【摘要】：目的：探討近十年來(lái)不明原因發(fā)熱(FUO)患者的臨床病因分布構(gòu)成和變化,提高臨床醫(yī)生對(duì)FUO的認(rèn)識(shí)和了解,提高FUO的確診率方法：回顧分析2003年12月至2014年6月在中國(guó)人民解放軍空軍總醫(yī)院住院的500例FUO患者的臨床資料,統(tǒng)計(jì)分析其病因分布、常見(jiàn)疾病和診斷方法,比較不同性別、年齡組和疾病熱程FUO患者在病因分布和構(gòu)成上的差異,并根據(jù)發(fā)病時(shí)間不同,將2003年12月～2008年12月、2009年1月～2014年6月劃分為前后5年并比較兩個(gè)時(shí)期的病因分布和構(gòu)成。復(fù)習(xí)國(guó)內(nèi)2000年以來(lái)相關(guān)文獻(xiàn),比較分析國(guó)內(nèi)FUO患者臨床病因分布和構(gòu)成情況,了解國(guó)內(nèi)其它地區(qū)FUO患者的臨床特點(diǎn)。結(jié)果：1.500例FUO患者中,452例(90.4%)最終確診,包括感染性疾病231例(46.2%),結(jié)締組織病99例(19.8%)；腫瘤性疾病58例(11.6%)；其他疾病64例(12.8%)；未明確診斷48例(9.6%),疾病分布83種,常見(jiàn)疾病依次為結(jié)核感染、成人斯蒂爾病、肺部感染、淋巴瘤、血流感染等。2.在感染性疾病中,細(xì)菌感染176例,分別占全部病例和感染性疾病病例的35.2%(176/500)和76.2%(176/231),其中結(jié)核感染76例,分別占全部病例和感染性疾病病例的15.2%(76/500)和32.9%(76/231)；病毒感染35例,分別占全部病例和感染性疾病病例的7.0%(35/500)和15.2%(35/231)；其他感染20例,分別占全部病例和感染性疾病病例的4.0%(20/500)和8.7%(20/231)。感染性疾病分布30種,常見(jiàn)疾病依次為結(jié)核感染、肺部感染、血流感染、泌尿系感染、膿腫及布氏桿菌病等；結(jié)締組織病18種,常見(jiàn)疾病依次為成人斯蒂爾病、血管炎、系統(tǒng)性紅斑狼瘡等；腫瘤性疾病58例,疾病分布17種,血液系統(tǒng)腫瘤和實(shí)質(zhì)性腫瘤分別43例(74.1%,43/58)和15例(25.9%,15/58),常見(jiàn)疾病依次為淋巴瘤、噬血細(xì)胞綜合征、白血病等；其他疾病64例,疾病分布18種,常見(jiàn)疾病依次為壞死增生性淋巴結(jié)炎、亞急性甲狀腺炎、藥物熱等。3.FUO女性患者中結(jié)締組織疾病所占比例為26.3%(59/224)明顯高于男性的14.5%(40/276),x25.027,P＝0.025；男性患者中腫瘤性疾病所占比例為14.5%(40/276)明顯高于女性患者的8.0%(18/224),x2＝10.928,P=0.001。在各年齡組中感染性疾病均為首要病因,在21-39歲和40-59歲年齡組中結(jié)締組織疾病為第二位病因,在60歲及以上年齡組中惡性腫瘤性疾病為第二位病因,FUO病因的構(gòu)成在不同年齡組患者中差異有統(tǒng)計(jì)學(xué)意義(X2=43.10,P＝0.000)。腫瘤性疾病的熱程為60(28,90)d,明顯長(zhǎng)于感染性疾病的28(21,42)d(Z＝-4.168,P=0.000)和結(jié)締組織病的30(21,60)d(Z＝-2.406,P=0.016)。2009～2014年間結(jié)締組織疾病所占比例為23.8%,明顯高于2003～2008年間的13.7%(x2＝8.598,P=0.003)；感染性疾病、腫瘤性疾病和其他疾病的構(gòu)成雖較2003-2008年間有下降趨勢(shì),但差異無(wú)統(tǒng)計(jì)學(xué)意義(P均0.05)。4.北京地區(qū)FUO中感染性疾病所占比例低于譚星宇文獻(xiàn)組(全國(guó))所占比例(46.7%vs 51.1%,X2=1 7.51,P=0.000),北京地區(qū)文獻(xiàn)組FUO中其他疾病所占比例、未明確診斷所占比例均高于譚星宇文獻(xiàn)組(全國(guó))其他疾病所占比例、未明確診斷所占比例(8.6%vs7.0%, X2=8.008, P=0.004; 12.5%vs8.9%, X2-48.896, P=0.000),北京地區(qū)文獻(xiàn)組FUO中結(jié)締組織病及腫瘤性疾病所占比例均高于譚星宇文獻(xiàn)組(全國(guó))FUO中結(jié)締組織病及腫瘤性疾病所占比例(P均0.05)。結(jié)論：1.引起FUO的疾病達(dá)80余種,病因復(fù)雜；9.6%的病例最后仍未能明確診斷,少部分患者臨床確診仍很困難。2.感染性疾病仍然是FUO的主要病因,結(jié)核感染為感染性疾病中的首要病因,也是FUO中最常見(jiàn)的病因。結(jié)締組織病及腫瘤性疾病在FUO病因中占有重要地位。3.FUO病因分布和構(gòu)成在不同性別、年齡組、疾病熱程等方面存在一定的差異,女性患者結(jié)締組織疾病所占比例明顯高于男性,男性患者腫瘤性疾病所占比例明顯高于女性；隨著患者年齡增長(zhǎng)和疾病熱程的延長(zhǎng),感染性疾病所占比例逐漸下降,非感染性疾病的所占比例逐漸增高。4.隨著年代變遷FUO病因分布和構(gòu)成發(fā)生了一定變化,結(jié)締組織疾病所占比例明顯增高,感染性疾病和腫瘤性疾病所占比例相對(duì)降低,值得臨床醫(yī)生注意和重視。
[Abstract]:Objective: To explore the distribution and change of clinical etiology of patients with fever of unknown origin (FUO) in the last ten years, to improve the understanding and understanding of FUO by clinicians and to improve the diagnostic rate of FUO: a retrospective analysis of the clinical data of 500 cases of FUO patients in the Air Force PLA General Hospital from December 2003 to June 2014, and to analyze the statistical analysis of the clinical data. The etiological distribution, common diseases and diagnostic methods were used to compare the differences in the distribution and composition of FUO patients with different sex, age group and disease heat course. According to the time of onset, the distribution and composition of the etiological factors were divided into 5 years from December 2003 to December 2008, January 2009 to June 2014, and compared with the two periods. The clinical characteristics of FUO patients in China were compared and analyzed, and the clinical characteristics of FUO patients in other areas of China were compared and analyzed. Results: among 1.500 patients with FUO, 452 cases (90.4%) were final diagnosed, including 231 cases of infectious diseases (46.2%), 99 cases of connective tissue disease (19.8%), 58 cases of tumor (11.6%) and 64 cases (1) (64 cases). 2.8%): 48 cases (9.6%) and 83 kinds of diseases were not clearly diagnosed. The common diseases were tuberculosis infection, adult Steele's disease, lung infection, lymphoma, blood flow infection and other.2. in infectious diseases and 176 cases of bacterial infection, which accounted for 35.2% (176/500) and 76.2% (176/231) of all cases and infectious diseases, respectively, and 76 cases of tuberculosis infection, respectively. 