不明原因發(fā)熱臨床特點(diǎn)的回顧性分析
發(fā)布時(shí)間：2018-09-16 19:08
【摘要】：目的:不明原因發(fā)熱(Fever of unknown origin,以下簡稱為FUO )的定義是:發(fā)熱持續(xù)2至3周以上,體溫大于等于38.5攝氏度,經(jīng)過詳細(xì)的詢問病史、體格檢查和常規(guī)的實(shí)驗(yàn)室檢查仍不能明確診斷者[1]。FUO涉及呼吸內(nèi)科、血液內(nèi)科、風(fēng)濕免疫科等多個(gè)領(lǐng)域疾病,多種臨床表現(xiàn)非常相似,缺乏容易診斷的典型臨床特征;因初診醫(yī)師大多為�？漆t(yī)師,很難對(duì)FUO病因有系統(tǒng)的認(rèn)識(shí)和把握,容易造成誤診、漏診;同時(shí)還因?yàn)獒t(yī)療水平有限、患者本身心理因素,導(dǎo)致FUO疾病長時(shí)間難以確診,成為臨床醫(yī)師困擾的一大難題。臨床醫(yī)師對(duì)FUO的診療思維直接影響的FUO疾病的診治效率,為提高FUO診斷的準(zhǔn)確性、探索診療模式的改進(jìn)方法,本研究采取回顧性分析的方法分析了 88例FUO患者的病因、診斷方法、性別、年齡、熱程、最高體溫、初診科室分布,總結(jié)FUO診療思維指導(dǎo)臨床診斷及治療。方法:回顧分析了廣州醫(yī)科大學(xué)附屬第一醫(yī)院2016年4月至2016年9月符合FUO診斷標(biāo)準(zhǔn)的住院患者88例。記錄了 88例患者的病因、診斷方法、性別、年齡、熱程、最高體溫、初診科室,探討FUO的病因、診斷方法、性別、年齡、熱程、初診體溫、初診科室分布。用SPSS 21 (Statistical Product and Service Solutions,以下簡稱SPSS)軟件行卡方檢驗(yàn)、秩和檢驗(yàn)統(tǒng)計(jì)處理,P≤0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果:1、按病因分布:88例FUO患者中,有85例(96.5%)最終確診,包含感染性疾病41例(46.6%),結(jié)締組織疾病26例(29.5%),腫瘤性疾病12例(13.6%),其他疾病6例(6.8%),未確診疾病3例(3.4%)。感染性疾病中肺結(jié)核最多,共12例(29.3%)。結(jié)締組織病中成人斯蒂爾病最多,共11例(42.3%)。腫瘤疾病中淋巴瘤最多,共6例(50.00%)。其他疾病中藥物熱最多,共2例(33.3%)。2、按診斷方法分布:診斷性治療為確診FUO病因的主要方法,占34.1%,其次為組織活檢,占20.5%,其后依次為影像學(xué)、細(xì)菌學(xué),分別占15.9%和10.2%,體液和骨髓穿刺、免疫學(xué),各占8.0%3、按性別分布:男性總體數(shù)量比女性略高,感染性疾病中男女比例較均等,但結(jié)締組織疾病中女性占的比例較大,腫瘤性疾病中男性占的比例較大。4、按年齡段分布:感染性疾病在各年齡段中占了較高比重,且在不同年齡組感染性疾病所占比例較均等。結(jié)締組織疾病在41-60歲這個(gè)年齡段為第一位病因。腫瘤性疾病在60歲以上年齡段成為第二位病因。5、按熱程分布:感染性疾病在小于2月熱程組中為第一位病因。結(jié)締組織疾病在2至4月熱程組中為第一位病因。腫瘤性疾病在大于4月熱程組中為第一位病因。6、按最高體溫分布:感染性疾病、結(jié)締組織疾病在38.5-38.9℃組中均為首位病因。腫瘤性疾病在39.0-39.5℃組中為首位病因。7、按初診科室分布:感染性疾病、結(jié)締組織病、腫瘤性疾病患者初診科室中,呼吸內(nèi)科、急診科分別占第一位、第二位科室。消化內(nèi)科、感染內(nèi)科、內(nèi)分泌科等其他科室與呼吸內(nèi)科、急診科所占比例差距較大。結(jié)論:(1)引起FUO的病種眾多,病因繁雜;研究對(duì)象中最后有3.4%的病例仍不能明確診斷。(2)感染性疾病仍舊是FUO的主要病因,肺結(jié)核是感染性疾病中的首要病因,同時(shí)也是FUO的第一位病因。結(jié)締組織疾病、腫瘤性疾病分別占FUO第二位、第三位病因。(3) FUO的診斷方法中,診斷性治療占FUO確診方法的首要方法、其后依次為組織活檢、影像學(xué)、細(xì)菌學(xué)、免疫學(xué)、體液和骨髓穿刺,FUO的診斷是有一定規(guī)則的,根據(jù)詳細(xì)的詢問病史、細(xì)致的體格檢查、必要的輔助檢查以及診斷性治療還是可以確診的。(4) FUO病因分布在不同性別、年齡組、熱程、最高體溫、初診科室等方面存在一定程度上的差異,女性結(jié)締組織疾病所占比例明顯多于男性,腫瘤疾病中男性患者比例明顯高于女性;隨著患者年齡增長和發(fā)熱熱程延長,腫瘤性疾病、結(jié)締組織疾病所占比重相應(yīng)地增高,而感染性疾病所占比重卻相對(duì)降低。FUO患者中若為反復(fù)高熱,熱程長,年紀(jì)偏大,要先排除腫瘤性疾病。大多數(shù)FUO患者初診科室選擇呼吸內(nèi)科和急診科,說明大多數(shù)患者忽略FUO病因中結(jié)締組織疾病、腫瘤性疾病的重要地位,值得臨床醫(yī)生重視,做好分診工作,以免延誤病情。
[Abstract]:OBJECTIVE: Fever of unknown origin (FUO) is defined as: fever lasts for more than 2 to 3 weeks, body temperature is greater than or equal to 38.5 degrees Celsius, after a detailed history of inquiry, physical examination and routine laboratory examination can not be clearly diagnosed [1]. Domain disease, a variety of clinical manifestations are very similar, lack of typical clinical characteristics easy to diagnose; because most of the first physicians are specialists, it is difficult to have a systematic understanding and grasp of the causes of FUO, easy to cause misdiagnosis, missed diagnosis; at the same time because of limited medical level, the patient's own psychological factors, resulting in FUO disease for a long time difficult to diagnose, become a clinical practice. To improve the diagnostic accuracy of FUO and explore the improvement methods of diagnosis and treatment mode, a retrospective study was conducted to analyze the etiology, diagnostic methods, sex, age, heat course, maximum body temperature and initial diagnosis room of 88 FUO patients. Methods: A retrospective analysis was made of 88 inpatients who met the FUO diagnostic criteria from April 2016 to September 2016 in the First Affiliated Hospital of Guangzhou Medical University. Methods: Gender, age, duration of fever, temperature of the first diagnosis, distribution of the first clinic. Chi-square test was performed with SPSS 21 (Statistical Product and Service Solutions) software, and rank sum test was statistically significant when P < 0.05. Results: 1. According to the etiological distribution, 85 (96.5%) of 88 FUO patients were finally diagnosed, including 41 infectious diseases. Twelve (29.3%) of the infectious diseases were tuberculosis, and 11 (42.3%) of the connective tissue diseases were adult Still's disease. There were 2 cases (33.3%) and 2 cases (2.2%). According to the diagnostic method, diagnostic treatment was the main method to diagnose the cause of FUO, accounting for 34.1%, followed by biopsy, accounting for 20.5%, followed by imaging, bacteriology, accounting for 15.9% and 10.2% respectively, humoral and bone marrow puncture, immunology, accounting for 8.0% 3, according to gender distribution: the overall number of men slightly higher than women, infectious diseases. The ratio of male to female was equal, but the proportion of female was higher in connective tissue diseases, and the proportion of male was higher in tumor diseases. 