摘要
目的探讨血清铁蛋白在成人斯蒂尔(Still)病诊断中的意义.方法采用诊断试验的研究方法.研究样本为'不明原因发热'患者,即发热3周以上,住院1周以上未能明确诊断者.根据日本成人Still病的Yamaguchi标准和随访的结果,将患者分为成人Still病组和非成人Still病组.分析血清铁蛋白对成人Still病诊断的临床价值.结果横断面研究资料124例中,38例为成人Still病.在成人Still病中,男女间血清铁蛋白水平差异无统计学意义(P=0.7798,功效=0.80).成人Still病组血清铁蛋白水平显著高于非成人Still病组(P＜0.01).受试者运算特征(ROC)曲线下方的面积为86.8%(95%可信区间为79.5%～94.2%)提示,血清铁蛋白对成人Still病诊断具有重要意义.根据临床实用意义和ROC曲线,选取血清铁蛋白的3个截断点:750μg/L,1250μg几,2500μg/L,它们的敏感性分别为81.58%,68.42%和39.47%;特异性分别为82.56%,89.53%和96.51%.血清铁蛋白=1250 μg/L能最大程度兼顾敏感性和特异性.如果以Yamaguchi标准为基础,加上血清铁蛋白＞1250μg/L结合作为诊断成人Still病的条件,其特异性则由92.1%上升至99.2%.结论对'不明原因发热'的病人,检测血清铁蛋白,对诊断成人Still病有重要的临床意义.
Objective To investigate the diagnostic value of serum ferritin in adult onset Still′s disease (AOSD). Methods A diagnostic test was employed in the study. The consecutive in-patients with fever of unknown origin over 3 weeks in the university hospital from 1999 to 2004 were enrolled in the study. The patients were divided into two groups, AOSD and non-AOSD, based on Yamaguchi′s criteria for AOSD and the results of follow up. The serum ferritin was detected in all patients when recruited. SPSS 11.0 and STATA 6.0 were used for statistical analysis. Results One hundred and twenty-four cases were available in the study and 38 patients were AOSD. The serum ferritin was not different between female and male in patients with AOSD, P=0.7798 and power=0.80. The serum ferritin was significantly different between AOSD group and non-AOSD group, Z=-6.526 (P<0.001 by Wilcoxon signed rank test). The area below ROC curve was 0.868 (95%CI 0.795~0.942). Three cut-off points of serum ferritin, 750 ?滋g/L, 1250 ?滋g/L and 2500 ?滋g/L were selected based on clinical practice and ROC curve. When the cut-off points of serum ferritin were 750 ?滋g/L, 1250 ?滋g/L and 2500 ?滋g/L, the sensitivity was 81.58%, 68.42% and 39.47%; the specificity was 82.56%, 89.53% and 96.51%; the positive predictive values was 67.39%, 74.29% and 83.33%; the negative predictive values was 91.03%, 86.52% and 78.30%. Conclusion Serum ferritin is a valuable marker for the diagnosis of AOSD in the patients with fever of unknown origin.
出处
《中华风湿病学杂志》
CAS
CSCD
2005年第6期338-341,共4页
Chinese Journal of Rheumatology
