114例经典型不明原因发热的病因及临床特点分析

发布时间：2018-05-17 07:01

本文选题：不明原因发热 + 病因分布　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的探讨经典型不明原因发热的病因分布及临床特点。方法回顾性分析2014年1月-2015年12月广西医科大学第一附属医院感染性疾病科114例经典型不明原因发热(fever of unknown origin,FUO)住院患者的临床资料。根据出院诊断将经典型FUO分为感染性疾病、结缔组织病、恶性肿瘤、杂病类以及病因未明五大类,分析其病因分布、诊断方法并总结感染性疾病、结缔组织病、恶性肿瘤的临床特点以及感染性疾病与非感染性疾病的鉴别要点。结果1.114例经典型FUO患者中明确诊断者108例,确诊率为94.7%。感染性疾病为最主要病因,共68例(59.6%),其次为结缔组织病(20例,17.5%)、杂病类(11例,9.7%)、恶性肿瘤(9例,7.9%),病因未明者最少仅6例(5.3%)。就具体病种而言,以成人Still病(Adult-onset Still disease,AOSD)(12例,10.5%)最多见,其次为伤寒(7例,6.1%)、淋巴瘤(7例,6.1%)多见。2.确诊方法包括:经验性治疗42例(38.9%)(包括经验性抗感染、诊断性抗结核、经验性激素和/或非甾体类消炎药治疗),血清学或病原学检查31例(28.7%),影像学15例(13.9%),组织病理检查12例(11.1%),临床观察8例(7.4%)。其中,骨髓培养阳性率低(73例骨髓培养中仅4例结果为阳性且有临床意义,5.5%),3例骨髓培养阳性者血液培养亦培养出相同病原菌。3.感染性疾病、结缔组织病及恶性肿瘤三类病因的临床特点:感染性疾病多见于男性、畏寒、头痛患者(P0.05);结缔组织病多见于20-40岁人群,男女比例无显著差异,且多有皮疹、关节痛、淋巴结肿大,白细胞计数(white blood cell count,WBC)、中性粒细胞百分比、血清铁蛋白(serum ferritin,SF)、血沉(erythrocyte sedimentation rate,ESR)较感染性疾病与恶性肿瘤升高明显(P0.05);恶性肿瘤全部为40岁以上人群且绝大多数为男性,且脾大、贫血、血小板减少、低蛋白血症较显著,乳酸脱氢酶(lactate dehydrogenase,LDH)、碱性磷酸酶、谷草转氨酶、单核细胞百分比较高(P0.05)。4.多因素非条件Logistic回归结果显示:SF为感染性疾病的独立预测因子且成负相关,提示感染性疾病中血清铁蛋白较非感染性疾病低(P0.05)(Hosmer-Lemeshow拟合优度检验显示,χ2=5.354,P=0.499),Logistic回归方程为:LogitP=3.509-1.158x(x=SF)。SF的ROC曲线下面积(AUC)为0.763,95%置信区间为0.660-0.866。结论1.不明原因发热最常见的病因为感染性疾病,其次为结缔组织病、杂病类以及恶性肿瘤;就具体病种而言,AOSD为经典型FUO的最多见疾病,其次为伤寒、淋巴瘤。2.经典型FUO患者的骨髓培养阳性率低,骨髓培养对于经典型FUO患者的诊断价值有待商榷。3.经典型FUO中感染性疾病、结缔组织病及恶性肿瘤有各自的临床表现及实验室检查特点,结合这些特点有助于经典型FUO的鉴别。4.血清铁蛋白对于感染性疾病与非感染性疾病的鉴别诊断有一定意义。
[Abstract]:Objective to investigate the Etiological Distribution and clinical characteristics of classical fever of unknown origin. Methods a retrospective analysis was made of the clinical data of 114 hospitalized patients with fever of unknown origin (FUO) in the First Affiliated Hospital of Guangxi Medical University, -2015, January 2014. Five major categories of infectious disease, connective tissue disease, malignant tumor, miscellaneous diseases and unknown etiology, analysis of its cause distribution, diagnostic methods and summary of infectious diseases, connective tissue disease, clinical characteristics of malignant tumors and identification of infectious and non infectious diseases. Results 108 cases of 1.114 classic FUO patients were diagnosed, The diagnosis rate of 94.7%. infection was the main cause, 68 cases (59.6%), followed by connective tissue disease (20 cases, 17.5%), miscellaneous diseases (11 cases, 9.7%), malignant tumor (9 cases, 7.9%), and the least 6 (5.3%) cases (5.3%). In terms of specific disease, Still disease (Adult-onset Still disease, AOSD) (12, 10.5%) was the most common, and the second was typhoid (7). Cases (6.1%), lymphoma (7 cases, 6.1%) were found to be diagnosed with.2., including empirical treatment in 42 (38.9%) (including empirical anti infection, diagnostic anti tuberculosis, empirical hormone and / or non steroidal anti-inflammatory drugs), serological or pathogenic examination 31 cases (28.7%), imaging 15 cases (13.9%), histopathology 12 cases (11.1%), clinical observation 8 cases (7.4%). Among them, the positive rate of bone marrow culture was low (in 73 cases of bone marrow culture, only 4 cases were positive and had clinical significance, 5.5%). 3 cases of positive bone marrow culture also cultivated the same pathogenic bacteria.3. infectious diseases, connective tissue disease and malignant tumor of three types of clinical characteristics: infectious diseases were mostly seen in men, cold, headache (P0.05); Connective tissue disease is mostly found in 20-40 years old people, and there is no significant difference in male and female proportion, and there are many rashes, joint pain, lymph node enlargement, white blood cell count, WBC, the percentage of neutrophils, serum ferritin (serum ferritin, SF), erythrocyte sedimentation (erythrocyte sedimentation rate, ESR) higher than infection and malignant tumors. P0.05; malignant tumors were all over 40 years old and most of them were male, and splenomegaly, anemia, thrombocytopenia, hypoproteinemia were significant, lactate dehydrogenase (lactate dehydrogenase, LDH), alkaline phosphatase, gluten aminotransferase, and monocyte percent higher (P0.05).4. multiple factors unconditional Logistic regression results showed that SF was a sense The independent predictors of dyed diseases were negatively correlated, suggesting that serum ferritin in infectious diseases was lower than that of non infectious diseases (P0.05) (Hosmer-Lemeshow goodness of fit test, X 2=5.354, P=0.499), and Logistic regression equation was that the area under ROC curve of LogitP=3.509-1.158x (x=SF).SF (AUC) was 0.763,95% confidence interval for 0.660-0.866. junction 1. the most common diseases of fever of unknown origin are infectious diseases, followed by connective tissue disease, miscellaneous diseases and malignant tumors. In terms of specific diseases, AOSD is the most common disease in the classic FUO, followed by typhoid, and the positive rate of bone marrow culture in the classical FUO patients with lymphoma.2. is low, and the diagnostic value of bone marrow culture for the classic FUO patients is the value of the disease. It is still to be discussed that the infectious diseases of.3. classic FUO, connective tissue disease and malignant tumor have their own clinical manifestations and laboratory tests. These characteristics are helpful to the differential diagnosis of.4. serum ferritin for the differential diagnosis of infectious and non infectious diseases by the classical FUO.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R441.3

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