4. Distribution by age group: Infectious diseases accounted for a higher proportion in all age groups, and the proportion of infectious diseases was equal in different age groups. Tumor disease is the second cause of the disease in the age group over 60 years old. 5. Distribution by heat course: infectious disease is the first cause in the fever course group less than 2 months. Connective tissue disease is the first cause in the fever course group from 2 to 4 months. Tumor disease is the first cause in the fever course group more than 4 months. 6. Distribution by the highest body temperature: sensation. Tumor disease is the first cause of disease in the 39.0-39.5 C group. 7. According to the distribution of the first clinic: infectious diseases, connective tissue diseases, cancer patients in the first clinic, respiratory medicine, emergency department accounted for the first, the second. Conclusion: (1) There are many kinds of diseases causing FUO, and the etiology is complicated; 3.4% of the cases in the final study can not be clearly diagnosed. (2) Infectious diseases are still the main cause of FUO, tuberculosis is the primary cause of infectious diseases, but also the first cause of FUO. Connective tissue disease, tumor disease accounted for the second, the third cause of FUO. (3) Diagnostic therapy was the first method of FUO diagnosis, followed by tissue biopsy, imaging, bacteriology, immunology, humoral and bone marrow puncture, FUO diagnosis has certain rules, according to detailed inquiries. History, careful physical examination, necessary auxiliary examination and diagnostic treatment can still be diagnosed. (4) FUO pathogeny distribution in different gender, age group, fever, the highest temperature, first visit departments, there are some differences, the proportion of female connective tissue diseases is significantly more than men, the proportion of male cancer patients is clear. With the increase of age and fever duration, the proportion of tumor diseases and connective tissue diseases increased correspondingly, but the proportion of infectious diseases decreased relatively. If FUO patients have recurrent high fever, long fever duration and older age, they should exclude tumor diseases first. Most FUO patients choose respiratory department for the first time. Department and emergency department, explain that most patients neglect the cause of FUO connective tissue disease, the important position of tumor disease, clinicians should pay attention to, do a good job in the division of diagnosis, in order to avoid delaying the disease.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R441.3
本文編號(hào)：2244501
[Abstract]:OBJECTIVE: Fever of unknown origin (FUO) is defined as: fever lasts for more than 2 to 3 weeks, body temperature is greater than or equal to 38.5 degrees Celsius, after a detailed history of inquiry, physical examination and routine laboratory examination can not be clearly diagnosed [1]. Domain disease, a variety of clinical manifestations are very similar, lack of typical clinical characteristics easy to diagnose; because most of the first physicians are specialists, it is difficult to have a systematic understanding and grasp of the causes of FUO, easy to cause misdiagnosis, missed diagnosis; at the same time because of limited medical level, the patient's own psychological factors, resulting in FUO disease for a long time difficult to diagnose, become a clinical practice. To improve the diagnostic accuracy of FUO and explore the improvement methods of diagnosis and treatment mode, a retrospective study was conducted to analyze the