Gruber P J, Silverman R A, Gottesfeld S, Flaster E
Division of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York.
Ann Emerg Med. 1996 Sep;28(3):273-7. doi: 10.1016/s0196-0644(96)70025-2.
To determine the frequency of fever and leukocytosis in patients presenting to the emergency department with acute cholecystitis (AC).
We carried out a retrospective review of charts from 1990 to 1993 at a university-affiliated hospital. Our subjects were ED patients with hepato-iminodiacetic acid (HIDA) scans interpreted as showing AC and who had undergone cholecystectomy during hospitalization. Final diagnosis was determined on the basis of the pathology report. Fever was defined as an oral temperature of 100 degrees F (37.7 degrees C) or greater or a rectal temperature of 100.4 degrees F (38.0 degrees C) or greater. Leukocytosis was defined as a WBC count of 11,000/mm3 or greater.
Of the 198 cases studied, the pathologic diagnosis of nongangrenous AC was made in 103 (52%), gangrenous AC was diagnosed in 51 (26%), and chronic cholecystitis was diagnosed in 44 (22%). In patients with nongangrenous AC, 71% were afebrile, 32% lacked leukocytosis, and 28% lacked fever and leukocytosis. In patients with gangrenous AC, 59% were afebrile, 27% lacked leukocytosis, and 16% lacked fever and leukocytosis.
We found that patients with AC diagnosed in the ED frequently lacked fever or leukocytosis. The clinician should not rely on the presence of these signs in making the diagnosis of acute cholecystitis.
确定因急性胆囊炎（AC）就诊于急诊科的患者中发热和白细胞增多症的发生率。
我们对一家大学附属医院1990年至1993年的病历进行了回顾性研究。我们的研究对象是急诊患者，其肝亚氨基二乙酸（HIDA）扫描结果显示为AC，且在住院期间接受了胆囊切除术。最终诊断根据病理报告确定。发热定义为口腔温度100华氏度（37.7摄氏度）或更高，或直肠温度100.4华氏度（38.0摄氏度）或更高。白细胞增多症定义为白细胞计数11,000/mm³或更高。
在198例研究病例中，103例（52%）病理诊断为非坏疽性AC，51例（26%）诊断为坏疽性AC，44例（22%）诊断为慢性胆囊炎。在非坏疽性AC患者中，71%无发热，32%无白细胞增多症，28%无发热和白细胞增多症。在坏疽性AC患者中，59%无发热，27%无白细胞增多症，16%无发热和白细胞增多症。
我们发现，在急诊科诊断为AC的患者中，经常没有发热或白细胞增多症。临床医生在诊断急性胆囊炎时不应依赖这些体征的存在。
