晚发成人斯蒂尔病的临床特点分析

Clinical Features of Late-onset AOSD

目的研究并分析晚发成人斯蒂尔病(adult onset Still’s disease, AOSD)患者的临床特点、治疗、预后及病程情况,探讨晚发AOSD的疾病特点。方法收集2004年1月—2013年12月住院治疗的328例AOSD患者临床资料,成功随访100例患者,发病年龄≥50岁为晚发组(late onset AOSD, LOAOSD)、<50岁为早发组(young onset AOSD, YOAOSD),比较2组间的临床表现、实验室指标、治疗、预后及病程情况。结果 LOAOSD患者较YOAOSD较少出现关节痛/炎、肝肿大及脾肿大(P<0.05),而常出现肺部受累表现(P<0.05)。作为改善风湿病情(disease-modifying anti-rheumatic drugs,DMARDs)的首选药物,甲氨蝶呤较少联合应用于LOAOSD控制病情,出院时LOAOSD患者一般单用激素或仅激素联合DMARDs即可控制病情。在发病初始有效控制病情后,2组患者的预后及病程无明显差异。结论尽管LOAOSD较YOAOSD患者呈现出不同的特点,然而发病年龄并不是AOSD患者预后及病程的影响因素。

Objective To explore the clinical features,treatment,prognosis and the course of late-onset Adult Onset Still’s Disease(LOAOSD).Methods The clinical data of 328 cases with AOSD hospitalized during the period from Jan.,2004 to Dec.,2013 were collected;100 cases were successfully followed up;cases with onset age≥50 were enrolled in LOAOSD group while cases with onset age<50 were enrolled in young onset AOSD(YOAOSD)group;a comparative study was made to clinical manifestations,lab index,treatment,prognosis and courses between the 2 groups.Results Arthritis/arthralgia,hepatomegaly and splenomegaly were less frequently found but lung involvement more frequently found in cases in LOAOSD group than in YOAOSD group(P<0.05);methotrexate,as the first choice of disease-modifying anti-rheumatic drugs(DMARDs),was seldom applied in combined treatment of LOAOSD;single application of glucocorticoid or DMARDs combined with glucocorticoid only could usually control the disease progress in cases with LOAOSD at discharge;there existed no statistical differences in prognosis and course between the 2 groups with an effective control at the early stage of onset.Conclusions Cases with LOAOSD or with YOAOSD show out different manifestations;the onset age is not the factor impacting the prognosis and courses of the cases with AOSD.