不明原因发热临床特点的回顾性分析

发布时间：2018-09-16 19:08

【摘要】：目的:不明原因发热(Fever of unknown origin,以下简称为FUO )的定义是:发热持续2至3周以上,体温大于等于38.5摄氏度,经过详细的询问病史、体格检查和常规的实验室检查仍不能明确诊断者[1]。FUO涉及呼吸内科、血液内科、风湿免疫科等多个领域疾病,多种临床表现非常相似,缺乏容易诊断的典型临床特征;因初诊医师大多为专科医师,很难对FUO病因有系统的认识和把握,容易造成误诊、漏诊;同时还因为医疗水平有限、患者本身心理因素,导致FUO疾病长时间难以确诊,成为临床医师困扰的一大难题。临床医师对FUO的诊疗思维直接影响的FUO疾病的诊治效率,为提高FUO诊断的准确性、探索诊疗模式的改进方法,本研究采取回顾性分析的方法分析了 88例FUO患者的病因、诊断方法、性别、年龄、热程、最高体温、初诊科室分布,总结FUO诊疗思维指导临床诊断及治疗。方法:回顾分析了广州医科大学附属第一医院2016年4月至2016年9月符合FUO诊断标准的住院患者88例。记录了 88例患者的病因、诊断方法、性别、年龄、热程、最高体温、初诊科室,探讨FUO的病因、诊断方法、性别、年龄、热程、初诊体温、初诊科室分布。用SPSS 21 (Statistical Product and Service Solutions,以下简称SPSS)软件行卡方检验、秩和检验统计处理,P≤0.05有统计学意义。结果:1、按病因分布:88例FUO患者中,有85例(96.5%)最终确诊,包含感染性疾病41例(46.6%),结缔组织疾病26例(29.5%),肿瘤性疾病12例(13.6%),其他疾病6例(6.8%),未确诊疾病3例(3.4%)。感染性疾病中肺结核最多,共12例(29.3%)。结缔组织病中成人斯蒂尔病最多,共11例(42.3%)。肿瘤疾病中淋巴瘤最多,共6例(50.00%)。其他疾病中药物热最多,共2例(33.3%)。2、按诊断方法分布:诊断性治疗为确诊FUO病因的主要方法,占34.1%,其次为组织活检,占20.5%,其后依次为影像学、细菌学,分别占15.9%和10.2%,体液和骨髓穿刺、免疫学,各占8.0%3、按性别分布:男性总体数量比女性略高,感染性疾病中男女比例较均等,但结缔组织疾病中女性占的比例较大,肿瘤性疾病中男性占的比例较大。4、按年龄段分布:感染性疾病在各年龄段中占了较高比重,且在不同年龄组感染性疾病所占比例较均等。结缔组织疾病在41-60岁这个年龄段为第一位病因。肿瘤性疾病在60岁以上年龄段成为第二位病因。5、按热程分布:感染性疾病在小于2月热程组中为第一位病因。结缔组织疾病在2至4月热程组中为第一位病因。肿瘤性疾病在大于4月热程组中为第一位病因。6、按最高体温分布:感染性疾病、结缔组织疾病在38.5-38.9℃组中均为首位病因。肿瘤性疾病在39.0-39.5℃组中为首位病因。7、按初诊科室分布:感染性疾病、结缔组织病、肿瘤性疾病患者初诊科室中,呼吸内科、急诊科分别占第一位、第二位科室。消化内科、感染内科、内分泌科等其他科室与呼吸内科、急诊科所占比例差距较大。结论:(1)引起FUO的病种众多,病因繁杂;研究对象中最后有3.4%的病例仍不能明确诊断。(2)感染性疾病仍旧是FUO的主要病因,肺结核是感染性疾病中的首要病因,同时也是FUO的第一位病因。结缔组织疾病、肿瘤性疾病分别占FUO第二位、第三位病因。(3) FUO的诊断方法中,诊断性治疗占FUO确诊方法的首要方法、其后依次为组织活检、影像学、细菌学、免疫学、体液和骨髓穿刺,FUO的诊断是有一定规则的,根据详细的询问病史、细致的体格检查、必要的辅助检查以及诊断性治疗还是可以确诊的。(4) FUO病因分布在不同性别、年龄组、热程、最高体温、初诊科室等方面存在一定程度上的差异,女性结缔组织疾病所占比例明显多于男性,肿瘤疾病中男性患者比例明显高于女性;随着患者年龄增长和发热热程延长,肿瘤性疾病、结缔组织疾病所占比重相应地增高,而感染性疾病所占比重却相对降低。FUO患者中若为反复高热,热程长,年纪偏大,要先排除肿瘤性疾病。大多数FUO患者初诊科室选择呼吸内科和急诊科,说明大多数患者忽略FUO病因中结缔组织疾病、肿瘤性疾病的重要地位,值得临床医生重视,做好分诊工作,以免延误病情。
[Abstract]:OBJECTIVE: Fever of unknown origin (FUO) is defined as: fever lasts for more than 2 to 3 weeks, body temperature is greater than or equal to 38.5 degrees Celsius, after a detailed history of inquiry, physical examination and routine laboratory examination can not be clearly diagnosed [1]. Domain disease, a variety of clinical manifestations are very similar, lack of typical clinical characteristics easy to diagnose; because most of the first physicians are specialists, it is difficult to have a systematic understanding and grasp of the causes of FUO, easy to cause misdiagnosis, missed diagnosis; at the same time because of limited medical level, the patient's own psychological factors, resulting in FUO disease for a long time difficult to diagnose, become a clinical practice. To improve the diagnostic accuracy of FUO and explore the improvement methods of diagnosis and treatment mode, a retrospective study was conducted to analyze the etiology, diagnostic methods, sex, age, heat course, maximum body temperature and initial diagnosis room of 88 FUO patients. Methods: A retrospective analysis was made of 88 inpatients who met the FUO diagnostic criteria from April 2016 to September 2016 in the First Affiliated Hospital of Guangzhou Medical University. Methods: Gender, age, duration of fever, temperature of the first diagnosis, distribution of the first clinic. Chi-square test was performed with SPSS 21 (Statistical Product and Service Solutions) software, and rank sum test was statistically significant when P < 0.05. Results: 1. According to the etiological distribution, 85 (96.5%) of 88 FUO patients were finally diagnosed, including 41 