摘要
【目的】探讨成人still病的临床特征以及诊断标准和治疗。【方法】回顾性分析 4 8例成人still病患者的临床表现和相关检查 ,按照Bruno诊断标准重新进行评价 ,验证其准确性。【结果】骤起骤降的高热 (≥39℃ ) ,关节痛 ,咽痛 ,一过性红斑 ,白细胞计数≥ 10× 10 9/L ,血清铁蛋白升高 ,网状内皮系统增生等是最常见的临床表现 ;非甾类抗炎药加用激素甚至免疫抑制剂是常用的治疗方法。预后相对好 ,急性呼吸窘迫综合征(ARDS)是主要的死亡原因。 4 8例中 4 7例按照Bruno诊断标准在住院后很快即能确诊 ,无需排除诊断 ,提示敏感性高。 6例按传统的排除性诊断为基本成立的患者 ,若按Bruno诊断标准可确诊 ,1例患者按传统的诊断标准诊为成人still病 ,但半年后即诊断为系统性红斑狼疮 (SLE) ,若按照Bruno诊断标准尚不能诊为成人still病。提示其特异性相对高。【结论】Bruno诊断标准的敏感性和特异性相对高 ,值得临床进一步验证。
To investigate the clinical manifestations, diagnostic criteria and treatment of adult-onset still's disease (AOSD).The clinical manifestation and related examination of forty-eight patients with AOSD treated from 1997-2002 were analyzed retrospectively. Bruno's criteria were used for recheck to verify their accuracy.Spiking fever(≥39℃), arthralgia, transient erythema, pharyngitis, hyperplasia of reticulo-endothelial system, elevated leukocyte counts(≥10 000/mm 3) and serum ferritin levels were the most common clinical manifestations. Non-steroid anti-inflammatory drugs plus hormone or even immunosuppressor were common measures of treatment. Their prognosis was considerably good, acute respiratory distress syndrome (ARDS) was the chief cause of death. Forty-seven out of 48 cases could be diagnosed quickly by Bruno's criteria without exclusion after hospitalization; one case that was diagnosed as AOSD by traditional criteria developed systemic lupus erythematosus (SLE) half a year later, suggesting that the specificity of Bruno's criteria was relatively high.[Conclusion]Bruno's criteria possess high sensitivity and specificity, it is worthy to be further verified clinically.
出处
《医学临床研究》
CAS
2004年第2期104-107,共4页
Journal of Clinical Research
