245例发热待查病例临床分析

Clinic analysis on 245 cases with fever of unknown origin

摘要:

目的探讨245例不明原因发热(fever of unknown origin，FUO)患者的病因构成、临床特点及诊疗体会。方法回顾性分析2009年1月—2011年4月在中南大学湘雅医院感染病科住院且符合FUO诊断标准的245例患者的病历资料。结果245例FUO患者中，最终明确诊断220例，确诊率为89.80％；出院时仍未明确诊断25例（10.20%）。220例确诊病例的病因分别为：感染性疾病158例（64.49％），其中细菌/真菌感染所占比率最高，达63.92％（101/158），结核病居第2位，占23.42％（37/158）；结缔组织疾病33例（13.47％），成人斯蒂尔病所占比率最高，达60.61％（20/33）；肿瘤性疾病22例（8.98％），其中淋巴瘤占59.09％（13/22）；其他疾病7例（2.86%）。结论FUO的病因诊断主要是感染性疾病，细菌/真菌感染是其中最主要病因；结缔组织疾病和肿瘤性疾病在FUO病因中也占重要地位。大多数FUO经仔细地体格检查和清晰的临床分析以及必要的实验室检查是可以得到确诊的。

关键词:

发热;感染性疾病;结缔组织疾病;肿瘤;结核;成人斯蒂尔病;淋巴瘤;诊断

Abstract:

ObjectiveTo evaluate the causes and clinical features of 245 fever of unknown origin(FUO) cases.MethodsClinical data of 245 hospitalized FUO patients from January,2009 to April, 2011 in a hospital were analyzed retrospectively.ResultsOf 245 patients with FUO, 220 cases (89.80%) were diagnosed definitely，25 cases (10.20%) were still not diagnosed definitely when they discharged from hospital. The overall etiology distribution were as follows: 158 (64.49%) were infectiou diseases, 63.92%(101/158) of which were caused by bacteria/fungi， 23.42% (37/158) were tuberculosis; 33(13.47%) were connective tissue disease(CTD), 60.16%(20/33) of which were adultonset Still’s disease; 22 (8.98%) were tumor, 59.09%(13/22) of which were lymphoma; 7（2.86%） were other diseases.ConclusionThe main causes in FUO are infectious diseases, bacteria/fungi infection is the most common cause; In addition, the percentage of the CTD and tumor are also relatively high. Most FUO cases can be diagnosed definitely through careful physical examination, clinical analysis, and necessary laboratory test.

Key words:

fever of unknown origin; infectious disease; connective tissue disease; tumor; tuberculosis; adultonset Still’s disease; lymphoma;diagnosis