不明原因发热中起热时间与病因诊断的关联性研究  

Correlation between time of fever onset and etiologies：a novel diagnostic strategy for fever of unknown origin

作　　者：申晓东[1] 单志刚[2] 韩国鑫 肖红菊[1] 陈歆[1] 黎檀实[1] 刘刚[1] 朱海燕[1] 

机构地区：[1]解放军总医院急诊科,北京100853 [2]北京军区总医院263临床部急诊科

出　　处：《中华急诊医学杂志》2016年第4期465-469,共5页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金（30900543）;北京市自然科学基金（7152136）;解放军总医院临床扶持基金（2013FC-TSYS-1028）;解放军总医院苗圃基金面上课题（14KMM49）.

摘　　要：目的：探讨不明原因发热（ fever of unknown origin， FUO）患者发病过程中起热时间与最终病因诊断的关联性。方法从2013年1月-2014年12月解放军总医院以不明原因发热就诊患者（ n＝1570）中选取符合FUO诊断标准且病因诊断与起热时间明确的病例348例，在检验病例选择是否存在偏倚后，采用Logistic回归方法，回顾性分析起热时间与最终病因诊断的关联性。结果入选的348例病例一般情况与总体1570例患者比较，性别（χ^2＝0.029， P＝0.903）及年龄（ t＝－1.040， P＝0.299）差异无统计学意义，可以认为病例选择差异无统计学意义； Logistic回归分析示下午起热与感染性疾病（P＝0.044， B＝1.275），夜间起热与结缔组织病呈正相关（P＝0.029， B＝0.838），均年龄与其他疾病有统计学关联，呈负相关（P＝0.010， B＝-0.042）。结论以起热时间为代表的发热症状可能对FUO患者最终病因诊断起一定帮助作用，可以指导初步诊断方向，利于给予针对性辅助检查或诊断性治疗，以提高诊疗效率。Objective To study the correlation between time of fever onset in the course of patients＇illness and etiologies of fever of unknown origin （FUO）.Methods A total of 1 570 patients with FUO admitted from January 2013 to December 2014 were retrospectively analyzed, and clinical data （ sex, age, time of fever onset） of 348 patients meeting FUO diagnosis criteria with definite etiology diagnosis and time of fever onset were collected for multivariate logistic regression analysis after bias check.Results No statistically significant bias was found between 348 selected cases and 1 570 overall cases in gender （χ^2 =0.029, P=0.903） and age （t=-1.040, P=0.299）, and multivariate logistic regression analysis showed positive correlation between fever onset during 13： 00-18： 00 and infection （P=0.044, B=1.275）, 18：00-24： 00 and connective tissue diseases （ P =0.029, B =0.838 ） , and showed negative correlation between age and miscellaneous （P =0.010, B =-0.042）.Conclusions Characteristics of fever onset time may have significant value in preliminary diagnosis and guiding the correct direction of final definite diagnosis by means of targeted examinations or diagnostic treatments.It is worth to be further studied and discussed.

关 键 词：不明原因发热 诊断 病因学 体征和症状 LOGISTIC回归 回顾性分析 关联 起热时间 

分 类 号：R441.3[医药卫生—诊断学]