不明原因发热90例临床分析

A clinical review of 90 cases with fever of unknown origin

关键词:  不明原因发热  噬血细胞性淋巴组织细胞增生症  血管免疫母细胞性T细胞淋巴瘤

Key words:  [Key words]　fever of unknown origin  hemophagocytic lymphohistiocytosis  angioimmunoblastic T-cell lymphoma

摘要:

目的　探讨不明原因发热(fever of unknown origin, FUO)的病因分布及临床特点，减少误诊率。　方法　　回顾性分析2008年1月—2011年10月于大连医科大学附属第二医院血液科住院的90例FUO患者的临床资料，包括病史、症状、体征，实验室检查，影像学检查及病理检查。采用独立样本t检验，比较不同病因相关生化指标的差异。　结果　　90例患者中81例确诊，确诊率90%。病因包括：感染性疾病43例占53.1%，其中结核14例，占感染性疾病首位；恶性肿瘤10例占12.3%,其中非霍奇金淋巴瘤5例，血管免疫母细胞性T细胞淋巴瘤4例；结缔组织病10例占12.3%，其中成人Still’s病5例占50%；其他疾病18例占22.2%，其中噬血细胞性淋巴组织细胞增生症（hemophagocytic lymphohistiocytosis，HLH)11例，占61.11%；未确诊病例9例占9%。　结论　　感染性疾病是本组FUO患者的主要病因，其中结核所占比例最高。此外噬血细胞性淋巴组织细胞增生症，非霍奇金淋巴瘤也常见。

Abstract:

[Abstract] Objective　To investigate the etiololgic classification and clinical characteristics of Fever of Unknown Origin (FUO) in 90 patients.　Methods　Ninety patients with FUO were diagnosed in the Second Affiliated Hospital of Dalian Medical University from January 2008 to October 2011.The clinical data included clinical manifestations, laboratory tests, imaging examinations and pathological examination. 　Results　Among the 90 FUO cases, definite diagnosis was eventually achieved in 81 patients（90%）. Infectious diseases (n=43, 53.1%) were the most common causes of FUO. Tuberculosis (n=14) accounted for 32.56% of all the infectious causes. Neoplasm was found in 10 (12.3%) patients, Angioimmunoblastic T-Cell Lymphoma(n=4) were mostly associated with FUO among neoplasms. Ten patients were suffered from collagen vascular diseases: with adult Still's disease(n=5) accounting for 50%. Miscellaneous diseases were found in 18 (22.2%) patients, hemophagocytic lymphohistiocytosis(n=11) were mostly associated with FUO among Miscellaneous diseases.　Conclusion　Infectious diseases, especially tuberculosis, were the leading diagnostic category of FUO in this study. Hemophagocytic lymphohistiocytosis and Angioimmunoblastic T-Cell Lymphoma were more common than others.