21世紀における原因不明の発熱と炎症
Christina Antoniadou1, Efstratios Gavriilidis1, Petros Chatzopoulos1
1First Department of Internal Medicine and Laboratory of Molecular Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
European journal of internal medicine
|August 21, 2025
まとめ
原因不明の発熱 (FUO) と原因不明の炎症 (IUO) の診断は複雑である. 最近の傾向は,特に高所得地域では,未診断疾患 (UI) と非感染性炎症疾患 (NIID) の増加を示しています.
科学分野:
- 内科 医学
- 診断 の 難題
- クリニカルシンドローム
背景:
- 原因不明の熱 (FUO) と原因不明の炎症 (IUO) は,内科医にとって診断上の課題です.
- 確立された分類には,感染症 (INF),非感染症性炎症疾患 (NIID),悪性腫瘍 (MAL),様々な疾患 (MISC),未診断疾患 (UI) が含まれる.
- 歴史的に見て,感染症はFUOの主な原因でしたが,最近の傾向は,特に高所得環境では,UIとNIIDへの移行を示しています.
研究 の 目的:
- FUOとIUOの診断方法と進化する病因をレビューする.
- 潜在的診断ヒント (PDC) の特定における臨床史と検査の重要性を強調する.
- PET/CTや次世代シーケンシング (NGS) のような先進的な診断技術の役割と限界について議論する.
主な方法:
- FUO/IUOの診断分類と病因学的分布の見直し
- 病歴と身体検査の役割を強調する
- 近代技術 (PET/CT,NGS) と新興技術 (メタゲノミクスNGS,サイトカイン測定) の評価
主要な成果:
- 特に高所得国において,FUOの病因がUIとNIIDに 移行している.
- IUOは感染と関連付けられることが少なく,NIIDは最も一般的な原因です.
- NGSやサイトカインアッセイのような高度な技術は有望ですが,選択的,PDC主導の適用が必要です.
結論:
- FUO/IUOの診断には 細心の臨床評価が不可欠です
- 先進的な技術は診断を助けますが, PDCによって導かれる費用対効果と選択的な使用は不可欠です.
- FUOの主要な原因はUIであるため,根本的なメカニズムと病理生理学に基づく診断ツールに関するさらなる研究が必要である.
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