本文選題：不明原因發(fā)熱 + 病因分布�。� 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討經(jīng)典型不明原因發(fā)熱的病因分布及臨床特點。方法回顧性分析2014年1月-2015年12月廣西醫(yī)科大學(xué)第一附屬醫(yī)院感染性疾病科114例經(jīng)典型不明原因發(fā)熱(fever of unknown origin,FUO)住院患者的臨床資料。根據(jù)出院診斷將經(jīng)典型FUO分為感染性疾病、結(jié)締組織病、惡性腫瘤、雜病類以及病因未明五大類,分析其病因分布、診斷方法并總結(jié)感染性疾病、結(jié)締組織病、惡性腫瘤的臨床特點以及感染性疾病與非感染性疾病的鑒別要點。結(jié)果1.114例經(jīng)典型FUO患者中明確診斷者108例,確診率為94.7%。感染性疾病為最主要病因,共68例(59.6%),其次為結(jié)締組織病(20例,17.5%)、雜病類(11例,9.7%)、惡性腫瘤(9例,7.9%),病因未明者最少僅6例(5.3%)。就具體病種而言,以成人Still病(Adult-onset Still disease,AOSD)(12例,10.5%)最多見,其次為傷寒(7例,6.1%)、淋巴瘤(7例,6.1%)多見。2.確診方法包括:經(jīng)驗性治療42例(38.9%)(包括經(jīng)驗性抗感染、診斷性抗結(jié)核、經(jīng)驗性激素和/或非甾體類消炎藥治療),血清學(xué)或病原學(xué)檢查31例(28.7%),影像學(xué)15例(13.9%),組織病理檢查12例(11.1%),臨床觀察8例(7.4%)。其中,骨髓培養(yǎng)陽性率低(73例骨髓培養(yǎng)中僅4例結(jié)果為陽性且有臨床意義,5.5%),3例骨髓培養(yǎng)陽性者血液培養(yǎng)亦培養(yǎng)出相同病原菌。3.感染性疾病、結(jié)締組織病及惡性腫瘤三類病因的臨床特點:感染性疾病多見于男性、畏寒、頭痛患者(P0.05);結(jié)締組織病多見于20-40歲人群,男女比例無顯著差異,且多有皮疹、關(guān)節(jié)痛、淋巴結(jié)腫大,白細胞計數(shù)(white blood cell count,WBC)、中性粒細胞百分比、血清鐵蛋白(serum ferritin,SF)、血沉(erythrocyte sedimentation rate,ESR)較感染性疾病與惡性腫瘤升高明顯(P0.05);惡性腫瘤全部為40歲以上人群且絕大多數(shù)為男性,且脾大、貧血、血小板減少、低蛋白血癥較顯著,乳酸脫氫酶(lactate dehydrogenase,LDH)、堿性磷酸酶、谷草轉(zhuǎn)氨酶、單核細胞百分比較高(P0.05)。4.多因素非條件Logistic回歸結(jié)果顯示:SF為感染性疾病的獨立預(yù)測因子且成負相關(guān),提示感染性疾病中血清鐵蛋白較非感染性疾病低(P0.05)(Hosmer-Lemeshow擬合優(yōu)度檢驗顯示,χ2=5.354,P=0.499),Logistic回歸方程為:LogitP=3.509-1.158x(x=SF)。SF的ROC曲線下面積(AUC)為0.763,95%置信區(qū)間為0.660-0.866。結(jié)論1.不明原因發(fā)熱最常見的病因為感染性疾病,其次為結(jié)締組織病、雜病類以及惡性腫瘤;就具體病種而言,AOSD為經(jīng)典型FUO的最多見疾病,其次為傷寒、淋巴瘤。2.經(jīng)典型FUO患者的骨髓培養(yǎng)陽性率低,骨髓培養(yǎng)對于經(jīng)典型FUO患者的診斷價值有待商榷。3.經(jīng)典型FUO中感染性疾病、結(jié)締組織病及惡性腫瘤有各自的臨床表現(xiàn)及實驗室檢查特點,結(jié)合這些特點有助于經(jīng)典型FUO的鑒別。4.血清鐵蛋白對于感染性疾病與非感染性疾病的鑒別診斷有一定意義。
[Abstract]:Objective to investigate the Etiological Distribution and clinical characteristics of classical fever of unknown origin. Methods a retrospective analysis was made of the clinical data of 114 hospitalized patients with fever of unknown origin (FUO) in the First Affiliated Hospital of Guangxi Medical University, -2015, January 2014. Five major categories of infectious disease, connective tissue disease, malignant tumor, miscellaneous diseases and unknown etiology, analysis of its cause distribution, diagnostic methods and summary of infectious diseases, connective tissue disease, clinical characteristics of malignant tumors and identification of infectious and non infectious diseases. Results 108 cases of 1.114 classic FUO patients were diagnosed, The diagnosis rate of 94.7%. infection was the main cause, 68 cases (59.6%), followed by connective tissue disease (20 cases, 17.5%), miscellaneous diseases (11 cases, 9.7%), malignant tumor (9 cases, 7.9%), and the least 6 (5.3%) cases (5.3%). In terms of specific disease, Still disease (Adult-onset Still disease, AOSD) (12, 10.5%) was the most common, and the second was typhoid (7). Cases (6.1%), lymphoma (7 cases, 6.1%) were