不明原因发热患者的诊断与病因分析

【摘要】  　　目的 分析不明原因发热（FUO）患者诊断方法的选择和病因的确定。方法 回顾性分析246例FUO患者的诊断方法和病因。结果 212例患者经过血清学、细菌学、体液检查、骨髓检查、组织活检、手术探查，并结合临床经过和试验治疗效果明确临床诊断。其中感染性疾病129例（包括细菌感染91例，病毒感染28例，真菌感染6例，其他4例），非感染性疾病83例（包括血管结缔组织病38例，肿瘤性疾病34例，其他疾病11例）。最后仍有34例患者诊断不明。结论 对于FUO的诊断应该尽量获得病原学、免疫学和病理学的诊断依据，感染性疾病、血管结缔组织病和肿瘤性疾病是FUO发病的主要原因。

【关键词】  发热，不明原因；诊断；病因分析

　　Analysis of the diagnostic methods and etiological factors in patients with  fever of unknown origin

    SHAO Zhu-cheng.The Second People’s Hospital of Zoucheng，Zoucheng 273500，China

    ［Abstract］  Objective  To analyze the diagnostic methods and etiological factors in patients with fever of unknown origin （FUO）.Methods  The clinical data of 246 patients with FUO，who were treated in hospital since March 2001 to May 2005，were retrospetively analyzed.Results  Among the 246 patients，212 patients were definitely diagnosed （86.2%）.Among the 212 definite diagnosis patients，129 cases were infectious disease，91 cases were becterial infection （91 cases were virus infection，6 cases were fungus infection and 4 case belonged to other disese），83 cases were non-infections disease （38 cases were collagen vac-ular cular diseases，34 cases were malignant tumor and 11 cases belonged  to other diseases）.34 cases remained origin unknown until they were discharged from hospital.Conclusion  In the diagnosis of FUO，we should manage to collect path ogenic，immunologic and pathologic evidences.Infectious diseases，collagen vascular diseases and malignant tumors are the main causes of  FUO.

    ［Key words］  fever，unknown origin;diagnosis;etiology analysis

    1961年Petersderf提出不明原因发热（fever of unknown origin，FUO）的诊断，1999年全国发热性疾病研讨会将FUO定义为：发热持续3周以上，体温在38.5 ℃以上，经详细询问病史、体格检查和常规实验室检查仍不能明确诊断者［1］。有

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