不明原因发热372例临床分析  

An analysis of etiologies of fever of unknown origin in 372 patients

作　　者：石秋萍[1] 王超[1] 徐定华[1] 李凤舞[1] 任爱民[1] 王红[1] 张淑文[1] 

机构地区：[1]首都医科大学附属北京友谊医院感染内科,100050

出　　处：《中华内科杂志》2014年第4期298-302,共5页Chinese Journal of Internal Medicine

摘　　要：目的 探讨不明原因发热（FUO）患者的病因分布,提高对其诊治水平.方法 回顾性分析2003年1月-2013年8月期间首都医科大学附属北京友谊医院收治的、符合Petersdorf和Beeson提出的FUO诊断标准的患者372例.根据发病时间将入选病例分为前期组（2003年1月一2007年12月）和后期组（2008年1月-2013年8月）,比较两个时期的病因分布、确诊率、住院天数、确诊时间等.结果 372例FUO病例中,最终获得确诊336例,确诊率为90.3％.病因为感染性疾病者224例（60.2％）,仍为FUO的首要病因,其中结核病72例（32.1％,72/224）;结缔组织病48例（12.9％）;肿瘤性疾病31例（8.3％）;其他疾病33例（8.9％）;出院时原因仍未明36例（9.7％）.肿瘤性疾病的热程长于感染性疾病[60.0（30.0,90.0）d比30.0（20.0,60.0）d,P=0.003],结缔组织病和肿瘤性疾病的确诊时间均长于感染性疾病[（12.0（7.3,18.8）d、11.0（7.0,18.0）d比5.0（3.0,8.0）d,P值均为0.000].前期组的住院天数较后期组长[17.0（12.0,30.0）d比14.0（10.0,20.0）d,P=0.000],两个时期的确诊率、确诊时间差异无统计学意义.前期组结缔组织病的比例大于后期组（18.1％比9.2％,x2=6.201,P=0.013）,两个时期感染性疾病、肿瘤性疾病及其他类的比例差异无统计学意义.结论 感染性疾病是FUO的主要病因,而结核病在其中占较大比例;结缔组织病及肿瘤性疾病在FUO病因中占有重要地位.感染性疾病、结缔组织病、肿瘤性疾病的热程、确诊时间差异有统计学意义.Objective To analyze the etiology of fever of unknown origin （FUO）.Methods A total of 372 patients with FUO who hospitalized in Capital Medical University Affiliated Beijing Friendship Hospital were retrospectively analyzed from January 2003 to August 2013.All the patients were divided into two groups：group A （January 2003-December 2007） and group B （January 2008-August 2013）.Diagnosis rate,duration of hospitalization （days） and time to diagnosis between the two groups were artificially compared.Results Of the 372 FUO cases,336 were positively diagnosed with a diagnosis rate of 90.3%.Infectious diseases were still the primary causes of FUO （60.2%）,including 72 cases （32.1%） of tuberculosis.Connective tissue diseases accounted for 12.9% of the FUO cases,malignancies were 8.3%,and miscellaneous diseases were 8.9%.Yet thirty six patients （9.7%） could not be confirmed until they were discharged from hospital.The duration of fever in patients with malignancies was longer than that with infectious diseases [60.0 （30.0,90.0） days vs 30.0 （20.0,60.0） days,P =0.003].Time to diagnosis of connective tissue disease and malignancies was longer than infectious diseases [（12.0 （7.3,18.8） days and 11.0 （7.0,18.0） vs 5.0 （3.0,8.0） days,both P values =0.000].The duration of hospitalization in group A was longer than that of group B [17.0（12.0,30.0） days vs 14.0（10.0,20.0） days,P =0.000].The diagnosis rate and time to diagnosis of group A were similar with those of group B.The proportion of connective tissue diseases in group A was higher than group B（18.1% vs 9.2%,x2 =6.201,P =0.013）.The proportion of infectious disease,malignancies and miscellaneous diseases was not significantly different between the two groups.Conclusions Infectious diseases are the major causes of FUO,and the most common cause is tuberculosis.Connective tissue diseases and malignancies are the second and third causes of FUO.The duration of fever and time to diagnosis are significantly different be

关 键 词：发热 不明原因 回顾性研究 病因 

分 类 号：R441.3[医药卫生—诊断学]