found to be diagnosed with.2., including empirical treatment in 42 (38.9%) (including empirical anti infection, diagnostic anti tuberculosis, empirical hormone and / or non steroidal anti-inflammatory drugs), serological or pathogenic examination 31 cases (28.7%), imaging 15 cases (13.9%), histopathology 12 cases (11.1%), clinical observation 8 cases (7.4%). Among them, the positive rate of bone marrow culture was low (in 73 cases of bone marrow culture, only 4 cases were positive and had clinical significance, 5.5%). 3 cases of positive bone marrow culture also cultivated the same pathogenic bacteria.3. infectious diseases, connective tissue disease and malignant tumor of three types of clinical characteristics: infectious diseases were mostly seen in men, cold, headache (P0.05); Connective tissue disease is mostly found in 20-40 years old people, and there is no significant difference in male and female proportion, and there are many rashes, joint pain, lymph node enlargement, white blood cell count, WBC, the percentage of neutrophils, serum ferritin (serum ferritin, SF), erythrocyte sedimentation (erythrocyte sedimentation rate, ESR) higher than infection and malignant tumors. P0.05; malignant tumors were all over 40 years old and most of them were male, and splenomegaly, anemia, thrombocytopenia, hypoproteinemia were significant, lactate dehydrogenase (lactate dehydrogenase, LDH), alkaline phosphatase, gluten aminotransferase, and monocyte percent higher (P0.05).4. multiple factors unconditional Logistic regression results showed that SF was a sense The independent predictors of dyed diseases were negatively correlated, suggesting that serum ferritin in infectious diseases was lower than that of non infectious diseases (P0.05) (Hosmer-Lemeshow goodness of fit test, X 2=5.354, P=0.499), and Logistic regression equation was that the area under ROC curve of LogitP=3.509-1.158x (x=SF).SF (AUC) was 0.763,95% confidence interval for 0.660-0.866. junction 1. the most common diseases of fever of unknown origin are infectious diseases, followed by connective tissue disease, miscellaneous diseases and malignant tumors. In terms of specific diseases, AOSD is the most common disease in the classic FUO, followed by typhoid, and the positive rate of bone marrow culture in the classical FUO patients with lymphoma.2. is low, and the diagnostic value of bone marrow culture for the classic FUO patients is the value of the disease. It is still to be discussed that the infectious diseases of.3. classic FUO, connective tissue disease and malignant tumor have their own clinical manifestations and laboratory tests. These characteristics are helpful to the differential diagnosis of.4. serum ferritin for the differential diagnosis of infectious and non infectious diseases by the classical FUO.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R441.3

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