【摘要】：目的： 研究浙江大學醫(yī)學院附屬邵逸夫醫(yī)院成人Still病患者的病史資料,包括一般情況、臨床表現(xiàn)、實驗室檢查、治療及預后等,探討該病的病因、臨床特點,為臨床診斷和治療提供經(jīng)驗,提高診療水平,改善預后。 方法： 對我院2004年1月至2015年1月收治的42例診斷為成人Still病患者的臨床資料進行回顧性分析。采用Yamaguchi標準作為疾病診斷標準。統(tǒng)計成人still病患者的發(fā)病年齡、臨床癥狀、實驗室檢查、治療方法、預后等情況,并對各臨床癥狀、實驗室檢查結(jié)果、激素使用劑量進行相關(guān)性分析。同時根據(jù)病情緩解情況對患者進行分組,比較組間血清鐵蛋白差異。 結(jié)果： AOSD平均發(fā)病年齡41.76+15.69歲,女性多見。臨床表現(xiàn)主要為發(fā)熱(100%)、皮疹(83.3%)、咽痛(78.6%)、關(guān)節(jié)痛(73.8%)、肌痛(50%)、淋巴結(jié)腫大(50%)、脾大(23.8%)。實驗室檢查表現(xiàn)為白細胞(83.3%)、鐵蛋白(88.1%)、ESR (92.9%)、CRP(100%)、GT (49.3%)、LDH (66.7%)、ALP (100%)AST和(或)ALT(64.3%)升高,貧血(45.2%)及白蛋白降低(87.5%)。RF和抗核抗體譜陰性率分別為100%、92.9%。NSAIDS、糖皮質(zhì)激素和DMARDs治療有效。多數(shù)預后良好,部分表現(xiàn)為慢性關(guān)節(jié)痛,均為30至50歲女性。白細胞14*10^9/L是疾病復發(fā)危險因素(OR=6231,P0.05)。白細胞、中性粒細胞計數(shù)、乳酸脫氫酶、淺表淋巴結(jié)腫大四項與患者所需最高激素劑量正相關(guān)(P0.05)。起病時與部分緩解時鐵蛋白無顯著差異(P0.05),但起病時與完全緩解時、部分緩解時與完全緩解時鐵蛋白均有顯著性差異P0.05)。采用多重線性分析,僅中性粒細胞計數(shù)被方程接受,中性粒細胞計數(shù)高的患者傾向于使用更高劑量的激素。結(jié)論： 1) AOSD多見于中年女性。 2)白細胞、中性粒細胞計數(shù)、乳酸脫氫酶顯著升高或淺表淋巴結(jié)有腫大的患者需更高的激素劑量。 3)白細胞增高顯著的患者復發(fā)幾率大。 4)血清鐵蛋白作為提示疾病轉(zhuǎn)歸的指標有其滯后性。 5)多數(shù)患者預后良好,但青中年女性可能出現(xiàn)慢性關(guān)節(jié)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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R593.2

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