成人Still病26例临床分析

目的探讨成人Still病的临床特点和治疗方法，提高对本病的认识。方法回顾研究我院2003年至2006年26例成人Still病的临床表现、实验室检查结果和治疗效果。结果26例病人中发热100％，皮疹88％，关节疼痛92％，咽痛62％，淋巴结肿大54％，脾脏肿大69％。并发心包炎心包填塞1例（4％）。白细胞增高96％，肝功能异常81％，血沉增快100％，C反应蛋白升高92％，血清铁蛋白升高100％，96％的病人类风湿因子和抗核抗体均为阴性。血培养26例均为阴性。骨髓象示造血组织增生活跃，90％呈感染骨髓象。单用糖皮质激素对成人Still病有效率为85％。结论本病临床症状多变，无特异性诊断方法。临床上易造成误诊误治。发热、皮疹、关节痛是成人Still病的主要临床表现，血白细胞升高、血沉增快、类风湿因子和抗核抗体阴性、血培养阴性为主要特征，血清铁蛋白可作为疾病急性期的活动指标。治疗以糖皮质激素为首选，部分病人需同时加用免疫抑制。

Clinical analysis of twenty-six cases with Adult onset still＇s disease

Objective To investigate the clinical characteristic, accompanying symptomas and treatment of Adult onset still＇s disease（AOSD） in order to improve physician level of reorganizations and diagnosis on it. Methods The clinical manifestation, laboratory examinations and curative effect of 26 patients with AOSD in my hospital from 2003~2006 were analyzed and summarized in clinical view of point with reviewing articles. Results There are fever 100%, rash 88%, arthralgia 92%, sore throat 62%, lymphadenopathy 54%, hepatomegaly 69%, 1 case complicated with pericarditis （4%）, leukocytosisl00%, hypohepatia 81%, elevation of erythrocyte sedimentation rates 100%, higher C-reaction protein 92%, serum ferritin creased 100%, negative rheumatoid factor and antinuclear antibodies 96%. 100% of blood culture is negative. Bone marrow biopsy showed infection 90%. The rate of the effective using glucocorticoid is 85%. Conclusions The clinical manifestation is complexity and changefully, without special diagnosis. The main clinical symptomas are fever, rash and arthralgia. Leukocytosis, fasten serum ferritin, negative rheumatoid factor and antinuclear antibodies, negative blood culture are the main characteristics. Serum ferritin can be an index of activity of the disease. The first chosen of the treatment is the glucocorticoid, and some patients should add immunosuppressant.