难治性成人斯蒂尔病的临床相关因素分析

The analysis of clinical related factors of refractory adult-onset Still＇s disease

目的探讨难治性成人斯蒂尔病（AOSD）的临床特点及相关因素，为其诊断和治疗提供临床经验。方法对15例难治性AOSD和60例轻症AOSD进行回顾性分析。先将研究变量做单因素分析，再将有意义的计数资料型变量进行多因素非条件Logistic回归分析，对有意义的计量资料型变量绘制受试者工作特征曲线（ROC）。结果临床症状中，难治性AOSD组浆膜炎和心肺受累发生频率和外周血白细胞计数和C反应蛋白（CRP）值显著高于轻症AOSD组。Logistic回归分析提示，心肺受累的患者更倾向于难治性AOSD。根据ROC曲线分析得出：CRP≥182．5mg／L（特异性98．3％，敏感性86．7％）或白细胞计数≥23．4×10^9／L（特异性93．3％，敏感性80．0％）时，难治性AOSD的可能性较大。结论伴有心肺受累，白细胞≥23．4×10^9／L或CRP≥182．5mg／L的AOSD患者可能是难治性AOSD。

Objective To investigate the clinical features and the risk factors for refractory adultonset Still＇s disease （AOSD）. Methods Fifteen patients with refractory AOSD and 60 mild AOSD patients were analyzed .The risk factors for refractory AOSD were analyzed by univariate analysis and then by multivariate Logistic regression and ROC curve. Results Univariate analysis showed that the incidence of hydrohymenitis and pulmonary/cardiac involvement were significantly higher in refractory AOSD patients than in the mild group （P〈0.05）; and white blood cells （WBC） counts and C-reactive protein （CRP） levels of refractory AOSD was significantly higher than mild group. The logistic regression analysis showed that it tended to be refractory when the patients had pulmonary/cardiac involvement. The ROC curve of WBC and CRP showed that patients were more likely to be refractory when CRP levels more than 182.5 mg/L or WBC counts more than 23.4×10^9/L. Conclusion Those AOSD patients who has pulmonary/cardiac involvement and CRP levels more than 182.5 mg/L or WBC counts more than 23.4×10^9/L may become refractory AOSD. High dose glucocorticoid is commonly needed in refractory AOSD.