成人Still病的早期诊断及临床特征

Clinical probe of early stage diagnosis of adult Still disease

目的 :探讨成人Still病的早期临床特点和实验室检查指标 ,以提高早期诊断率 ,减少误诊误治率。方法 :对 2 2例Still病人进行各种实验室检查 ,先根据病情给予 7～ 10d一般治疗 ,确诊后即给予 3～ 6个月激素治疗。 结果 :早期临床表现 :发热 2 2例 (10 0 % ) ,一过性多形性皮疹 2 1例 (95 .4 5 % ) ,关节痛和 /或肌肉痛者 2 0例(90 .90 % ) ,浅表淋巴结肿大 2 2例 (10 0 % )。实验室检查 :白细胞明显增高 2 2例 (10 0 % ) ,血沉增快 2 2例 (10 0 % ) ,轻度贫血 9例 (40 .90 % )。骨髓检查 :2 2例均为核左移 ,血培养及骨髓培养均为阴性。血清学检查 :2 2例免疫球蛋白G(IgG)增高 (10 0 % ) ,蛋白电泳 :2 1例γ球蛋白增高 (95 .4 5 % ) ,血清铁蛋白 (SF)测定 :16例增高 (72 .72 % )。病理检查 :浅表淋巴结活检均为非特异性炎症改变。结论 :血清铁蛋白水平显著增高对于成人Still病早期诊断有意义 ,铁蛋白水平动态变化对于本病活动和治疗好转有参考意义。

Objective: Early clinical characteristic and laboratory tests of adult still disease were probed for improving rate of early stage diagnosis. Methods: 22 cases of adult still patients were in hospital and many tests (blood examined, culture of blood bacteria, culture of marrow, serologic examination, serum ferritin examined, pathologic examination of lymph node) were engaged. General treatment and special treatment was gaven. Results: Clinical symptom and sign of early stage had fever (22 cases, 100%), rash of a period of time (21 cases, 95.45%), pain of joint and/or muscle (20 cases, 90.90%), swelling of shallow lymph nodes (22 cases, 100%). Results of laboratory tests had obvious increasing of WBC (22 cases, 100%), quicken of ESR (22 cases, 100%), light anemia (9 cases, 40.90%), left-moved of nuclei of marrow cells (22 cases, 100%), IgG increasing (22 cases, 100%), γ-globulin increasing (21 cases, 95.4%), SF increasing (16 cases, 72.72%). Pathologic examination of lymph nodes were a non-special inflammatory. Conclusion: These results indicated that increasing level of SF was important for early diagnosis of adult still disease. Its dynamic change was consulted for making progress and getting better of the patients.