15.2% (76/500) and 32.9% (76/231) of all cases and infectious diseases, 35 cases of viral infection, 7% (35/500) and 15.2% (35/231) in all cases and infectious diseases, 20 cases of other infections, 4% (20/500) and 8.7% (20/231) of all cases and infectious diseases, respectively. The common distribution of infectious diseases is 30. The diseases were tuberculosis infection, pulmonary infection, blood flow infection, urinary infection, abscess and brucellosis, connective tissue disease 18, the common diseases were adult Steele's disease, vasculitis, systemic lupus erythematosus, 58 cases of tumor disease, 17 kinds of disease distribution, 43 cases of blood system tumor and parenchyma tumor (74.1%, 43/58). And 15 cases (25.9%, 15/58), common diseases were lymphoma, hemophagocytic syndrome, leukemia and other diseases, 64 other diseases and 18 disease distribution. The common diseases were necrotic lymphadenitis, subacute thyroiditis, and drug fever in.3.FUO women, the proportion of connective tissue diseases was 26.3% (59/224) significantly higher than that of men's 14. .5% (40/276), x25.027, P = 0.025; the proportion of tumor disease in male patients was 14.5% (40/276) significantly higher than 8% (18/224) and X2 = 10.928 in female patients. P=0.001. was the primary cause of infectious diseases in all age groups, and second causes of connective tissue disease in 21-39 and 40-59 years old group, and in the age group of 60 and above. The middle and malignant tumor disease was the second cause, the FUO cause was statistically significant in different age groups (X2=43.10, P = 0). The heat course of the tumor was 60 (28,90) d, obviously longer than 28 (21,42) d (Z = -4.168, P=0.000) and 30 of connective tissue disease (21,60) d. The proportion of interconnective tissue diseases was 23.8%, which was significantly higher than 13.7% (x2 = 8.598, P=0.003) in 2003~2008 years. Infectious diseases, tumor diseases and other diseases had a downward trend in 2003-2008 years, but the difference was not statistically significant (P 0.05). The proportion of infectious diseases in FUO in Beijing area was lower than that of Tan Xingyuwen. The proportion of the group (46.7%vs 51.1%, X2=1 7.51, P=0.000), the proportion of other diseases in the Beijing literature group FUO, the proportion of undefined diagnosis was higher than the proportion of other diseases in the Tan Xingyu literature group (National), and the proportion of the diagnosis was not clear (8.6% vs7.0%, X2=8.008, P=0.004; 12.5%vs8.9%, X2-48.896, P=0.000), Beijing. The proportion of connective tissue disease and tumor disease in the regional literature group FUO was higher than the proportion of connective tissue disease and tumor disease in the Tan Xingyu literature group (National) FUO (P 0.05). Conclusion: 1. of the diseases of FUO are more than 80 species, and the cause of the disease is complex; 9.6% of the cases are still not clearly diagnosed, and a few patients are still difficult to confirm the clinical diagnosis. .2. infectious disease is still the main cause of FUO. Tuberculosis infection is the primary cause of infectious diseases and the most common cause of FUO. Connective tissue disease and tumor disease occupy an important position in the cause of FUO. The distribution and composition of the cause of.3.FUO are different in different sex, age group, and disease fever. The proportion of connective tissue diseases was significantly higher than that of men. The proportion of tumor diseases in male patients was significantly higher than that of women. With the age of patients and the prolongation of the disease fever, the proportion of infectious diseases gradually decreased and the proportion of non infectious diseases gradually increased.4. with the distribution and composition of the etiological factors of FUO. The proportion of connective tissue diseases is significantly higher, and the proportion of infectious and tumor diseases is relatively lower. It is worth paying attention to and paying attention to the clinicians.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R441.3

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