66例以不明原因发热为表现的淋巴瘤患者的临床特征。
Clinical features of 66 lymphoma patients presenting with a fever of unknown origin.
作者信息
Zhang Jing, Chen Bobin, Xu Xiaoping, Lin Zhiguang, Huang Bo, Song Jing, Lin Guowei
机构信息
Department of Hematology, Huashan Hospital, Shanghai Medical School, Fudan University, China.
出版信息
Intern Med. 2012;51(18):2529-36. doi: 10.2169/internalmedicine.51.7817. Epub 2012 Sep 15.
OBJECTIVE
To investigate the clinical characteristics, diagnostic approaches, short-term efficacy of treatment and prognosis of lymphoma patients presenting with a fever of unknown origin (FUO).
METHODS
We reviewed the records of 132 patients finally diagnosed with lymphoma in Huashan Hospital, half of whom initially presented with a FUO. The other 66 lymphoma patients without a history of FUO were diagnosed within a month when several patients in the FUO group were also diagnosed.
RESULTS
The patients presenting with a FUO were predominantly young men (71.21%, p=0.35) characterized by a temperature ≥ 39°C (55/66, 83.33%). Compared with the non-FUO group, patients in the FUO group more often had pancytopenia and hypohepatia, 61.54% with hypoalbuminemia (p<0.0001), 15.50% with significantly elevated lactate dehydrogenase (LDH) (p<0.0001), 92.45% with elevated serum β(2) microglobulin (p=0.017), 93.48% with elevated urine β(2) microglobulin (p=0.002) and 30.77% with elevated alkaline phosphatase (p=0.001). Ninety-four percent of the FUO patients had aggressive lymphomas (p=0.012), with a poor performance status (96.97%, p=0.003), stage III/IV disease (96.97%, p<0.0001), night sweats (21.21%, p=0.026), unexplained weight loss (46.97%, p=0.002) and more than one extranodal site involved (65.15%, p=0.002). The patients in the FUO group also showed poor prognoses, and most of them were in the high-intermediate or high risk classification of the disease (96.61%, p<0.0001), with a low complete remission (CR) rate (61.11% vs. 93.75%, p=0.043). Twenty-one (15.91%) of all the patients were diagnosed based on the finding of lesion sites by Positron Emission Tomography/Computed Tomography (PET/CT) scanning, which had not been detected by conventional scans.
CONCLUSION
Lymphoma presenting as FUO has a rapid progression and poor prognosis, and is difficult to diagnose. PET/CT scans can provide complementary information for an etiological diagnosis of a FUO and biopsy examinations are significant to establish an early diagnosis for patients presenting with a FUO.
目的
探讨以不明原因发热（FUO）为表现的淋巴瘤患者的临床特征、诊断方法、短期治疗疗效及预后。
方法
我们回顾了在华山医院最终确诊为淋巴瘤的132例患者的病历，其中一半患者最初表现为FUO。另外66例无FUO病史的淋巴瘤患者在1个月内确诊，此时FUO组的部分患者也已确诊。
结果
以FUO为表现的患者以年轻男性为主（71.21%，p = 0.35），特征为体温≥39°C（55/66，83.33%）。与非FUO组相比，FUO组患者全血细胞减少和肝功能减退更为常见，61.54%患者有低白蛋白血症（p<0.0001），15.50%患者乳酸脱氢酶（LDH）显著升高（p<0.0001），92.45%患者血清β2微球蛋白升高（p = 0.017），93.48%患者尿β2微球蛋白升高（p = 0.002），30.77%患者碱性磷酸酶升高（p = 0.001）。94%的FUO患者患有侵袭性淋巴瘤（p = 0.012），体能状态较差（96.97%，p = 0.003），疾病分期为III/IV期（96.97%，p<0.0001），盗汗（21.21%，p = 0.026），不明原因体重减轻（46.97%，p = 0.002），累及一个以上结外部位（65.15%，p = 0.002）。FUO组患者预后也较差，大多数患者处于疾病的高中危或高危分类（96.61%，p<0.0001），完全缓解（CR）率较低（61.11%对93.75%，p = 0.0
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