原因不明の古典的発熱1,641例を対象としたレトロスペクティブ解析

Retrospective analysis of 1,641 cases of classic fever of unknown origin.

• Guanyu Zhou
• Ying Zhou
• Cejun Zhong
• Hui Ye
• Zhenzhen Liu
• Yanbin Liu
• Guangmin Tang
• Junyan Qu
• Xiaoju Lv

抄録

背景:

原因不明熱（FU）とは、一般的に、38.3℃以上の高熱が少なくとも3週間に何度か発生し、多くの義務的な検査を行っても診断がつかないものと定義されている。これは特殊なタイプの発熱であり、内科では一般的な疾患である。しかし，その病因が複雑であること，特徴的な臨床症状がないこと，検査指標が不十分であることから，診断に困惑することが多い．本研究では，原因不明の古典的発熱の病因と臨床的特徴を明らかにし，関連する臨床診断・治療の参考とすることを目的とした．

Background: Fever of unknown origin (FUO) is commonly defined as fever higher than 38.3 °C on several occasions during at least 3 weeks with uncertain diagnosis after a number of obligatory investigations. It is a special type of fever and a common disease in internal medicine. However, due to its complex etiology, lack of characteristic clinical manifestations, and insufficient laboratory examination indicators, it often baffles clinicians in diagnosis. We herein present a study of the etiological factors and clinical features of classic fever of unknown origin (FUO) to provide help for related clinical diagnosis and treatment.

方法:

2011年1月1日から2017年12月31日までの間に四川大学西中国病院に入院した古典的UO患者1,641例を収集し、古典的UOの病因因子を分析した。感染症に関連する検査指標の探索とスクリーニングに特別な努力を払い、上記のデータを診断が困難な結核とリンパ腫の臨床的特徴と比較した。

Methods: A total of 1,641 cases of patients with classic FUO hospitalized in West China Hospital of Sichuan University between January 1, 2011 and December 31, 2017, were collected, and the etiological factors of classic FUO were analyzed. A special effort was made to explore and screen the laboratory indicators related to infectious diseases, and the above data were compared with the clinical features of tuberculosis and lymphoma, which are difficult to diagnose.

結果:

1,641人の患者のうち、1,504人が各種検査や診断方法で最終的に診断され、診断率は91.65%であった。1,641例のFUの原因のうち、48.69% [799]が感染症であり、その中で結核が最も多く19.50% [320]を占めていた。結合組織疾患は19.26％[316]であり、そのうち成人型スティル病（AOSD）が最も多く89例（5.42％）、悪性腫瘍は腫瘍性疾患が16.94％[278]、リンパ腫（143例、8.71％）が最も多く、その他の疾患が6.76％[111]、原因不明が8.35％[137]となっていた。結核とリンパ腫を比較分析したところ、両疾患の症状、徴候、非特異的日常検査の結果に有意な差は認められなかった。これらの疾患の診断は、結核に関連した検査や病理検査への依存度が高かった。

Results: Among the 1,641 patients, 1,504 were finally diagnosed through various types of examination or diagnostic methods, and the diagnosis rate was 91.65%. Among all the causes of the 1,641 cases of FUO, 48.69% [799] were infectious diseases, of which tuberculosis was the most common, accounting for 19.50% [320]. Connective tissue diseases were responsible for 19.26% [316] of cases, of which adult-onset Still's disease (AOSD) was the most common, comprising 89 (5.42%) of the cases; 16.94% [278] were neoplastic diseases, and lymphoma (143, 8.71%) cases, was the most common malignant tumor; 6.76% [111] were other diseases; and in 8.35% [137] of cases, the cause was unclear. Through comparative analysis of tuberculosis and lymphoma, no significant differences were found between the symptoms, signs, and non-specific routine examination results of the two diseases. The diagnosis of these diseases was more dependent on tuberculosis-related examinations and pathological examinations.

結論:

古典的なＦＵＯの主な原因は感染症であり、その中でも結核が大きな割合を占めている。FUOの原因となる非感染性疾患は、主に結合組織疾患と悪性腫瘍である。古典的ＦＵＯの様々な原因のうち、結核とリンパ腫は比較的診断が難しい。ほとんどの場合、古典的なUOの原因を特定することができます。

Conclusions: Infectious diseases are the principal cause of classic FUO, in which tuberculosis accounts for a large proportion. Non-infectious diseases that cause FUO are mainly connective tissue diseases and malignant tumors. Of the various causes of classic FUO, tuberculosis and lymphoma are relatively difficult to diagnose. In most cases, the causes of classic FUO can be ascertained.

2020 Annals of Translational Medicine. All rights reserved.