infectious diseases. Twelve (29.3%) of the infectious diseases were tuberculosis, and 11 (42.3%) of the connective tissue diseases were adult Still's disease. There were 2 cases (33.3%) and 2 cases (2.2%). According to the diagnostic method, diagnostic treatment was the main method to diagnose the cause of FUO, accounting for 34.1%, followed by biopsy, accounting for 20.5%, followed by imaging, bacteriology, accounting for 15.9% and 10.2% respectively, humoral and bone marrow puncture, immunology, accounting for 8.0% 3, according to gender distribution: the overall number of men slightly higher than women, infectious diseases. The ratio of male to female was equal, but the proportion of female was higher in connective tissue diseases, and the proportion of male was higher in tumor diseases. 4. Distribution by age group: Infectious diseases accounted for a higher proportion in all age groups, and the proportion of infectious diseases was equal in different age groups. Tumor disease is the second cause of the disease in the age group over 60 years old. 5. Distribution by heat course: infectious disease is the first cause in the fever course group less than 2 months. Connective tissue disease is the first cause in the fever course group from 2 to 4 months. Tumor disease is the first cause in the fever course group more than 4 months. 6. Distribution by the highest body temperature: sensation. Tumor disease is the first cause of disease in the 39.0-39.5 C group. 7. According to the distribution of the first clinic: infectious diseases, connective tissue diseases, cancer patients in the first clinic, respiratory medicine, emergency department accounted for the first, the second. Conclusion: (1) There are many kinds of diseases causing FUO, and the etiology is complicated; 3.4% of the cases in the final study can not be clearly diagnosed. (2) Infectious diseases are still the main cause of FUO, tuberculosis is the primary cause of infectious diseases, but also the first cause of FUO. Connective tissue disease, tumor disease accounted for the second, the third cause of FUO. (3) Diagnostic therapy was the first method of FUO diagnosis, followed by tissue biopsy, imaging, bacteriology, immunology, humoral and bone marrow puncture, FUO diagnosis has certain rules, according to detailed inquiries. History, careful physical examination, necessary auxiliary examination and diagnostic treatment can still be diagnosed. (4) FUO pathogeny distribution in different gender, age group, fever, the highest temperature, first visit departments, there are some differences, the proportion of female connective tissue diseases is significantly more than men, the proportion of male cancer patients is clear. With the increase of age and fever duration, the proportion of tumor diseases and connective tissue diseases increased correspondingly, but the proportion of infectious diseases decreased relatively. If FUO patients have recurrent high fever, long fever duration and older age, they should exclude tumor diseases first. Most FUO patients choose respiratory department for the first time. Department and emergency department, explain that most patients neglect the cause of FUO connective tissue disease, the important position of tumor disease, clinicians should pay attention to, do a good job in the division of diagnosis, in order to avoid delaying the disease.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R441.3

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