500例不明原因发热患者临床病因分析  

Clinical Etiologies of Fever of Unknown Origin in 500 Cases

作　　者：涂俊才[1] 周平[1] 李晓娟[1] 孙莹[1] 司慧远[1] 王纯巍[1] 韩守雷[1] 朱飞云[1] 

机构地区：[1]安徽医科大学空军临床学院感染内科,北京100142

出　　处：《中国医学科学院学报》2015年第3期348-351,共4页Acta Academiae Medicinae Sinicae

摘　　要：目的探讨不明原因发热（FUO）的病因分布及变化,提高临床医生对FUO的认识和确诊率。方法回顾性分析2003年12月至2014年6月在中国人民解放军空军总医院就诊的500例FUO患者的临床资料,分析其诊断方法、病因分布及其与性别、年龄、热程、年代的关系。结果 500例FUO患者中,452例（90.4%）最终确诊,包括感染性疾病231例（46.2%）,其中结核病76例（32.9%,76/231）;结缔组织病99例（19.8%）;肿瘤58例（11.6%）;其他疾病64例（12.8%）;未明确诊断48例（9.6%）。女性患者中结缔组织疾病的比例为26.3%,明显高于男性患者的14.5%（P=0.025）;男性患者中肿瘤性疾病的比例为14.5%,明显高于女性患者的8.0%（P=0.001）。感染性疾病在各年龄组中均为首要病因,结缔组织疾病在21～39岁及40～59岁年龄组中为第2位病因,恶性肿瘤性疾病在大于60岁年龄组中为第2位病因。FUO病因的构成在不同年龄组患者中差异有统计学意义（χ2=43.10,P=0.000）。肿瘤性疾病的中位热程为60（28,90）d,明显长于感染性疾病的28（21,42）d（Z=-4.168,P=0.000）和结缔组织病的30（21,60）d（Z=-2.406,P=0.016）。2009～2014年间结缔组织疾病所占比例为23.8%,明显高于2003～2008年间的13.7%（χ2=8.598,P=0.003）;感染性疾病、肿瘤性疾病和其他疾病的构成虽较2003～2008年间有下降趋势,但差异无统计学意义（P均〉0.05）。结论感染性疾病仍然是FUO的主要病因,结核感染在其中占较大比例。结缔组织病及肿瘤性疾病在FUO病因中也占有重要地位。FUO病因分布在不同性别、年龄、热程和年代间存在一定差异。Objective To investigate the distribution and change of the causes of fever of unknown origin（ FUO）. Methods The clinical data of 500 inpatients with FUO in our center between December 2003 and June 2014 were retrospectively analyzed. The diagnostic methods,etiologies,and their possible relationship with age,sex,fever duration,and period. Results Of these 500 FUO patients,452（ 90. 4%） were confirmed to be with fever caused by conditions including infectious diseases [（ n = 231,46. 2%; e. g. tuberculosis（ 32. 9%,76 /231） ],connective tissue diseases（ CTD）（ n = 99,19. 8%）,neoplasms（ n = 58,11. 6%）,miscellaneous causes（ n = 64,12. 8%）. The causes were not identified in 48 cases（ 9. 6%）. The proportion of CTD in female patients was significantly higher than that in male patients（ 26. 3% vs. 14. 5%,P = 0. 025）,whereas the proportion of neoplasms in male patients was significantly higher than that in female patients（ 14. 5% vs. 8. 0%,P = 0. 001）. Infectious diseases was the most common cause in all age groups,CTD ranked the second in the21-39-year group and 40-59-year group,and neoplasm was the second most coomon cause in the over 60 year group. Thus,the distribution of FUO etiologies significantly differed in different age groups（ χ2= 43. 10,P =0. 000）. The duration of fever in patients with neoplasms [60（ 28,90） d] was longer than that in patients with infectious diseases [28（ 21,42） d, Z =- 4. 168, P = 0. 000] or CTD [30（ 21,60） d, Z =- 2. 406,P = 0. 016） ]. Compared with the level in 2003-2008,the proportion of CTD significantly increased in 2009-2014（ 13. 7% vs. 23. 8%,χ2= 8. 598,P = 0. 003）,along with the dicrease of the proportions of infectious diseases,neoplasms and miscellaneous diseases were decreased（ all P〈0. 05）. Conclusions Infectious diseases（ in particular,tuberculosis） remains the major cause of FUO. CTD and neoplasms also play important roles in the development of FUO. The distributions of the FUO etiologies have certain diff

关 键 词：不明原因发热 病因 诊断 

分 类 号：R441.3[医药卫生—诊断学]