不明原因发热伴肝脏肿大临床诊断思维  

Clinical diagnosis thinking of patients with fever of unknown origin accompanied by hepatomegaly

作　　者：蔡美和 杨军杰 蔡美奎 李姗 雷旭 刘园园 李儒贵 谭华炳 CAI Mei-he;YANG Jun-jie;CAI Mei-kui;LI Shan;LEI Xu;LIU Yuan-yuan;LI Ru-gui;TAN Hua-bing(Department of Infectious Diseases,Lab.of Liver Disease,Renmin Hospital,Hubei University of Medicine,Shiyan Hubei442000,China;不详)

机构地区：[1]十堰市人民医院(湖北医药学院附属人民医院)感染性疾病科肝病研究所,湖北十堰442000 [2]竹山县人民医院中医科 [3]随州市中心医院

出　　处：《医学动物防制》2021年第5期463-466,共4页Journal of Medical Pest Control

基　　金：2019年十堰市科学技术研究与开发项目计划(19K67);2014年湖北医药学院附属人民医院创新团队项目(201404)。

摘　　要：不明原因发热(fever of unknown origin,FUO)伴肝脏肿大的病因诊断十分重要,一方面可以发现传染病,实现早发现、早诊断、早隔离、早治疗,防治疾病传播;另一方面可以针对病因实施治疗,提高治疗效果。但FUO伴肝脏肿大病因诊断十分困难,是国内外感染性疾病学诊治研究的热点。本文将FUO伴肝脏肿大病因分为系统感染性疾病和非感染性系统疾病两大类。前者包括EB病毒(Epstein-Barr virus,EBV)和巨细胞病毒(cytomegalovirus,CMV)感染、肝结核、肝脓肿、嗜血细胞综合征(hemophagocytic syndrome,HPS)、黑热病、布鲁菌病、疟疾等,后者包括成人Still综合征(adult onset still disease,AOSD)、Felty综合征、系统性红斑狼疮(systemic lupus erythematosus,SLE)、肿瘤疾病等。在此基础上,对FUO伴肝脏肿大患者诊断和鉴别诊断要点作一综述,以提高临床对FUO并肝脏肿大的临床诊断思维,提高诊断准确性和治疗针对性。The diagnosis of thr cause of fever of unknown origin(FUO)with hepatomegaly is very important,on the one hand,to detect infectious diseases,achieve early detection,diagnosis,isolation and treatment,and prevent the spread of the disease,on the other hand,to implement treatment for the cause and improve the effectiveness of treatment.However,the diagnosis of the cause of FUO with hepatomegaly is very difficult and is a hot topic of research in the diagnosis and management of infectious disease at home and abroad.In this paper,the causes of FUO with hepatomegaly are divided into two categories:systemic infectious disease and non-infectious systemic diseases.The former include Epstein-Barr virus(EBV)and cytomegalovirus(CMV)infections,liver tuberculosis,liver abscesses,hemophagocytic syndrome(HPS),black fever,brucellosis,malaria and so on.The latter includes adult Still synderome(adult onset still disease,AOSD),Felty syndrome,systemic lupus erythematosus(SLE),and oncological diseases.On this basis,a review of the diagnostic and differential diagnosis of FUO with hepatomegaly is presented to improve clinical thinking on diagnosis of FUO with hepatmegaly and to improve the diagnostic accuracy and treatment relevance.

关 键 词：不明原因发热 肝脏肿大 感染性疾病 非感染性疾病 病因 诊断 

分 类 号：R441.3[医药卫生—诊断学]