成人Still病42例临床分析

发布时间：2018-08-24 09:55

【摘要】：目的：研究浙江大学医学院附属邵逸夫医院成人Still病患者的病史资料,包括一般情况、临床表现、实验室检查、治疗及预后等,探讨该病的病因、临床特点,为临床诊断和治疗提供经验,提高诊疗水平,改善预后。方法：对我院2004年1月至2015年1月收治的42例诊断为成人Still病患者的临床资料进行回顾性分析。采用Yamaguchi标准作为疾病诊断标准。统计成人still病患者的发病年龄、临床症状、实验室检查、治疗方法、预后等情况,并对各临床症状、实验室检查结果、激素使用剂量进行相关性分析。同时根据病情缓解情况对患者进行分组,比较组间血清铁蛋白差异。结果： AOSD平均发病年龄41.76+15.69岁,女性多见。临床表现主要为发热(100%)、皮疹(83.3%)、咽痛(78.6%)、关节痛(73.8%)、肌痛(50%)、淋巴结肿大(50%)、脾大(23.8%)。实验室检查表现为白细胞(83.3%)、铁蛋白(88.1%)、ESR (92.9%)、CRP(100%)、GT (49.3%)、LDH (66.7%)、ALP (100%)AST和(或)ALT(64.3%)升高,贫血(45.2%)及白蛋白降低(87.5%)。RF和抗核抗体谱阴性率分别为100%、92.9%。NSAIDS、糖皮质激素和DMARDs治疗有效。多数预后良好,部分表现为慢性关节痛,均为30至50岁女性。白细胞14*10^9/L是疾病复发危险因素(OR=6231,P0.05)。白细胞、中性粒细胞计数、乳酸脱氢酶、浅表淋巴结肿大四项与患者所需最高激素剂量正相关(P0.05)。起病时与部分缓解时铁蛋白无显著差异(P0.05),但起病时与完全缓解时、部分缓解时与完全缓解时铁蛋白均有显著性差异P0.05)。采用多重线性分析,仅中性粒细胞计数被方程接受,中性粒细胞计数高的患者倾向于使用更高剂量的激素。结论： 1) AOSD多见于中年女性。 2)白细胞、中性粒细胞计数、乳酸脱氢酶显著升高或浅表淋巴结有肿大的患者需更高的激素剂量。 3)白细胞增高显著的患者复发几率大。 4)血清铁蛋白作为提示疾病转归的指标有其滞后性。 5)多数患者预后良好,但青中年女性可能出现慢性关节痛。
[Abstract]:Objective: to study the history of adult Still's disease, including general situation, clinical manifestation, laboratory examination, treatment and prognosis, and to explore the etiology and clinical characteristics of the disease. To provide experience for clinical diagnosis and treatment, improve the level of diagnosis and treatment, improve the prognosis. Methods: the clinical data of 42 patients with adult Still's disease from January 2004 to January 2015 were retrospectively analyzed. Yamaguchi criteria were used as diagnostic criteria. The age of onset, clinical symptoms, laboratory examination, treatment methods and prognosis of adult patients with still disease were analyzed. At the same time, the patients were grouped according to the state of remission, and the difference of serum ferritin was compared. Results: the average age of onset of AOSD was 41. 76 15. 69 years old. The clinical manifestations were fever (100%), rash (83.3%), pharyngialgia (78.6%), arthralgia (73.8%), myalgia (50%), lymphadenopathy (50%), splenomegaly (23.8%). Laboratory examination showed that the leucocyte (83.3%), ferritin (88.1%) ESR (92.9%), CRP (100%), LDH (66.7%), ALP (100%) and (or) ALT (64.3%) increased, anemia (45.2%) and albumin decreased (87.5%). The negative rates of RF and anti-nuclear antibody were 1000.92.9. NSAIDS, glucocorticoid and DMARDs were effective. Most of them had good prognosis, some of them were chronic joint pain, which were 30 to 50 years old women. Leukocyte 14% 10 ^ 9 L is a risk factor for disease recurrence (OR=6231,P0.05). WBC, neutrophil count, lactate dehydrogenase and superficial lymphadenopathy were positively correlated with the highest hormone dose (P0.05). There was no significant difference in ferritin between the onset and partial remission (P0.05), but there was significant difference between the onset and complete remission, partial remission and complete remission (P0.05). Using multiple linear analysis, only neutrophil count was accepted by equation. Patients with high neutrophil count tended to use higher doses of hormones. Conclusion: 1) AOSD is more common in middle-aged women. 2) WBC and neutrophil count. Patients with significantly elevated lactate dehydrogenase or superficial lymphadenopathy need a higher dose of hormone. 3) patients with significant leukocytosis have a higher risk of relapse. 4) serum ferritin as an indication of the outcome of the disease Most patients had a good prognosis. But young and middle-aged women may have chronic joint pain.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.2

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