286例不明原因发热患者临床分析

摘要

目的 分析不明原因发热(FUO)患者的病因、临床特征和相关因素,以期为今后的临床经验性诊治提供参考.方法 回顾性分析2008年7月至2014年7月我院内科收治的286例FUO患者的临床资料.结果 286例患者最终确诊257例,确诊率为89.9%;确诊患者中最常见的疾病类型是感染性疾病136例(47.6%)、结缔组织性疾病83例(29.0%)和肿瘤性疾病18例(6.3%).最常见疾病依次是成人still病(50例,17.5%)、结核病(39例,13.6%).几种类型FUO患者中,肿瘤性疾病中男性比例最大,为77.8%(14例);感染性疾病病程最短,为25.0~60.0 d.感染性疾病患者多表现为弛张热(87例,64.0%),结缔组织病患者主要表现为间歇热(74例,89.2%).实验室结果显示:肿瘤性疾病患者血小板计数(PLT)较高(平均为301.0×109/L);血红蛋白(HB)较低(平均为108.0 g/L).结缔组织病患者白细胞计数(WBC)最高(7.6~13.9),红细胞沉降率(ESR)较快(44.5~99.5).对感染性疾病和严重疾病可能的相关因素进行Logistic多元回归分析,得出感染性疾病主要的相关因素为男性、WBC、ESR、血清降钙素原(PCT)和乳酸脱氢酶(LDH);严重疾病与男性、年龄、寒战和PLT等4个因素相关.结论 我院内科住院的FUO患者病因分布以感染性疾病多见,其次为结缔组织病和恶性肿瘤.不同病因FUO患者临床表现各异,但仍然缺乏统一、特异和敏感的临床检测方法.大多数FUO经细致的临床检查和分析可以得到确诊.%Objective To probe into the etiology,clinical features,and the related factors of fever of un-known origin (FUO),and to provide reference for the diagnosis and treatment of the disease.Methods The clini-cal data of 286 patients with FUO treated in our hospital from July 2008 to July 2014 were retrospectively ana-lyzed.Results Among the 286 patients,257 were finally confirmed,with the diagnosis rate of 89.9%.The most common disease categories confirmed were infectious disease (136 cases,47.6%),followed by connective tissue dis-ease (83 cases,29.0%),neoplastic disease (18 cases,6.3%).The most common disease were adult-onset Still's disease (50 cases,17.5%) and tuberculosis (39 cases,13.6%).The patients with neoplastic disease were mostly male,account-ing for 77.8%(14 cases).The infectious disease has the shortest course of disease (25.0~60.0 d),and has the manifesta-tions of remittent fever (87 cases,64.0%).Connective tissue disease mainly manifested as intermittent fever (74 cases,89.2%).Laboratory results showed relatively high platelets (PLT,301.0 × 109/L in average) and low hemoglobin (HB,108.0 g/L in average) in neoplastic disease,and the most high white blood cell (WBC,7.6~13.9) and relatively fast erythrocyte sedimentation rate (ESR,44.5~99.5) in connective tissue disease.Logistic regression analysis showed that the related factors of infectious disease were male,WBC,ESR,procalcitonin (PCT),lactate dehydrogenase (LDH),and the related factors of severe disease were male,age,shiver,PLT.Conclusion The cause of FUO is mostly infec-tive diseases in our hospital,followed by connective tissue diseases,neoplastic disease.FUO patients of different causes have different clinical manifestations,but unified,specific and sensitive methods for clinical testing are still needed.Most patients with FUO could be confirmed after careful clinical examination and analysis.