Abstract:

Objective　To understand the characteristics of etiological distribution in 183 patients with fever of unknown origin (FUO), to compare the etiological composition of patients from different hospitals and age groups and with different genders and durations of fever, and to provide references for clinical diagnosis and treatment. Methods　The clinical data of 183 inpatients with FUO admitted to the departments of infectious diseases in Zhengzhou Sixth People's Hospital and First Hospital, Peking University from August 2022 to October 2023 were retrospectively analyzed. Based on the etiology, the patients were classified into infectious diseases (93 cases), non-infectious inflammatory diseases (NIID, 42 cases), neoplastic diseases (14 cases), other diseases (21 cases), and undiagnosed cases (13 cases). The differences in etiological distribution were compared between the patients from different hospitals and age groups and with different genders and durations of fever. χ² test was applied. Results　Among the patients, 61.20% (112/183) were male. They were (49.70±19.09) years old. The common confirmed causes in each group were bacterial infections, adult Still's disease, lymphoma, and necrotizing lymphadenitis. The proportions of infectious diseases in the patients in the two hospitals were 64.29% (27/42) and 46.81% (66/141), respectively, with a statistical difference (χ²=3.96; P<0.05). The proportion of infectious diseases in the patients who were 31-45 years old was higher than in that the patients who were 15-30 years old [63.89% (23/36) vs. 34.15% (14/41); χ²=6.79; P<0.05]. The proportion of other diseases in the patients who were 15-30 years old [29.27% (12/41)] was higher than those in the other groups (χ²=4.10, 6.35, and 9.51; all P<0.05). The proportion of NIID in the females was higher than that in the males [33.80% (24/71) vs. 16.07% (18/112); χ²=7.73; P<0.05]. The proportion of the infectious disease cases with a fever duration >3 months [12.50% (3/24)] was lower than those in the patients with fever durations <1 month and 1-3 months [61.33% (46/75) and 52.38% (44/84)] (χ²=15.45 and 10.51; both P<0.05). The proportion of the neoplastic diseases cases with a fever duration >3 months was higher than that in the patients with a fever duration <1 month [20.83% (5/24) vs. 4.00% (3/75); χ²=4.86; P<0.05]. The proportion of the undiagnosed cases with a fever duration >3 months was higher than that in the patients with a fever duration <1 month [16.67% (4/24) vs. 2.67% (2/75); χ²=4.04; P<0.05]. Conclusions　Clinicians should first consider infectious diseases when facing patients with FUO. The etiological composition of FUO may vary in different hospitals, age groups, and patients with different genders and fever durations. Therefore, precise and rapid relevant tests and examinations should be conducted based on the patients' clinical characteristics to clarify the causes as soon as possible.

Key words:

Fever of unknown origin, Causes, Infection

摘要：

目的　了解183例发热待查（fever of unknown origin，FUO）患者的病因分布特点，比较其在不同医院、年龄段、性别、热程的病因构成，为临床诊治提供参考。方法　回顾性分析郑州市第六人民医院及北京大学第一医院感染疾病科2022年8月至2023年10月收治的183例FUO住院患者的临床资料，按病因分为感染性疾病93例、非感染性炎症性疾病（non-infectious inflammatory diseases，NIID）42例、肿瘤性疾病14例、其他疾病21例、诊断不明13例，比较在不同医院、不同年龄段、不同性别、不同热程的病因分布差异。采用χ²检验进行比较。结果　纳入FUO患者中男性占61.20%（112/183），年龄（49.70±19.09）岁，细菌感染、成人Still病、淋巴瘤、坏死性淋巴结炎分别为各组确诊患者中常见病因。两家医院FUO患者中感染性疾病例数占比分别为64.29%（27/42）、46.81%（66/141），差异有统计学意义（χ²=3.96，P<0.05）；31～45岁患者感染性疾病数占比高于15～30岁患者［63.89%（23/36）比34.15%（14/41），χ²=6.79，P<0.05］；15～30岁患者其他疾病占比［29.27%（12/41）］高于其他各组患者（χ²=4.10、6.35、9.51，均P<0.05）；女性NIID占比高于男性［33.80%（24/71）比16.07%（18/112），χ²=7.73，P<0.05］；热程>3个月的感染性疾病患者占比［12.50%（3/24）］低于热程<1个月与热程1～3个月患者［61.33%（46/75）、52.38%（44/84）］（χ²=15.45、10.51，均P<0.05）；热程>3个月的肿瘤性疾病患者占比高于热程<1个月的患者［20.83%（5/24）比4.00%（3/75）；χ²=4.86，P<0.05］；热程>3个月的诊断不明病例数占比高于热程<1个月的患者［16.67%（4/24）比2.67%（2/75），χ²=4.04，P<0.05］。结论　对于FUO患者，应首先考虑感染性疾病。不同医院、年龄、性别、热程的FUO患者病因构成可能有所不同，应结合患者临床特点进行精确、快速的相关检验及检查以尽快明确病因。

关键词:

发热待查, 病因, 感染