儿童不明原因长期发热114例临床分析  

Clinical analysis of 114 children with fever of unknown origin

作　　者：王爱丽[1] 成胜权[1] 牛焕红[1] 张惠琴[1] 钱新宏[1] 张月萍[1] 

机构地区：[1]第四军医大学西京医院儿科,西安710032

出　　处：《山西医科大学学报》2017年第2期176-180,共5页Journal of Shanxi Medical University

摘　　要：目的探讨儿童不明原因长期发热(FUO)的病因构成、诊断方法和临床转归。方法收集2005-2015年第四军医大学西京医院儿科收住院并符合FUO诊断标准的114例患儿的临床资料和部分随访资料,进行回顾性分析。结果 114例患儿中确诊102例(89.5%)。感染性疾病57例(50%),结缔组织病29例(25.4%),肿瘤性疾病5例(4.4%),其他疾病11(9.6%),未明确诊断12例(10.5%)。依据临床表现、常规实验室检查和治疗效果观察确诊91例(89.2%),依据骨髓检查确诊5例(4.9%),依据影像学检查(B超、CT及MRI)确诊3例(2.9%),依据组织活检确诊3例(2.9%)。出院时痊愈40例(35.1%),好转66例(57.9%),无效6例(5.3%),放弃治疗2例(1.8%)。随访63例,随访率(55.3%),痊愈44例(69.8%),好转14例(22.2%),死亡5例(7.9%),误诊5例(7.9%)。结论儿童不明原因长期发热的首要原因为感染性疾病,其次为结缔组织病和肿瘤性疾病,依据详细的病史,体格检查和常规的实验室检查可以明确大多数FUO病因,影像学检查、骨髓检查及组织活检有助于FUO的诊断。长期随访有助于了解FUO患儿的预后并及时纠正误诊。Objective To investigate the etiology, diagnostic methods and clinical outcome of fever of unknown origin（FUO） in chil- dren. Methods All 114 children with FUO admitted to Department of Pediatrics, Xijing Hospital from 2005 to 2015 were enrolled. Medical records and the follow-up information were reviewed retrospectively. Results Of 114 cases, 102（89.5%） Were definitively diagnosed. There were 57 cases（50%） of infectious diseases,29 cases（25.4%） of connective tissue disorders,5 cases（4.4%） of ma- lignancies, 11 cases（9.6%） of miscellaneous etiologies, and 12 cases（10.5%） of unidentified diseases. Totally 91 cases（89.2%） got the final diagnosis by evaluating the clinical manifestation, routine laboratory tests and the responses to diagnostic treatment, 5 cases （4.9%） were diagnosed by bone marrow aspiration,3 cases（2.9%） by the imaging studies （such as ultrasonography, CT and MRI）, and 3 cases（2.9%） by biopsy specimens. In discharged patients,40 patients （35.1%） were cured, 66 patients （57.9%） got better, and 6 patients（5.3%） showed no any improvement,and 2（1.8%） gave up. A total of 63 cases（55.3%）were followed up,of which,44 cases（69.8%） were cured,14 cases（22.2%） got better, 5 cases（7.9%） died,and five cases（7.9%） were misdiagnosed. Conclu- sion Infectious illness is the most common cause of FUO in children, followed by connective tissue disorders and malignancies. The majority of children with FUO achieve the definitive diagnosis by extensive history, thorough physical examinations and routine laborato- ry examination. Imaging techniques,bone marrow aspiration and biopsy are helpful to diagnose FUO. Clinical follow-up is very impor- tant for finding and correcting the misdiagnosis.

关 键 词：长期发热 儿童 病因 诊断 

分 类 号：R725[医药卫生—儿科]