内科患者不明原因发热病因分析

目的 探讨内科患者不明原因发热（fever of unknown origin,FUO）的病因及临床特征.方法 对2012年1月至2013年6月我院内科收治的符合FUO诊断标准的468例患者的临床资料进行回顾性分析,并对老年患者和非老年患者进行比较.结果 468例FUO患者通过各种检验最后明确诊断者441例（确诊率为94.2％）.其病因按比例由高至低为感染性疾病201例,占45.6％（其中结核病占43.2％）;结缔组织病153例,占34.7％（其中斯蒂尔病占48.7％）;恶性肿瘤55例,占12.5％;其他疾病32例,占7.3％;其余27例患者最终未明确病因.老年患者发热原因多为感染性疾病与恶性肿瘤,比例（60.3％）明显高于非老年患者（37.3％）,两者差异具有统计学意义（P＜0.05）;而非老年患者中结缔组织病的发病率（48.8％）则明显高于老年患者（23.2％）,两者差异具有统计学意义（P＜0.05）.结论 临床上大多数FUO患者经过细致的病史询问、详细的各项检验和综合分析是可以明确诊断的,感染性疾病是其重要病因,尤以结核病为主,且常见于老年患者,而恶性肿瘤和结缔组织病也是FUO患者主要病因.

Analysis of FUO cause of patients in internal medical department

Objective To explore the etiology and clinical features of internal medical patients with FUO （fever of unknown origin）. Methods To analyze the clinical data of 468 patients in our medical hospital, who were in line with the diagnostic criteria of FUO from January 2012 to June 2013 retrospectively, and made a comparison between the elderly patients and the nonelderly patients. Results 441 cases （positive rate of 94.2% ） of 468 patients with FUO were finally diagnosed through various examinations. Etiology of infectious diseases with 201 cases, from high to low in proportion was accounted for 45.6% with 43.2% tuberculosis. The proportion of connective tissue disease with 153 cases was accounted for 34.7% （including Steele disease with 48.7% ）. 55 cases of malignancy were accounted for 12.5% and 32 cases of other diseases which were for 7.3%. The rest of the 27 patients did not have clear causes. The most fever reasons of elderly patients were infectious disease and malignant tumour, with proportion of 60.3%, which was significantly higher than that of nonelderly patients with 37.3%. The difference was statistically significant （ P 〈 0. 05 ）. The incidence of connective tissue disease of nonelderly patients with 48.8%, was significantly higher than that of the elderly patients with 23.2%, and the difference was statistically significant （P 〈 0. 05）. Conclusions Clinically most patients with FUO can be diagnosed clearly through careful consulting of medical history, detailed survey and comprehensive analysis. Infectious disease was the important cause, especially on the elderly patients with the TB. Malignant tumour and connective tissue diseases were also the main causes of FUO patients.