏杆菌病等；结缔组织病18种,常见疾病依次为成人斯蒂尔病、血管炎、系统性红斑狼疮等；肿瘤性疾病58例,疾病分布17种,血液系统肿瘤和实质性肿瘤分别43例(74.1%,43/58)和15例(25.9%,15/58),常见疾病依次为淋巴瘤、噬血细胞综合征、白血病等；其他疾病64例,疾病分布18种,常见疾病依次为坏死增生性淋巴结炎、亚急性甲状腺炎、药物热等。3.FUO女性患者中结缔组织疾病所占比例为26.3%(59/224)明显高于男性的14.5%(40/276),x25.027,P＝0.025；男性患者中肿瘤性疾病所占比例为14.5%(40/276)明显高于女性患者的8.0%(18/224),x2＝10.928,P=0.001。在各年龄组中感染性疾病均为首要病因,在21-39岁和40-59岁年龄组中结缔组织疾病为第二位病因,在60岁及以上年龄组中恶性肿瘤性疾病为第二位病因,FUO病因的构成在不同年龄组患者中差异有统计学意义(X2=43.10,P＝0.000)。肿瘤性疾病的热程为60(28,90)d,明显长于感染性疾病的28(21,42)d(Z＝-4.168,P=0.000)和结缔组织病的30(21,60)d(Z＝-2.406,P=0.016)。2009～2014年间结缔组织疾病所占比例为23.8%,明显高于2003～2008年间的13.7%(x2＝8.598,P=0.003)；感染性疾病、肿瘤性疾病和其他疾病的构成虽较2003-2008年间有下降趋势,但差异无统计学意义(P均0.05)。4.北京地区FUO中感染性疾病所占比例低于谭星宇文献组(全国)所占比例(46.7%vs 51.1%,X2=1 7.51,P=0.000),北京地区文献组FUO中其他疾病所占比例、未明确诊断所占比例均高于谭星宇文献组(全国)其他疾病所占比例、未明确诊断所占比例(8.6%vs7.0%, X2=8.008, P=0.004; 12.5%vs8.9%, X2-48.896, P=0.000),北京地区文献组FUO中结缔组织病及肿瘤性疾病所占比例均高于谭星宇文献组(全国)FUO中结缔组织病及肿瘤性疾病所占比例(P均0.05)。结论：1.引起FUO的疾病达80余种,病因复杂；9.6%的病例最后仍未能明确诊断,少部分患者临床确诊仍很困难。2.感染性疾病仍然是FUO的主要病因,结核感染为感染性疾病中的首要病因,也是FUO中最常见的病因。结缔组织病及肿瘤性疾病在FUO病因中占有重要地位。3.FUO病因分布和构成在不同性别、年龄组、疾病热程等方面存在一定的差异,女性患者结缔组织疾病所占比例明显高于男性,男性患者肿瘤性疾病所占比例明显高于女性；随着患者年龄增长和疾病热程的延长,感染性疾病所占比例逐渐下降,非感染性疾病的所占比例逐渐增高。4.随着年代变迁FUO病因分布和构成发生了一定变化,结缔组织疾病所占比例明显增高,感染性疾病和肿瘤性疾病所占比例相对降低,值得临床医生注意和重视。
[Abstract]:Objective: To explore the distribution and change of clinical etiology of patients with fever of unknown origin (FUO) in the last ten years, to improve the understanding and understanding of FUO by clinicians and to improve the diagnostic rate of FUO: a retrospective analysis of the clinical data of 500 cases of FUO patients in the Air Force PLA General Hospital from December 2003 to June 2014, and to analyze the statistical analysis of the clinical data. The etiological distribution, common diseases and diagnostic methods were used to compare the differences in the distribution and composition of FUO patients with different sex, age group and disease heat course. According to the time of onset, the distribution and composition of the etiological factors were divided into 5 years from December 2003 to December 2008, January 2009 to June 2014, and compared with the two periods. The clinical characteristics of FUO patients in China were compared and analyzed, and the clinical characteristics of FUO patients in other areas of China were compared and analyzed. Results: among 1.500 patients with FUO, 452 cases (90.4%) were final diagnosed, including 231 cases of infectious diseases (46.2%), 99 cases of connective tissue disease (19.8%), 58 cases of tumor (11.6%) and 64 cases (1) (64 cases). 2.8%): 48 cases (9.6%) and 83 kinds of diseases were not clearly diagnosed. The common diseases were tuberculosis infection, adult Steele's disease, lung infection, lymphoma, blood flow infection and other.2. in infectious diseases and 176 cases of bacterial infection, which accounted for 35.2% (176/500) and 76.2% (176/231) of all cases and infectious diseases, respectively, and 76 cases of tuberculosis infection, respectively. 15.2% (76/500) and 32.9% (76/231) of all cases and infectious diseases, 35 cases of viral infection, 7% (35/500) and 15.2% (35/231) in all cases and infectious diseases, 20 cases of other infections, 4% (20/500) and 8.7% (20/231) of all cases and infectious diseases, respectively. The common distribution of infectious diseases is 30. The diseases were tuberculosis infection, pulmonary infection, blood flow infection, urinary infection, abscess and brucellosis, connective tissue disease 18, the common diseases were adult Steele's disease, vasculitis, systemic lupus erythematosus, 58 cases of tumor disease, 17 kinds of disease distribution, 43 cases of blood system tumor and parenchyma tumor (74.1%, 43/58). And 15 cases (25.9%, 15/58), common diseases were lymphoma, hemophagocytic syndrome, leukemia and other diseases, 64 other diseases and 18 disease distribution. The common diseases were necrotic lymphadenitis, subacute thyroiditis, and drug fever in.3.FUO women, the proportion of connective tissue diseases was 26.3% (59/224) significantly higher than that of men's 14. .5% (40/276), x25.027, P = 0.025; the proportion of tumor disease in male patients was 14.5% (40/276) significantly higher than 8% (18/224) and X2 = 10.928 in female patients. P=0.001. was the primary cause of infectious diseases in all age groups, and second causes