School of Basic Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2022 Jun 30;37(2):134-141. doi: 10.24920/003975.
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 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 regression analysis of factors with a -value < 0.05 in univariate analysis shown that white blood cell count (: 0.545, 95%: 0.306-0.971, = 0.039), neutrophil count (: 2.074, 95%: 1.004-4.284, = 0.049), and proportion of neutrophils (: 0.928, 95%: 0.871-0.990, = 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.
目的 总结经典发热待查（FUO）自发缓解的临床特征。方法 回顾性分析 2018 年 1 月至 6 月北京协和医院住院诊断为 FUO 的 121 例患者的病历资料，出院时未明确病因的患者进行 2 年随访，总结此类患者的临床特征和结局。采用多因素回归分析 FUO 自发缓解的相关因素。结果 剔除失访的 2 例患者后，119 例 FUO 患者的病因如下：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%），不明原因 47 例（39.5%）。共 41 例患者发热自发缓解（从发病到缓解的中位时间为 9 周，范围 439 周）。FUO 自发缓解患者中，淋巴结肿大的临床表现较少见，白细胞计数、中性粒细胞计数、中性粒细胞比例、C 反应蛋白、铁蛋白等炎症标志物水平较低，CD8 阳性 T 淋巴细胞表达 CD38 的比例较低。单因素分析中 值<0.05 的因素进行多因素回归分析显示，白细胞计数（ : 0.545，95%：0.3060.971， = 0.039）、中性粒细胞计数（ : 2.074，95%：1.0044.284， = 0.049）和中性粒细胞比例（ : 0.928，95%：0.8710.990， = 0.022）是 FUO 自发缓解的独立显著相关因素。结论 本研究提示，大多数以不明原因经典 FUO 出院的患者会自发缓解，对于临床情况稳定的患者，随访和观察可能是最佳选择。炎症因子水平较低的患者，经典 FUO 自发缓解的可能性较高。
