CAJ | 학술논문

目的探讨不明原因发热(FUO)患者的病因分布,提高对其诊治水平.方法回顾性分析2003年1月-2013年8月期间首都医科大学附属北京友谊医院收治的、符合Petersdorf和Beeson提出的FUO诊断标准的患者372例.根据发病时间将入选病例分为前期组(2003年1月一2007年12月)和后期组(2008年1月-2013年8月),比较两个时期的病因分布、确诊率、住院天数、确诊时间等.结果 372例FUO病例中,最终获得确诊336例,确诊率为90.3％.病因为感染性疾病者224例(60.2％),仍为FUO的首要病因,其中结核病72例(32.1％,72/224);结缔组织病48例(12.9％);肿瘤性疾病31例(8.3％);其他疾病33例(8.9％);出院时原因仍未明36例(9.7％).肿瘤性疾病的热程长于感染性疾病[60.0(30.0,90.0)d比30.0(20.0,60.0)d,P=0.003],结缔组织病和肿瘤性疾病的确诊时间均长于感染性疾病[(12.0(7.3,18.8)d、11.0(7.0,18.0)d比5.0(3.0,8.0)d,P值均为0.000].前期组的住院天数较后期组长[17.0(12.0,30.0)d比14.0(10.0,20.0)d,P=0.000],两个时期的确诊率、确诊时间差异无统计学意义.前期组结缔组织病的比例大于后期组(18.1％比9.2％,x2=6.201,P=0.013),两个时期感染性疾病、肿瘤性疾病及其他类的比例差异无统计学意义.结论感染性疾病是FUO的主要病因,而结核病在其中占较大比例;结缔组织病及肿瘤性疾病在FUO病因中占有重要地位.感染性疾病、结缔组织病、肿瘤性疾病的热程、确诊时间差异有统计学意义.
목적 탐토불명원인발열(FUO)환자적병인분포,제고대기진치수평.방법 회고성분석2003년1월-2013년8월기간수도의과대학부속북경우의의원수치적、부합Petersdorf화Beeson제출적FUO진단표준적환자372례.근거발병시간장입선병례분위전기조(2003년1월일2007년12월)화후기조(2008년1월-2013년8월),비교량개시기적병인분포、학진솔、주원천수、학진시간등.결과 372례FUO병례중,최종획득학진336례,학진솔위90.3％.병인위감염성질병자224례(60.2％),잉위FUO적수요병인,기중결핵병72례(32.1％,72/224);결체조직병48례(12.9％);종류성질병31례(8.3％);기타질병33례(8.9％);출원시원인잉미명36례(9.7％).종류성질병적열정장우감염성질병[60.0(30.0,90.0)d비30.0(20.0,60.0)d,P=0.003],결체조직병화종류성질병적학진시간균장우감염성질병[(12.0(7.3,18.8)d、11.0(7.0,18.0)d비5.0(3.0,8.0)d,P치균위0.000].전기조적주원천수교후기조장[17.0(12.0,30.0)d비14.0(10.0,20.0)d,P=0.000],량개시기적학진솔、학진시간차이무통계학의의.전기조결체조직병적비례대우후기조(18.1％비9.2％,x2=6.201,P=0.013),량개시기감염성질병、종류성질병급기타류적비례차이무통계학의의.결론 감염성질병시FUO적주요병인,이결핵병재기중점교대비례;결체조직병급종류성질병재FUO병인중점유중요지위.감염성질병、결체조직병、종류성질병적열정、학진시간차이유통계학의의.
Objective To analyze the etiology of fever of unknown origin (FUO).Methods A total of 372 patients with FUO who hospitalized in Capital Medical University Affiliated Beijing Friendship Hospital were retrospectively analyzed from January 2003 to August 2013.All the patients were divided into two groups:group A (January 2003-December 2007) and group B (January 2008-August 2013).Diagnosis rate,duration of hospitalization (days) and time to diagnosis between the two groups were artificially compared.Results Of the 372 FUO cases,336 were positively diagnosed with a diagnosis rate of 90.3％.Infectious diseases were still the primary causes of FUO (60.2％),including 72 cases (32.1％) of tuberculosis.Connective tissue diseases accounted for 12.9％ of the FUO cases,malignancies were 8.3％,and miscellaneous diseases were 8.9％.Yet thirty six patients (9.7％) could not be confirmed until they were discharged from hospital.The duration of fever in patients with malignancies was longer than that with infectious diseases [60.0 (30.0,90.0) days vs 30.0 (20.0,60.0) days,P =0.003].Time to diagnosis of connective tissue disease and malignancies was longer than infectious diseases [(12.0 (7.3,18.8) days and 11.0 (7.0,18.0) vs 5.0 (3.0,8.0) days,both P values =0.000].The duration of hospitalization in group A was longer than that of group B [17.0(12.0,30.0) days vs 14.0(10.0,20.0) days,P =0.000].The diagnosis rate and time to diagnosis of group A were similar with those of group B.The proportion of connective tissue diseases in group A was higher than group B(18.1％ vs 9.2％,x2 =6.201,P =0.013).The proportion of infectious disease,malignancies and miscellaneous diseases was not significantly different between the two groups.Conclusions Infectious diseases are the major causes of FUO,and the most common cause is tuberculosis.Connective tissue diseases and malignancies are the second and third causes of FUO.The duration of fever and time to diagnosis are significantly different between the different origins.