of connective tissue disease in 21-39 and 40-59 years old group, and in the age group of 60 and above. The middle and malignant tumor disease was the second cause, the FUO cause was statistically significant in different age groups (X2=43.10, P = 0). The heat course of the tumor was 60 (28,90) d, obviously longer than 28 (21,42) d (Z = -4.168, P=0.000) and 30 of connective tissue disease (21,60) d. The proportion of interconnective tissue diseases was 23.8%, which was significantly higher than 13.7% (x2 = 8.598, P=0.003) in 2003~2008 years. Infectious diseases, tumor diseases and other diseases had a downward trend in 2003-2008 years, but the difference was not statistically significant (P 0.05). The proportion of infectious diseases in FUO in Beijing area was lower than that of Tan Xingyuwen. The proportion of the group (46.7%vs 51.1%, X2=1 7.51, P=0.000), the proportion of other diseases in the Beijing literature group FUO, the proportion of undefined diagnosis was higher than the proportion of other diseases in the Tan Xingyu literature group (National), and the proportion of the diagnosis was not clear (8.6% vs7.0%, X2=8.008, P=0.004; 12.5%vs8.9%, X2-48.896, P=0.000), Beijing. The proportion of connective tissue disease and tumor disease in the regional literature group FUO was higher than the proportion of connective tissue disease and tumor disease in the Tan Xingyu literature group (National) FUO (P 0.05). Conclusion: 1. of the diseases of FUO are more than 80 species, and the cause of the disease is complex; 9.6% of the cases are still not clearly diagnosed, and a few patients are still difficult to confirm the clinical diagnosis. .2. infectious disease is still the main cause of FUO. Tuberculosis infection is the primary cause of infectious diseases and the most common cause of FUO. Connective tissue disease and tumor disease occupy an important position in the cause of FUO. The distribution and composition of the cause of.3.FUO are different in different sex, age group, and disease fever. The proportion of connective tissue diseases was significantly higher than that of men. The proportion of tumor diseases in male patients was significantly higher than that of women. With the age of patients and the prolongation of the disease fever, the proportion of infectious diseases gradually decreased and the proportion of non infectious diseases gradually increased.4. with the distribution and composition of the etiological factors of FUO. The proportion of connective tissue diseases is significantly higher, and the proportion of infectious and tumor diseases is relatively lower. It is worth paying attention to and paying attention to the clinicians.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R441.3
本文编号：2163545
[Abstract]:Objective: To explore the distribution and change of clinical etiology of patients with fever of unknown origin (FUO) in the last ten years, to improve the understanding and understanding of FUO by clinicians and to improve the diagnostic rate of FUO: a retrospective analysis of the clinical data of 500 cases of FUO patients in the Air Force PLA General Hospital from December 2003 to June 2014, and to analyze the statistical analysis of the clinical data. The etiological distribution, common diseases and diagnostic methods were used to compare the differences in the distribution and composition of FUO patients with different sex, age group and disease heat course. According to the time of onset, the distribution and composition of the etiological factors were divided into 5 years from December 2003 to December 2008, January 2009 to June 2014, and compared with the two periods. The clinical characteristics of FUO patients in China were compared and analyzed, and the clinical characteristics of FUO patients in other areas of China were compared and analyzed. Results: among 1.500 patients with FUO, 452 cases (90.4%) were final diagnosed, including 231 cases of infectious diseases (46.2%), 99 cases of connective tissue disease (19.8%), 58 cases of tumor (11.6%) and 64 cases (1) (64 cases). 2.8%): 48 cases (9.6%) and 83 kinds of diseases were not clearly diagnosed. The common diseases were tuberculosis infection, adult Steele's disease, lung infection, lymphoma, blood flow infection and other.2. in infectious diseases and 176 cases of bacterial infection, which accounted for 35.2% (176/500) and 76.2% (176/231) of all cases and infectious diseases, respectively, and 76 cases of tuberculosis infection, respectively. 