189例儿童不明原因发热临床特征回顾性分析_邵彩林.pdf

中国病案2023 年第 24 卷第 4 期 1025 Wenjuan Zhang,Zhaohui Zheng,et al.Evaluation of 12 different assays for detecting ANCA in Chinese patients with GPA and MPA:a multicenter study in ChinaJ.Clin Rheumatol,2019,38(12):3477-3483.6 Xiuzhu Hou,Jing Liu,Tiancheng Wang,et al.The performance of the chemiluminescent immunoassay for measuring serum myeloperoxidase and proteinase 3 antibodiesJ.Journal of clinical laboratory analysis,2021,35(2):e23615.7 McAdoo SP,Hall A,Levy J,Salama AD,et al.Proteinase-3 antineutrophil cytoplasm antibody positivity in patients without primary systemic vasculitisJ.J Clin Rheumatol,2012,18(7):336-340.8 唐星磊,张文娟,王卫涛,等.临床患者血清抗中性粒细胞胞质抗体检测与疾病分布及相关性研究J.风湿病与关节炎,2021,10(9):32-35.9 郭荣荣,余晓洋,张文静,等.抗中性粒细胞胞浆抗体检测结果分析J.世界最新医学信息文摘(连续型电子期刊),2020,20(89):228-229.10 Fain O,Hamidou M,Cacoub P,et al.Vasculitides associated with malignancies:analysis of sixty patientsJ.Arthritis Rheum,2007,57(8):1473-1480.11 Mahr A,Batteux F,Tubiana S,et al.Brief report:prevalence of antineutrophil cytoplasmic antibodies in infective endocarditisJ.Arthritis Rheumatol,2014,66(6):1672-1677.12 Michael PH,Anna MP,Franziska RG,et al.PR3-ANCA and panel diagnostics in pediatric inflammatory bowel disease to distinguish ulcerative colitis from Crohns diseaseJ.PloS one,2018,13(12):e0208974.13 Yan Xu,Fei Xu,Wenjie Li,Mengting Li,et al.The diagnostic role and clinical association of serum proteinase 3 anti-neutrophil cytoplasmic antibodies in Chinese patients with inflammatory bowel diseaseJ.Scandinavian journal of gastroenterology,2020,55(7):806-813.14 Yuki A,Tomoki I,Sakuma T,et al.Anti-proteinase 3 antineutrophil cytoplasmic antibody reflects disease activity and predicts the response to steroid therapy in ulcerative colitisJ.BMC gastroenterology,2021,21(1):325-337.15 So I,Hidetoshi T,Keiichi M,et al.Role of Serum Proteinase 3 Antineutrophil Cytoplasmic Antibodies in the Diagnosis,Evaluation of Disease Severity,and Clinical Course of Ulcerative ColitisJ.Gut and liver,2022,16(1):92-100.(2022-05-05 收稿)189 例儿童不明原因发热临床特征回顾性分析 邵彩林 于 竟 吉训超*摘要 目的 总结和分析儿童不明原因发热(FUO)的临床特点，为 FUO 早期诊断提供一定线索和临床经验。方法 回顾性分析 2016 年 9 月 1 日至 2021 年 9 月 1 日在某院住院儿童 FUO 临床资料，分析并总结不同病因组年龄分布、发热持续时间、基础实验室检查结果分析及相关症状和体征的临床意义。结果 最终共纳入 189 例患儿，其中以男性患儿为主，占比为 65.6%，平均发病年龄为 4.54 岁，平均发热天数为25.1 天；感染性疾病占比为 70.9%，其中学龄前及婴幼儿患感染疾病占 73.9%。不明原因组皮疹发生率均小于感染组及及免疫组(U=1076、148，P值均0.01)，不明原因组淋巴结肿大发生率小于免疫组(U=212，P=0.008)，感染组淋巴结肿大发生率均小于免疫组及血液组(U=1237、106，P值均0.05)，感染组关节肿痛发生率均小于免疫组及肿瘤组(U=1229、69，P值均0.01)。感染组及免疫组 WBC 数值均高于血液组及不明原因组(U=44.5、1161，10、209.5，P值均0.05)，免疫组 CRP 数值均高于感染组、血液组、不明原因组(U=847、5、82，P值均0.05)，免疫组 PCT 数值均高于感染组及不明原因组(U=1064.5、129.5，P值均0.05)，免疫组 ESR 数值高于感染组、血液组、不明原因组(U=513.5、9、69，P值均0.05)。结论 不同年龄段患儿 FUO 均以感染性病因为主，其中以婴幼儿及学龄前更为明显，随诊年龄增长，学龄期及青春期 FUO 患儿非感染性疾病占比明显上升。WBC、CRP、PCT、ESR、LDH 等基础实验室检查指标在协助诊断儿童 FUO 中有一定指导意义，但对于鉴别感染性疾病和免疫性疾病，临床意义不大。关键词 不明原因发热；儿童；回顾性分析1 Retrospective Analysis of Clinical Characteristics of 189 Children with Fever of Unknown OriginRetrospective Analysis of Clinical Characteristics of 189 Children with Fever of Unknown Origin Shao Cailin,Yu Jing,Ji Xunchao AbstractAbstract Objectives Objectives To summarize and analyze the clinical characteristics of children with fever of unknown origin(FUO),and provide some clues and clinical experience for the early diagnosis of FUO.MethodsMethods The clinical data of FUO in children hospitalized from September 1st,2016 to September 1st,2021 were retrospectively analyzed,and the age distribution,fever duration,analysis of basic laboratory examination results and clinical significance of related symptoms and signs in different etiological groups were analyzed and summarized.ResultsResults A total of 189 children were included,mainly male,accounting for 65.6%,with an average onset age of 4.54 years and average fever days of 25.1 days.Infectious diseases accounted for 70.9%,among which preschool and infants accounted for 73.9%.The incidence of rash in the unknown cause group was lower than that in the infection group and the immune group(U=1076,148,P0.01),the incidence of lymphadenopathy in the unknown cause group was lower than that in 佛山市妇幼保健院，广东省，佛山市，528000 哈尔滨医科大学附属第二医院，黑龙江省，哈尔滨市，150086 广州中医药大学第一附属医院，广东省，广州市，510000*通信作者 中国病案2023 年第 24 卷第 4 期 103the immune group(U=212,P=0.008),and the incidence of lymphadenopathy in the infection group was lower than that in the immune group and the blood group(U=1237,106,P 0.05).The incidence of joint swelling and pain in infection group was lower than that in immune group and tumor group(U=1229,69,P0.01).WBC value in infection group and immune group was higher than that in blood group and unknown cause group(U=44.5,1161,10,209.5,all P0.05),CRP value in immune group was higher than that in infection group,blood group and unknown cause group(U=847,5,82,all P0.05).The PCT value of the immune group was higher than that of the infection group and the unknown cause group(U=1064.5,129.5,P 0.05),and the ESR value of the immune group was higher than that of the infection group,the blood group and the unknown cause