80例不明原因發(fā)熱病因及中醫(yī)辨證分析
發(fā)布時(shí)間：2018-11-20 13:18
【摘要】：目的:探討不明原因發(fā)熱(fever of unknown origin,FUO)的病因構(gòu)成及轉(zhuǎn)歸,總結(jié)其臨床特點(diǎn)、發(fā)病規(guī)律,為臨床診斷提供參考。方法:回顧性分析2009年1月~2013年12月我院呼吸科符合FUO診斷80例患者的最終病因診斷,并分析病因與性別、年齡、熱程、確診時(shí)間之間的關(guān)系及中醫(yī)證型分布。結(jié)果:1.80例FUO患者中,明確診斷70例(87.5%),5例患者死亡(6.3%),死亡病因均為感染性疾病;未明確診斷10例(12.5%)。70例明確診斷的FUO患者的病因構(gòu)成為:(1)感染性疾病49例(61.3%),其中結(jié)核病居首位,占17例(21.3%),肺結(jié)核病15例(18.8%),肺外結(jié)核2例(2.5%);其次,卒中相關(guān)性肺炎居第2位,占11例(13.8%),布氏桿菌病居第3位,占5例(6.3%);(2)結(jié)蹄組織病14例(17.5%),成人Still病所占比率最高,達(dá)5例(6.3%);(3)腫瘤性疾病3例(3.8%),其中淋巴瘤、結(jié)腸癌、肺癌各1例;(4)其他病因4例(5.0%)。2.不同疾病類型與性別間具有明顯差異有統(tǒng)計(jì)學(xué)意義(2?=8.316,P0.05)。3.不同疾病類型在不同年齡段的分布無(wú)統(tǒng)計(jì)學(xué)意義(2?=3.389,P0.05)。4.不同疾病類型在發(fā)熱時(shí)間上具有顯著差異有統(tǒng)計(jì)學(xué)意義(2?=30.898,P0.05)。5.不同疾病類型在確診時(shí)間上具有統(tǒng)計(jì)學(xué)差異(?2=24.662,P0.05)。6.FUO患者中,陰虛型(22/80 27.5%)、表熱型(14/80 17.5%)及秋燥型(10/80 12.5%)所占比例高于其他中醫(yī)證型。結(jié)論:感染及結(jié)締組織病是FUO的主要疾病,而結(jié)核病依然是感染性疾病中造成FUO的第一原因,在臨床不可忽視。同時(shí)要注意地方的一些特殊傳染病,新疆為畜牧業(yè)大省,經(jīng)濟(jì)、環(huán)境衛(wèi)生、醫(yī)療水平較差,與之相關(guān)的布氏桿菌病及艾滋病不容忽視。而腫瘤等在臨床往往容易診斷,很少拖延至FUO。對(duì)于不明原因發(fā)熱(FUO)的臨床診斷,應(yīng)在患者癥狀、體征及輔助檢查基礎(chǔ)上,綜合考慮不同疾病類型與性別、年齡、熱程、確診時(shí)間之間的差異。由此我們認(rèn)為,FUO是由于常見病的非典型表現(xiàn),應(yīng)該遵循“個(gè)體化治療原則”,對(duì)其進(jìn)行詳細(xì)而全面的病史采集和分析,大部分不明原因發(fā)熱是可以確診的。
[Abstract]:Objective: to investigate the etiology and outcome of fever of unknown origin (fever of unknown origin,FUO), summarize its clinical features and pathogenesis, and provide reference for clinical diagnosis. Methods: from January 2009 to December 2013, the final etiological diagnosis of 80 patients with FUO was analyzed retrospectively. The relationship between etiology and sex, age, fever course, diagnosis time and the distribution of TCM syndromes were analyzed. Results: 1. 70 cases (87.5%) were definitely diagnosed and 5 cases (6.3%) died of FUO. The cause of death was infectious disease. The etiological factors of 70 patients with FUO were as follows: (1) 49 cases (61.3%) of infectious diseases, of which 17 cases (21.3%) were tuberculosis. Pulmonary tuberculosis 15 cases (18.8%), extrapulmonary tuberculosis 2 cases (2.5%); Secondly, apoplexy associated pneumonia ranked second, accounting for 11 cases (13.8%), and brucellosis was the third place, accounting for 5 cases (6.3%). (2) there were 14 cases (17.5%) of nodular hoof disease, the highest rate of adult Still's disease was 5 cases (6.3%); (3), 3 cases (3.8%) of tumor disease, including 1 case of lymphoma, 1 case of colon cancer and 1 case of lung cancer. (4) other etiology: 4 cases (5.0%). There were significant differences between different disease types and sex (P 0.05). The distribution of different disease types in different age groups had no statistical significance (P 0.05). There was significant difference in febrile time between different disease types (P 0.05). There was statistical difference in the time of diagnosis between different types of disease (? 2t 24.662P 0.05). In 6.FUO patients, Yin deficiency type (22 / 8027.5%), The proportion of surface heat type (14 / 8017.5%) and autumn dryness type (10 / 8012.5%) was higher than that of other TCM syndromes. Conclusion: infection and connective tissue disease are the main diseases of FUO. Tuberculosis is still the first cause of FUO in infectious diseases, which can not be ignored in clinic. At the same time, we should pay attention to some special local infectious diseases, Xinjiang is a big animal husbandry province, economy, environmental hygiene, medical treatment level is poor, related to brucellosis and AIDS can not be ignored. While tumors are often easily diagnosed in clinic and rarely delayed to FUO. The clinical diagnosis of (FUO) with unknown causes should be based on the symptoms, signs and auxiliary examinations of the patients, and the differences between different disease types and sex, age, fever course and diagnosis time should be considered synthetically. Therefore, we think that FUO is due to the atypical manifestations of common diseases, so we should follow the principle of individualized treatment, collect and analyze the history of the disease in detail and comprehensively, and most of the fever of unknown origin can be diagnosed.