Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (2): 134-141.doi: 10.24920/003975

• 论著 • 上一篇    下一篇

自发缓解的经典型不明原因发热的临床特征

刘长宜1,刘晓清2,3,4,侍效春2,3,*()   

  1. 1中国医学科学院北京协和医学院基础学院,北京 100730
    2中国医学科学院北京协和医院感染科,北京 100730
    3中国医学科学院北京协和医学院结核病研究中心,北京 100730
    4中国医学科学院北京协和医学院国际临床流行病学网临床流行病学单位,北京 100730
  • 收稿日期:2021-07-29 接受日期:2022-01-11 出版日期:2022-06-30 发布日期:2022-07-07
  • 通讯作者: 侍效春 E-mail:shixch7722@163.com

Clinical Features of Spontaneous Remission in the Classic Fever of Unknown Origin: A Retrospective Study

Changyi Liu1,Xiaoqing Liu2,3,4,Xiaochun Shi2,3,*()   

  1. 1School of Basic Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    3Centre for Tuberculosis Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    4Clinical Epidemiology Unit, International Epidemiology Network, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2021-07-29 Accepted:2022-01-11 Published:2022-06-30 Online:2022-07-07
  • Contact: Xiaochun Shi E-mail:shixch7722@163.com

摘要:

目的 总结自发缓解的经典型不明原因发热(FUO)的临床特征。
方法 回顾性分析2018年1月~2018年6月北京协和医院住院诊治的符合经典型FUO诊断标准的121例患者的临床资料,对出院时诊断未明的患者进行为期2年的随访。总结这些患者的临床特征和结果,并采用多因素logistic回归分析FUO自发缓解的相关因素。
结果 除外失访的2例患者,最终119例FUO患者的病因构成为:感染性疾病30例(25.2%)、结缔组织病28例(23.5%)、肿瘤性疾病8例(6.7%)、其他疾病6例(5.0%)、诊断未明的47例(39.5%)。出院时仍诊断未明的51例患者中,41例患者的发热自发缓解(起病至缓解的时间为4~39周,中位时间为9周)。单因素分析显示皮疹和淋巴结肿大在非自发缓解FUO患者组比自发缓解FUO组更为常见;炎症指标中白细胞计数、中性粒细胞计数、中性粒细胞比例、C反应蛋白、IL-8和铁蛋白水平在非自发缓解FUO组比自发缓解FUO组更高;淋巴细胞亚群分析显示自发缓解组FUO患者外周血淋巴细胞比例比非自发缓解组FUO患者更高,而非自发缓解组FUO患者CD8阳性T淋巴细胞表达CD38的比例高于自发缓解FUO组。多因素logistic回归分析结果显示白细胞计数(OR:0.545,95%CI:0.306~0.971,P = 0.039)、中性粒细胞计数(OR:2.074,95%CI:1.004~4.284,P = 0.049)和中性粒细胞比例(OR:0.928,95%CI:0.871~0.990,P = 0.022)为FUO能否自发缓解的独立预测因素。
结论 有限的数据表明:出院时仍诊断未明的经典型FUO患者大多数会自发缓解,因此,对临床情况稳定的患者随访观察是最佳处理策略。部分炎症相关指标有可能成为FUO自发缓解预测因子。

关键词: 不明原因发热, 随访, 自发缓解, 诊断

Abstract:

Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin (FUO).
Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively. Patients who were discharged without etiological diagnoses were followed for 2 years. The clinical features and outcomes of these patients were summarized. Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.
Results After excluding 2 patients who lost to follow-up, the etiology of 119 FUO patients were as follows: infectious diseases in 30 (25.2%) cases, connective tissue diseases in 28 (23.5%) cases, tumor diseases in 8 (6.7%) cases, other diseases in 6 (5.0%) cases, and unknown diagnoses in 47 (39.5%) cases. Totally, 41 patients experienced spontaneous remission of fever (the median time from onset to remission was 9 weeks, ranging from 4 to 39 weeks). In patients with spontaneous remission in FUO, lymphadenopathy was less common clinical manifestation, the levels of inflammatory markers including leukocyte count, neutrophil count, neutrophil ratio, C-reactive protein, and ferritin were lower, and the proportion of CD8 positive T lymphocytes expressing CD38 was lower. Multivariate logistic regression analysis of factors with a P-value < 0.05 in univariate analysis shown that white blood cell count (OR: 0.545, 95%CI: 0.306-0.971, P = 0.039), neutrophil count (OR: 2.074, 95%CI: 1.004-4.284, P = 0.049), and proportion of neutrophils (OR: 0.928, 95%CI: 0.871-0.990, P = 0.022) were independent significant factors associated with spontaneous remission in FUO.
Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously. Thus, for patients with stable clinical conditions, follow-up and observation could be the best choice. Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.

Key words: fever of unknown origin, follow-up, spontaneous remission, diagnosis

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