Barbado Hernández F J, Vázquez Rodríquez J J, Gómez Molero L, Gil Aguado A, Arnalich Fernández F, García Seoane J, Peña Sánchez de Rivera J M, Ortiz Vázquez J
Med Clin (Barc). 1981 Jan 10;76(1):8-13.
This report concerns the analysis of 100 cases of fever of unknown origin, defined according to the criteria of Petersdorf and Beeson. An etiological diagnosis could be reached in 77 cases, distributed as follows: infections, 32 cases; tumors, 14 cases; collagen diseases, 13 cases; various etiologies, 18 cases; and idiopathic, 23 cases of whom 20 had selflimited fever. There were 51 male and 49 female. The incidence of infectious diseases was significantly higher below age 40 when compared with the group of collagen diseases. Recurrent fever was common (43 cases) while continuous fever was unusual (3 cases). Recurrent fever was most frequent in neoplastic diseases, the difference in relation to the other groups being statistically significant (p less than 0.05). Chills, diffuse perspiration and myalgia were more frequent in infectious diseases (p less than 0.01) than in the other groups. Collagen diseases had significantly higher (p less than 0.05) white blood cell counts than neoplastic diseases, while the latter had significantly higher (p less than 0.01) serum lactic-dehydrogenase and alpha 2 globulin levels than infectious and collagen diseases. Hepatosplenomegaly was present more frequently in neoplastic than in infectious diseases. When evaluating diagnostic procedures it was noted that invasive techniques (arteriography, biopsy, laparoscopy, laparotomy) were essential to arrive to the final diagnosis in 47 cases, while noninvasive procedures (serological and immunological tests, bacteriology, conventional radiology, clinical course, and response to therapy) were sufficient in 22 cases. In eight cases the etiology of the fever could only be determined by post-mortem examination.
本报告涉及对100例不明原因发热病例的分析,这些病例是根据彼得斯多夫和比森的标准定义的。77例病例可做出病因诊断,分布如下:感染性疾病32例;肿瘤14例;胶原病13例;多种病因18例;特发性23例,其中20例为自限性发热。男性51例,女性49例。与胶原病组相比,40岁以下感染性疾病的发病率显著更高。弛张热很常见(43例),而稽留热不常见(3例)。弛张热在肿瘤性疾病中最常见,与其他组相比差异有统计学意义(p<0.05)。寒战、全身出汗和肌痛在感染性疾病中比在其他组中更常见(p<0.01)。胶原病的白细胞计数显著高于肿瘤性疾病(p<0.05),而肿瘤性疾病的血清乳酸脱氢酶和α2球蛋白水平显著高于感染性疾病和胶原病(p<0.01)。肿瘤性疾病中肝脾肿大比感染性疾病更常见。在评估诊断方法时发现,侵入性技术(动脉造影、活检、腹腔镜检查、剖腹手术)对47例病例的最终诊断至关重要,而非侵入性方法(血清学和免疫学检查、细菌学、传统放射学、临床病程及对治疗的反应)对22例病例足够。在8例病例中,发热病因只能通过尸检确定。