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R441.3
，
本文編號(hào)：2345021
[Abstract]:Objective: to investigate the etiology and outcome of fever of unknown origin (fever of unknown origin,FUO), summarize its clinical features and pathogenesis, and provide reference for clinical diagnosis. Methods: from January 2009 to December 2013, the final etiological diagnosis of 80 patients with FUO was analyzed retrospectively. The relationship between etiology and sex, age, fever course, diagnosis time and the distribution of TCM syndromes were analyzed. Results: 1. 70 cases (87.5%) were definitely diagnosed and 5 cases (6.3%) died of FUO. The cause of death was infectious disease. The etiological factors of 70 patients with FUO were as follows: (1) 49 cases (61.3%) of infectious diseases, of which 17 cases (21.3%) were tuberculosis. Pulmonary tuberculosis 15 cases (18.8%), extrapulmonary tuberculosis 2 cases (2.5%); Secondly, apoplexy associated pneumonia ranked second, accounting for 11 cases (13.8%), and brucellosis was the third place, accounting for 5 cases (6.3%). (2) there were 14 cases (17.5%) of nodular hoof disease, the highest rate of adult Still's disease was 5 cases (6.3%); (3), 3 cases (3.8%) of tumor disease, including 1 case of lymphoma, 1 case of colon cancer and 1 case of lung cancer. (4) other etiology: 4 cases (5.0%). There were significant differences between different disease types and sex (P 0.05). The distribution of different disease types in different age groups had no statistical significance (P 0.05). There was significant difference in febrile time between different disease types (P 0.05). There was statistical difference in the time of diagnosis between different types of disease (? 2t 24.662P 0.05). In 6.FUO patients, Yin deficiency type (22 / 8027.5%), The proportion of surface heat type (14 / 8017.5%) and autumn dryness type (10 / 8012.5%) was higher than that of other TCM syndromes. Conclusion: infection and connective tissue disease are the main diseases of FUO. Tuberculosis is still the first cause of FUO in infectious diseases, which can not be ignored in clinic. At the same time, we should pay attention to some special local infectious diseases, Xinjiang is a big animal husbandry province, economy, environmental hygiene, medical treatment level is poor, related to brucellosis and AIDS can not be ignored. While tumors are often easily diagnosed in clinic and rarely delayed to FUO. The clinical diagnosis of (FUO) with unknown causes should be based on the symptoms, signs and auxiliary examinations of the patients, and the differences between different disease types and sex, age, fever course and diagnosis time should be considered synthetically. Therefore, we think that FUO is due to the atypical manifestations of common diseases, so we should follow the principle of individualized treatment, collect and analyze the history of the disease in detail and comprehensively, and most of the fever of unknown origin can be diagnosed.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R441.3
，
本文編號(hào)：2345021
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