成人斯蒂尔病的随访与预后研究

A study of prognosis in adult onset Still's disease patients

目的探讨影响成人斯蒂尔病(AOSD)预后的相关因素及与疾病复发的相关因素。方法采用队列研究的策略,研究样本为1996年3月至2004年9月住院的AOSD连续性病例。采用Logistic回归方法,分析影响预后的因素;COX回归方法分析与疾病复发的相关因素。结果本研究入组96例,失访9例。在87例的随访中,11例(12.6%)最终被诊断为其他风湿免疫病(5例)、肿瘤(4例)和感染(2例)。76例AOSD中,3例(3.9%)死亡,33例(43.4%)获得持续缓解1年以上。Logistic回归分析显示,脾脏肿大(OR=3.14,95%CI=1.01～9.74)和甲氨蝶呤治疗(OR=0.22,95%CI=0.07～0.67)与预后相关。COX回归分析显示,与疾病复发相关的因素包括血清铁蛋白(RR=1.05。95%CI=1.01～1.08)和甲氨蝶呤治疗(RR= 0.13,95%CI=0.02～0.76)。结论AOSD的患者中约12.6%的患者在随访中被诊断为另一个疾病:甲氨蝶呤的治疗,不但可以提高疗效,还有利于防止病情的复发。

Objective To investigate the potential clinical factors associated with the prognosis and relapse of adult onset Still＇s disease （AOSD）. Methods The factors possibly influencing the prognosis and relapse of AOSD were analyzed by logistic regression and COX regression in the cohort study. Ninety-six consecutive inpatients of AOSD diagnosed based on Yamaguchi criteria in the hospital from March 1996 to September 2004 were included in the study. Results Nine cases （9.4%） were lost during the follow-up. Eleven patients （12.6%） were diagnosed as other diseases （5 with other rheumatic diseases, 4 with tumor and 2 with infections） in the 87 follow-up cases. In 76 cases, 3 patients （3.9%） died and 33 patients （43.4%） got remission over one year after treatment. Splenomegaly （OR=3.14, 95%CI=1.01 -9.74） and treated with methotrexate （OR=0.22, 95%CI=0.07-0.67） were associated with the prognosis from the logistic regression analysis of the 76 cases. The serum ferritin （RR=1.05, 95%CI=1.01-1.08） and treated with methotrexate （RR=0.13, 95%CI=0.02-0.76） were associated with relapse from the COX regression analysis of the 61 remission cases. Conclusion We need to be very cautious in the follow-up of AOSD patients because some of them may change to other diseases. Methotrexate may be an importent therapy of AOSD not only in improvement the prognosis but also in reduction of relapse.