15.2% (76/500) and 32.9% (76/231) of all cases and infectious diseases, 35 cases of viral infection, 7% (35/500) and 15.2% (35/231) in all cases and infectious diseases, 20 cases of other infections, 4% (20/500) and 8.7% (20/231) of all cases and infectious diseases, respectively. The common distribution of infectious diseases is 30. The diseases were tuberculosis infection, pulmonary infection, blood flow infection, urinary infection, abscess and brucellosis, connective tissue disease 18, the common diseases were adult Steele's disease, vasculitis, systemic lupus erythematosus, 58 cases of tumor disease, 17 kinds of disease distribution, 43 cases of blood system tumor and parenchyma tumor (74.1%, 43/58). And 15 cases (25.9%, 15/58), common diseases were lymphoma, hemophagocytic syndrome, leukemia and other diseases, 64 other diseases and 18 disease distribution. The common diseases were necrotic lymphadenitis, subacute thyroiditis, and drug fever in.3.FUO women, the proportion of connective tissue diseases was 26.3% (59/224) significantly higher than that of men's 14. .5% (40/276), x25.027, P = 0.025; the proportion of tumor disease in male patients was 14.5% (40/276) significantly higher than 8% (18/224) and X2 = 10.928 in female patients. P=0.001. was the primary cause of infectious diseases in all age groups, and second causes of connective tissue disease in 21-39 and 40-59 years old group, and in the age group of 60 and above. The middle and malignant tumor disease was the second cause, the FUO cause was statistically significant in different age groups (X2=43.10, P = 0). The heat course of the tumor was 60 (28,90) d, obviously longer than 28 (21,42) d (Z = -4.168, P=0.000) and 30 of connective tissue disease (21,60) d. The proportion of interconnective tissue diseases was 23.8%, which was significantly higher than 13.7% (x2 = 8.598, P=0.003) in 2003~2008 years. Infectious diseases, tumor diseases and other diseases had a downward trend in 2003-2008 years, but the difference was not statistically significant (P 0.05). The proportion of infectious diseases in FUO in Beijing area was lower than that of Tan Xingyuwen. The proportion of the group (46.7%vs 51.1%, X2=1 7.51, P=0.000), the proportion of other diseases in the Beijing literature group FUO, the proportion of undefined diagnosis was higher than the proportion of other diseases in the Tan Xingyu literature group (National), and the proportion of the diagnosis was not clear (8.6% vs7.0%, X2=8.008, P=0.004; 12.5%vs8.9%, X2-48.896, P=0.000), Beijing. The proportion of connective tissue disease and tumor disease in the regional literature group FUO was higher than the proportion of connective tissue disease and tumor disease in the Tan Xingyu literature group (National) FUO (P 0.05). Conclusion: 1. of the diseases of FUO are more than 80 species, and the cause of the disease is complex; 9.6% of the cases are still not clearly diagnosed, and a few patients are still difficult to confirm the clinical diagnosis. .2. infectious disease is still the main cause of FUO. Tuberculosis infection is the primary cause of infectious diseases and the most common cause of FUO. Connective tissue disease and tumor disease occupy an important position in the cause of FUO. The distribution and composition of the cause of.3.FUO are different in different sex, age group, and disease fever. The proportion of connective tissue diseases was significantly higher than that of men. The proportion of tumor diseases in male patients was significantly higher than that of women. With the age of patients and the prolongation of the disease fever, the proportion of infectious diseases gradually decreased and the proportion of non infectious diseases gradually increased.4. with the distribution and composition of the etiological factors of FUO. The proportion of connective tissue diseases is significantly higher, and the proportion of infectious and tumor diseases is relatively lower. It is worth paying attention to and paying attention to the clinicians.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R441.3
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