Clinical analysis of 212 patients with fever of unknown origin
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摘要: 目的 分析212例不明原因发热(fever of unknown origin,FUO)患者的病因构成、确诊方法,总结经验教训,不断提高FUO早期诊断及治疗水平。 方法 回顾性分析2012年1月—2015年1月在蚌埠医学院第一附属医院感染科住院且符合FUO诊断标准的212例病例,分别以性别和年龄分组,探讨FUO病因在性别和年龄中的分布。应用SPSS 19.0统计软件计算和分析,计量资料以x±s表示,计数资料采用χ2检验,P<0.05为差异有统计学意义。 结果 212例FUO患者经相关检查或诊断性治疗最终明确诊断171例,确诊率为80.66%,出院未确诊者41例(19.34%)。病因分别为:感染性疾病98例(57.31%),其中结核病占25.51%(25/98);结缔组织病(connective tissue diseases,CTD)27例(15.79%),其中成人斯蒂尔病占44.44%(12/27);肿瘤性疾病17例(9.94%),以淋巴瘤为主35.29%(6/17);其他疾病29例,以药物热最多见41.38%(12/29),坏死性淋巴结炎占24.14%(7/29)。CTD以女性多见,肿瘤性疾病以男性多见,差异有统计学意义(P<0.05),感染性疾病、其他疾病及未明确诊断疾病在不同性别中差异无统计学意义(P>0.05)。感染性疾病在各年龄组中均为首要病因,以60岁以上年龄组多见;CTD以30~59岁年龄组多见,恶性肿瘤性疾病以60~86岁组多见,差异有统计学意义(χ2=17.521,P=0.025)。 结论 FUO病因复杂,感染性疾病为其主要病因诊断,结核杆菌感染占重要地位,结核病中肺外结核是重点、难点;CTD及肿瘤性疾病在FUO病因诊断中分别居第2、3位。大多数FUO患者经过详细的询问病史及必要的实验室检查一般能够明确诊断。Abstract: Objective To analyze the etiology and diagnosis of fever of unknown origin (FUO), and improve the early diagnosis and treatment of FUO. Methods Total 212 patients met FUO diagnostic criteria in our hospital between January, 2012 to January, 2015 were enrolled into this study. All the patients were grouped by gender and age. The distribution of etiology in gender and age was analyzed. The data was analyzed by SPSS 19. 0, Chi-square test and T test were used to compare the differences between different groups of qualitative or quantitative data. The p-value of 0. 05 was considered on the borderline of statistical significance. Results A total of 171 cases (80. 66%) were confirmed with FUO by relevant examination or diagnostic treatment, and 41 cases (19. 34%) still to be confirmed. The overall etiology distribution was as follows:98 (57. 31%) were infectious diseases (72. 45% bacterial infection and 25. 51% tuberculosis); 27 (15. 79%) were connective tissue diseases (CTD) in which adult-onset Still's disease accounted for 44. 44% (12/27); 17 (9. 94%) were tumor in which lymphoma accounted for 35. 29% (6/17); 29 were other diseases in which drug fever accounted for 41. 38% (12/29) and necrotizing lymphadenitis for 24. 14% (7/29). There was a higher incidence of CTD in women and of tumor diseases in men, the difference was statistically significant (P < 0. 05), But the incidence of infectious disease, other diseases, and uncertain diagnosis cases among the different gender group was not statistically significant (P > 0. 05).The infectious diseases in all age groups were the primary cause, especially in 60 or over age group; The CTD was common in 30 to 59 age group, malignant tumor diseases were common in 60-86 age group, the difference was statistically significant among the different age groups (χ2=17. 521, P=0. 025). Conclusion The etiology of FUO is complex, infectious diseases are common. The bacterial infection and infection of mycobacterium tuberculosis accounted for an important position, in which the diagnosis of extrapulmonary tuberculosis is focal and difficult point; the percentage of the CTD and tumor are also relatively high. FUO can be generally diagnosed definitely in most cases through detailed history and necessary physical examination.
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