Zhang Jing, Chen Bobin, Xu Xiaoping, Lin Zhiguang, Huang Bo, Song Jing, Lin Guowei
Department of Hematology, Huashan Hospital, Shanghai Medical School, Fudan University, China.
Intern Med. 2012;51(18):2529-36. doi: 10.2169/internalmedicine.51.7817. Epub 2012 Sep 15.
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).
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.
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.
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.
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。
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。
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
