不明原因发热患者病原学临床分析

发布时间：2018-03-20 14:33

本文选题：不明原因发热　切入点：病原学　出处：《临床和实验医学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的明确不明原因发热(FUO)人群的病原学检查结果情况。方法回顾性收集306例FUO病例的临床资料,对病原学检查结果进行分析。结果 306例FUO病例中,感染性疾病202例(66.0%),为FUO的首要病因;风湿免疫类病38例(12.4%);肿瘤性疾病20例(6.5%);其他疾病22例(7.2%);到出院时原因仍未明24(占7.8%)。306例FUO患者中病原学总的阳性率为72.5%,病原菌培养的阳性率为34.6%,病原体血清抗体的阳性率为43.5%,血病原体核酸的阳性率为6.2%,标本涂片镜检查病原体阳性率为18.3%,标本的病理学检查中病原体阳性率为1.6%。306例FUO患者中总的抗生素的使用率为94.1%。将风湿免疫病、肿瘤性疾病、其他疾病和最终仍原因不明合并成非感染组,与感染性疾病组进行比较,结果显示,感染组病原学总的阳性率显著高于非感染组(χ2=24.9,P0.01);病原学检出的阳性率中细菌的阳性率最高,为57.5%,其中结核杆菌的阳性率为22.9%,其次为病毒,为48.3%,真菌的阳性率为11.1%,支原体的阳性率为8.8%,衣原体的阳性率为6.5%,寄生虫的阳性率为1.0%。可疑的感染灶中,肺部最常见(45.4%),其次是淋巴结(12.4%),然后是血液(4.2%),少见的感染部位有腹腔(1%)、胆道(1%)、肝脏(0.7%)、颅内(0.7%)、心内膜(0.7%)、泌尿道(0.3%),还有相当一部分病例找不到可疑的感染灶(11.4%)。结论 FUO的诊治过程中,病原学的检查的意义在于,阳性结果能够提示感染的相关诊断,尤其是结合感染灶时;阴性结果可以协助排除感染的相关情况,为确诊感染以外的疾病提供相关的证据。在FUO中,无论引起发热的原发病因是感染因素还是非感染因素,都需要完善病原学的相关检查,以明确原发感染或继发感染的病原学情况。
[Abstract]:Objective to determine the etiological results of patients with fever of unknown origin (FUO). Methods the clinical data of 306 cases of FUO were collected retrospectively and the results of etiological examination were analyzed. 202 cases of infectious diseases were identified as the primary cause of FUO. 38 cases of rheumatic immune diseases (RIA), 20 cases of tumor diseases, 22 cases of other diseases, 22 cases of other diseases, 22 cases of other diseases, 22 cases of other diseases, at the time of discharge, the cause is still unclear 24 (7.8%). 306 cases of FUO patients, the total positive rate of etiology is 72.5%, the positive rate of pathogenic bacteria culture is 34.6%, and the positive rate of serum antibodies of pathogens is 34.6%. The positive rate was 43.5%, the positive rate of blood pathogen nucleic acid was 6.2 and the positive rate of specimen smear examination was 18.3.The positive rate of pathogen in pathological examination of specimen was 1.6.306 cases of FUO. Tumorous diseases, other diseases, and the final cause of the disease were unexplained and combined into a non-infected group, compared with the infectious disease group, and the results showed that, The total positive rate of pathogens in the infected group was significantly higher than that in the non-infected group (蠂 ~ 2 / 24. 9) P0.01.The positive rate of bacteria was the highest (57.5%), in which the positive rate of Mycobacterium tuberculosis was 22. 9%, followed by the virus. The positive rates of fungi, mycoplasma, chlamydia, parasites and parasites were 11.1, 8.8, 6.5 and 1.0, respectively. The most common site of infection in the lung is 45.4m, followed by 12.4m lymph node, and then blood 4.2. The infective sites are abdominal cavity, bile duct, liver, liver, brain, endocardium, urinary tract, urinary tract, and a considerable number of cases. Conclusion in the course of diagnosis and treatment of FUO, there are no suspicious lesions. Conclusion in the course of diagnosis and treatment of FUO, we can not find a suspicious infection focus of 11.44.Conclusion in the course of diagnosis and treatment of FUO, The significance of etiological examination is that the positive results can indicate the diagnosis of the infection, especially when combined with the infected foci; the negative results can help to exclude the related conditions of the infection. Provide relevant evidence for the diagnosis of diseases other than infection. In FUO, whether the primary cause of fever is an infectious factor or a non-infectious factor, it is necessary to improve the etiological examination. To determine the etiology of primary or secondary infections.
【作者单位】：首都医科大学附属北京友谊医院感染内科;中国康复研究中心北京博爱医院急诊科首都医科大学康复医学院急诊内科;
【基金】：北京中医药科技发展资金资助项目(编号:JJ2015-49)
【分类号】：R441.3

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