综合医院以不明原因发热为表现的结核病100例临床分析

目的 探讨以不明原因发热(FUO)为表现的结核病的临床特征.方法 回顾性分析100例北京协和医院确诊的以FUO为表现的结核病患者的临床资料.结果 (1)结核累及部位:单纯肺结核39例,单纯肺外结核28例,肺结核合并肺外结核33例.(2)临床表现:由于累及部位的不同,伴随症状各异.实验室检查多为ESR增快和C反应蛋白升高以及不同程度的消耗表现即贫血和低白蛋白血症.(3)诊断方法:抗酸杆菌阳性的34例,组织病理符合结核病的8例,临床诊断并经抗结核治疗有效的49例,诊断性抗结核治疗有效的9例.从发病至确诊的时间为3～77周,中位确诊时间14周.(4)治疗反应:73例随访的患者中仅有2例(2.7%)死亡,其余均好转或治愈.正规抗结核治疗4周以内显效率为77.5%.37例(52.1%)出现药物不良反应,经调整治疗方案和对症处理后均好转.结论 以FUO为表现的结核病诊断比较困难,应对该病临床表现进行综合分析,认真阅读胸部影像学资料,尽可能寻找病原学和病理学的证据,必要时可给予诊断性抗结核治疗.

An analysis of 100 cases of tuberculosis first presenting as fever of unknown origin in a general tertiary hospital

Objective To investigate the clinical characteristics of tuberculosis (TB) first presenting as fever of unknown origin (FUO). Methods The clinical data of 100 cases of FUO, diagnosed as TB finally, among in-patients in Peking Union Medical College Hospital were analyzed retrospectively.Results ( 1 ) Sites of TB: there were 39 patients with merely pulmonary TB, 28 patients with merely extrapulmonary TB, and 33 patients with both pulmonary and extrapulmonary TB. (2) Clinical manifestations: depending on the different sites of tuberculous lesion, the clinical symptoms varied accordingly. The common laboratory findings included anemia, hypoalbuminemia, elevation of the level of ESR and C-reactive protein (CRP). (3) Methods for diagnosis: 34 cases were diagnosed by sputum smearor cultivation-positive for acid-fast bacilli; 8 cases by histopathology; 49 cases by clinical diagnosis of TB with an effective anti-TB therapy; and 9 cases by effective diagnostic anti-TB therapy. (4) Responses to treatment: among 73 cases with complete follow-up data, only 2 cases (2. 7% ) died and the other cases were cured or alleviated. Fifty-five cases (77.5%) showed marked efficacy after less than 4 weeks of regular anti-TB therapy, 37 cases ( 52. 1% ) suffered adverse effects of anti-TB agents, and all of them had improved after modifying anti-TB therapy and supporting treatment. Conclusions The diagnosis of TB that presents as FUO is quite difficult, and the median interval time for making diagnosis is 14 weeks (3-77weeks). Investigating clinical manifestations comprehensively, reviewing radiology data carefully, and eliciting microbiological and pathologic evidence of TB, are extremely important for making the correct diagnosis. In some cases, a therapeatic trial of anti-TB therapy is necessary.