80例不明原因发热病因及中医辨证分析

发布时间：2018-11-20 13:18

【摘要】：目的:探讨不明原因发热(fever of unknown origin,FUO)的病因构成及转归,总结其临床特点、发病规律,为临床诊断提供参考。方法:回顾性分析2009年1月~2013年12月我院呼吸科符合FUO诊断80例患者的最终病因诊断,并分析病因与性别、年龄、热程、确诊时间之间的关系及中医证型分布。结果:1.80例FUO患者中,明确诊断70例(87.5%),5例患者死亡(6.3%),死亡病因均为感染性疾病;未明确诊断10例(12.5%)。70例明确诊断的FUO患者的病因构成为:(1)感染性疾病49例(61.3%),其中结核病居首位,占17例(21.3%),肺结核病15例(18.8%),肺外结核2例(2.5%);其次,卒中相关性肺炎居第2位,占11例(13.8%),布氏杆菌病居第3位,占5例(6.3%);(2)结蹄组织病14例(17.5%),成人Still病所占比率最高,达5例(6.3%);(3)肿瘤性疾病3例(3.8%),其中淋巴瘤、结肠癌、肺癌各1例;(4)其他病因4例(5.0%)。2.不同疾病类型与性别间具有明显差异有统计学意义(2?=8.316,P0.05)。3.不同疾病类型在不同年龄段的分布无统计学意义(2?=3.389,P0.05)。4.不同疾病类型在发热时间上具有显著差异有统计学意义(2?=30.898,P0.05)。5.不同疾病类型在确诊时间上具有统计学差异(?2=24.662,P0.05)。6.FUO患者中,阴虚型(22/80 27.5%)、表热型(14/80 17.5%)及秋燥型(10/80 12.5%)所占比例高于其他中医证型。结论:感染及结缔组织病是FUO的主要疾病,而结核病依然是感染性疾病中造成FUO的第一原因,在临床不可忽视。同时要注意地方的一些特殊传染病,新疆为畜牧业大省,经济、环境卫生、医疗水平较差,与之相关的布氏杆菌病及艾滋病不容忽视。而肿瘤等在临床往往容易诊断,很少拖延至FUO。对于不明原因发热(FUO)的临床诊断,应在患者症状、体征及辅助检查基础上,综合考虑不同疾病类型与性别、年龄、热程、确诊时间之间的差异。由此我们认为,FUO是由于常见病的非典型表现,应该遵循“个体化治疗原则”,对其进行详细而全面的病史采集和分析,大部分不明原因发热是可以确诊的。
[Abstract]:Objective: to investigate the etiology and outcome of fever of unknown origin (fever of unknown origin,FUO), summarize its clinical features and pathogenesis, and provide reference for clinical diagnosis. Methods: from January 2009 to December 2013, the final etiological diagnosis of 80 patients with FUO was analyzed retrospectively. The relationship between etiology and sex, age, fever course, diagnosis time and the distribution of TCM syndromes were analyzed. Results: 1. 70 cases (87.5%) were definitely diagnosed and 5 cases (6.3%) died of FUO. The cause of death was infectious disease. The etiological factors of 70 patients with FUO were as follows: (1) 49 cases (61.3%) of infectious diseases, of which 17 cases (21.3%) were tuberculosis. Pulmonary tuberculosis 15 cases (18.8%), extrapulmonary tuberculosis 2 cases (2.5%); Secondly, apoplexy associated pneumonia ranked second, accounting for 11 cases (13.8%), and brucellosis was the third place, accounting for 5 cases (6.3%). (2) there were 14 cases (17.5%) of nodular hoof disease, the highest rate of adult Still's disease was 5 cases (6.3%); (3), 3 cases (3.8%) of tumor disease, including 1 case of lymphoma, 1 case of colon cancer and 1 case of lung cancer. (4) other etiology: 4 cases (5.0%). There were significant differences between different disease types and sex (P 0.05). The distribution of different disease types in different age groups had no statistical significance (P 0.05). There was significant difference in febrile time between different disease types (P 0.05). There was statistical difference in the time of diagnosis between different types of disease (? 2t 24.662P 0.05). In 6.FUO patients, Yin deficiency type (22 / 8027.5%), The proportion of surface heat type (14 / 8017.5%) and autumn dryness type (10 / 8012.5%) was higher than that of other TCM syndromes. Conclusion: infection and connective tissue disease are the main diseases of FUO. Tuberculosis is still the first cause of FUO in infectious diseases, which can not be ignored in clinic. At the same time, we should pay attention to some special local infectious diseases, Xinjiang is a big animal husbandry province, economy, environmental hygiene, medical treatment level is poor, related to brucellosis and AIDS can not be ignored. While tumors are often easily diagnosed in clinic and rarely delayed to FUO. The clinical diagnosis of (FUO) with unknown causes should be based on the symptoms, signs and auxiliary examinations of the patients, and the differences between different disease types and sex, age, fever course and diagnosis time should be considered synthetically. Therefore, we think that FUO is due to the atypical manifestations of common diseases, so we should follow the principle of individualized treatment, collect and analyze the history of the disease in detail and comprehensively, and most of the fever of unknown origin can be diagnosed.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R441.3
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本文编号：2345021