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目的探讨儿童不明原因长期发热(FUO)的病因构成、诊断方法及预后,构建FUO标准化诊断流程。方法收集2005~2011年重庆医科大学附属儿童医院以“发热待查”收入院并符合FUO诊断标准的104例患儿的临床资料,按年龄分为3组:<3岁组(47例),3~7岁组(24例)和>7岁组(33例),进行回顾性分析,并对部分病例进行随访。结果确诊89例,确诊率为85.58%。位于前3位的病因在<3岁组中为:感染性疾病(23例,48.93%),结缔组织疾病(5例,10.64%),肿瘤性疾病(1例,2.13%);3~7岁组中为:感染性疾病(11例,45.83%),恶性肿瘤性疾病(5例,20.83%),结缔组织疾病(4例,16.67%);>7岁为:结缔组织疾病(19例,57.58%),感染性疾病(6例,18.18%),恶性肿瘤性疾病(2例,6.06%)。出院时痊愈24例(23.08%),好转60例(57.69%),未愈13例(12.50%),病情危重放弃治疗7例(6.73%)。随访61例,随访率58.65%,痊愈27例(44.26%),好转26例(42.62%),有严重并发症2例(3.28%),死亡6例(9.84%)。结论感染性疾病是婴幼儿FUO的主要病因,感染性疾病、结缔组织疾病和恶性肿瘤性疾病是学龄前期及学龄期儿童的主要病因。感染性疾病及结缔组织疾病预后较好,恶性肿瘤性疾病则预后差,死亡率高,但若能早期诊断,经规范治疗也可长期存活。
Objective To investigate the etiology, diagnosis and prognosis of children with unexplained chronic fever (FUO) and to establish a standardized diagnostic procedure for FUO. Methods The clinical data of 104 children who were admitted to the Children’s Hospital of Chongqing Medical University from 2005 to 2011 with “fever to be investigated” and met FUO diagnostic criteria were collected and divided into three groups according to their age: <3 years old (47 cases ), 3 to 7 years old group (24 cases) and> 7 years old group (33 cases) were retrospectively analyzed, and some cases were followed up. Results confirmed 89 cases, the diagnosis rate was 85.58%. The cause of the top 3 patients was infectious disease (23 cases, 48.93%), connective tissue disease (5 cases, 10.64%), neoplastic disease (1 case, 2.13%), The age group was as follows: Infectious disease (11 cases, 45.83%), Malignant tumor (5 cases, 20.83%), Connective tissue disease (4 cases, 16.67% , 57.58%), infectious diseases (6 cases, 18.18%) and malignant neoplasms (2 cases, 6.06%). At discharge, 24 cases (23.08%) were cured, 60 cases (57.69%) were improved, 13 (12.50%) were unhealed, and 7 cases (6.73%) were given treatment in critical condition. Follow-up was performed in 61 cases. The follow-up rate was 58.65%, 27 cases were cured (44.26%), 26 cases (42.62%) were improved, 2 cases (3.28%) had serious complications and 6 cases died (9.84%). Conclusion Infectious diseases are the major causes of FUO in infants and young children. Infectious diseases, connective tissue diseases and malignant neoplasms are the main causes of preschool and school-age children. Infectious disease and connective tissue disease prognosis is good, malignant tumor prognosis is poor, high mortality, but if early diagnosis, the standard treatment can also be long-term survival.