北京协和医院普通内科不明原因发热出院患者长期随诊分析  

Long-term outcome of patients discharged with fever of unknown origin in the Department of General Internal Medicine of Peking Union Medical College Hospital

作　　者：李源杰[1] 朱卫国[1] 王玉[1] 沙悦[1] 黄晓明[1] 黄程锦[1] 焦洋[1] 陈嘉林[1] 方卫纲[1] 曾学军[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院普通内科,100730

出　　处：《中华内科杂志》2015年第10期851-854,共4页Chinese Journal of Internal Medicine

摘　　要：目的 总结因不明原因发热（FUO）住院治疗出院仍未获得明确诊断患者的临床情况和预后.方法 检索北京协和医院普通内科病房2004年至2008年间首次住院,入院诊断和出院诊断均为FUO的患者,查阅病历及电话随访至2014年,收集整理分析其临床资料.结果 以FUO入院的758例患者出院诊断仍为FUO者70例,其中男23例,女47例.进入随访的70例患者最终诊断明确20例,确诊方法包括临床病程观察、重复活检和试验性治疗;其中3例因发热相关原发病死亡.诊断不明患者36例：23例最终发热缓解,其中近半数（10/23）曾因诊断结缔组织病可能使用糖皮质激素或非甾体消炎药治疗1 ～12个月;3例长期间断发热;7例出院后短期内死亡;3例长期随访中死亡.发热相关总病死率达18.6％.器官受累数目增多与死亡相关,其中血两系以上减低、临床出血事件、呼吸系统损害、急性肾功能损害的OR值分别为2.1、9.9、3.3、6.6（P＜ 0.05）.失访14例.结论 出院时仍未获得诊断的FUO患者,应密切随访、反复评估病情变化、及时重复活检有助于明确诊断,必要时可根据诊断倾向给予非甾体消炎药、糖皮质激素、抗结核等经验性治疗.功能损害器官数目多,特别是血液系统、呼吸系统、肾脏系统受累者死亡风险增加。Objective To investigate the clinical characteristics and outcome of patients with undiagnosed fever of unknown origin（FUO）.Methods To retrospectively review the clinic data of patients discharged with FUO from the Department of General Internal Medicine,Peking Union Medical College Hospital during 2004 to 2008.Medical records and phone call follow-up data were collected until 2014.Results Among 758 in-patients diagnosed with FUO,70 patients still discharged with FUO were enrolled in this study,including 23 males and 47 females.There were 14 missing patients.Finally,definite diagnoses were made in 20 patients by clinical reassessments,empirical therapy or repeated biopsies,in whom 3 patients dying from underlying diseases.A total of 36 patients did not get final diagnoses,while fever was relieved in 23 patients,including 10 treated with corticosteroids or non-steroid anti-inflammatory drugs（NSAIDs） from 1 month to 12 months due to suspected connective tissue diseases.Another 3 patients still had episodic fever.Seven patients died shortly after discharge.There were 3 dying in the long-term follow-up.The overall FUO-related mortality was 18.6%.Mortality was correlated with the number of dysfunctional organs,especially cytopenia,coagulation dysfunction,bleeding events,respiratory damage and acute renal failure with OR 2.1,9.9,3.3 and 6.6 （P 〈 0.05） respectively.Conclusions Close follow-up,intermittent clinical reassessments,repeated biopsies will contribute to the diagnosis of patients discharged with FUO.Empirical therapy with corticosteroids,NSAIDs or anti-tubercular drugs in selected patients may be safe and effective.Mortality rates increased with impaired organs,especially the hematological,respiratory and renal systems.

关 键 词：发热 原因不明 诊断 预后 随访研究 

分 类 号：R597[医药卫生—内科学]