etiology, diagnostic methods, sex, age, heat course, maximum body temperature and initial diagnosis room of 88 FUO patients. Methods: A retrospective analysis was made of 88 inpatients who met the FUO diagnostic criteria from April 2016 to September 2016 in the First Affiliated Hospital of Guangzhou Medical University. Methods: Gender, age, duration of fever, temperature of the first diagnosis, distribution of the first clinic. Chi-square test was performed with SPSS 21 (Statistical Product and Service Solutions) software, and rank sum test was statistically significant when P < 0.05. Results: 1. According to the etiological distribution, 85 (96.5%) of 88 FUO patients were finally diagnosed, including 41 infectious diseases. Twelve (29.3%) of the infectious diseases were tuberculosis, and 11 (42.3%) of the connective tissue diseases were adult Still's disease. There were 2 cases (33.3%) and 2 cases (2.2%). According to the diagnostic method, diagnostic treatment was the main method to diagnose the cause of FUO, accounting for 34.1%, followed by biopsy, accounting for 20.5%, followed by imaging, bacteriology, accounting for 15.9% and 10.2% respectively, humoral and bone marrow puncture, immunology, accounting for 8.0% 3, according to gender distribution: the overall number of men slightly higher than women, infectious diseases. The ratio of male to female was equal, but the proportion of female was higher in connective tissue diseases, and the proportion of male was higher in tumor diseases. 4. Distribution by age group: Infectious diseases accounted for a higher proportion in all age groups, and the proportion of infectious diseases was equal in different age groups. Tumor disease is the second cause of the disease in the age group over 60 years old. 5. Distribution by heat course: infectious disease is the first cause in the fever course group less than 2 months. Connective tissue disease is the first cause in the fever course group from 2 to 4 months. Tumor disease is the first cause in the fever course group more than 4 months. 6. Distribution by the highest body temperature: sensation. Tumor disease is the first cause of disease in the 39.0-39.5 C group. 7. According to the distribution of the first clinic: infectious diseases, connective tissue diseases, cancer patients in the first clinic, respiratory medicine, emergency department accounted for the first, the second. Conclusion: (1) There are many kinds of diseases causing FUO, and the etiology is complicated; 3.4% of the cases in the final study can not be clearly diagnosed. (2) Infectious diseases are still the main cause of FUO, tuberculosis is the primary cause of infectious diseases, but also the first cause of FUO. Connective tissue disease, tumor disease accounted for the second, the third cause of FUO. (3) Diagnostic therapy was the first method of FUO diagnosis, followed by tissue biopsy, imaging, bacteriology, immunology, humoral and bone marrow puncture, FUO diagnosis has certain rules, according to detailed inquiries. History, careful physical examination, necessary auxiliary examination and diagnostic treatment can still be diagnosed. (4) FUO pathogeny distribution in different gender, age group, fever, the highest temperature, first visit departments, there are some differences, the proportion of female connective tissue diseases is significantly more than men, the proportion of male cancer patients is clear. With the increase of age and fever duration, the proportion of tumor diseases and connective tissue diseases increased correspondingly, but the proportion of infectious diseases decreased relatively. If FUO patients have recurrent high fever, long fever duration and older age, they should exclude tumor diseases first. Most FUO patients choose respiratory department for the first time. Department and emergency department, explain that most patients neglect the cause of FUO connective tissue disease, the important position of tumor disease, clinicians should pay attention to, do a good job in the division of diagnosis, in order to avoid delaying the disease.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R441.3
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