本文選題：不明原因發(fā)熱　切入點：病原學(xué)　出處：《臨床和實驗醫(yī)學(xué)雜志》2017年05期 　論文類型：期刊論文

【摘要】：目的明確不明原因發(fā)熱(FUO)人群的病原學(xué)檢查結(jié)果情況。方法回顧性收集306例FUO病例的臨床資料,對病原學(xué)檢查結(jié)果進行分析。結(jié)果 306例FUO病例中,感染性疾病202例(66.0%),為FUO的首要病因;風(fēng)濕免疫類病38例(12.4%);腫瘤性疾病20例(6.5%);其他疾病22例(7.2%);到出院時原因仍未明24(占7.8%)。306例FUO患者中病原學(xué)總的陽性率為72.5%,病原菌培養(yǎng)的陽性率為34.6%,病原體血清抗體的陽性率為43.5%,血病原體核酸的陽性率為6.2%,標(biāo)本涂片鏡檢查病原體陽性率為18.3%,標(biāo)本的病理學(xué)檢查中病原體陽性率為1.6%。306例FUO患者中總的抗生素的使用率為94.1%。將風(fēng)濕免疫病、腫瘤性疾病、其他疾病和最終仍原因不明合并成非感染組,與感染性疾病組進行比較,結(jié)果顯示,感染組病原學(xué)總的陽性率顯著高于非感染組(χ2=24.9,P0.01);病原學(xué)檢出的陽性率中細(xì)菌的陽性率最高,為57.5%,其中結(jié)核桿菌的陽性率為22.9%,其次為病毒,為48.3%,真菌的陽性率為11.1%,支原體的陽性率為8.8%,衣原體的陽性率為6.5%,寄生蟲的陽性率為1.0%�？梢傻母腥驹钪�,肺部最常見(45.4%),其次是淋巴結(jié)(12.4%),然后是血液(4.2%),少見的感染部位有腹腔(1%)、膽道(1%)、肝臟(0.7%)、顱內(nèi)(0.7%)、心內(nèi)膜(0.7%)、泌尿道(0.3%),還有相當(dāng)一部分病例找不到可疑的感染灶(11.4%)。結(jié)論 FUO的診治過程中,病原學(xué)的檢查的意義在于,陽性結(jié)果能夠提示感染的相關(guān)診斷,尤其是結(jié)合感染灶時;陰性結(jié)果可以協(xié)助排除感染的相關(guān)情況,為確診感染以外的疾病提供相關(guān)的證據(jù)。在FUO中,無論引起發(fā)熱的原發(fā)病因是感染因素還是非感染因素,都需要完善病原學(xué)的相關(guān)檢查,以明確原發(fā)感染或繼發(fā)感染的病原學(xué)情況。
[Abstract]:Objective to determine the etiological results of patients with fever of unknown origin (FUO). Methods the clinical data of 306 cases of FUO were collected retrospectively and the results of etiological examination were analyzed. 202 cases of infectious diseases were identified as the primary cause of FUO. 38 cases of rheumatic immune diseases (RIA), 20 cases of tumor diseases, 22 cases of other diseases, 22 cases of other diseases, 22 cases of other diseases, 22 cases of other diseases, at the time of discharge, the cause is still unclear 24 (7.8%). 306 cases of FUO patients, the total positive rate of etiology is 72.5%, the positive rate of pathogenic bacteria culture is 34.6%, and the positive rate of serum antibodies of pathogens is 34.6%. The positive rate was 43.5%, the positive rate of blood pathogen nucleic acid was 6.2 and the positive rate of specimen smear examination was 18.3.The positive rate of pathogen in pathological examination of specimen was 1.6.306 cases of FUO. Tumorous diseases, other diseases, and the final cause of the disease were unexplained and combined into a non-infected group, compared with the infectious disease group, and the results showed that, The total positive rate of pathogens in the infected group was significantly higher than that in the non-infected group (蠂 ~ 2 / 24. 9) P0.01.The positive rate of bacteria was the highest (57.5%), in which the positive rate of Mycobacterium tuberculosis was 22. 9%, followed by the virus. The positive rates of fungi, mycoplasma, chlamydia, parasites and parasites were 11.1, 8.8, 6.5 and 1.0, respectively. The most common site of infection in the lung is 45.4m, followed by 12.4m lymph node, and then blood 4.2. The infective sites are abdominal cavity, bile duct, liver, liver, brain, endocardium, urinary tract, urinary tract, and a considerable number of cases. Conclusion in the course of diagnosis and treatment of FUO, there are no suspicious lesions. Conclusion in the course of diagnosis and treatment of FUO, we can not find a suspicious infection focus of 11.44.Conclusion in the course of diagnosis and treatment of FUO, The significance of etiological examination is that the positive results can indicate the diagnosis of the infection, especially when combined with the infected foci; the negative results can help to exclude the related conditions of the infection. Provide relevant evidence for the diagnosis of diseases other than infection. In FUO, whether the primary cause of fever is an infectious factor or a non-infectious factor, it is necessary to improve the etiological examination. To determine the etiology of primary or secondary infections.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京友誼醫(yī)院感染內(nèi)科;中國康復(fù)研究中心北京博愛醫(yī)院急診科首都醫(yī)科大學(xué)康復(fù)醫(yī)學(xué)院急診內(nèi)科;
【基金】：北京中醫(yī)藥科技發(fā)展資金資助項目(編號:JJ2015-49)
【分類號】：R441.3

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