不同指标在成人斯蒂尔病中诊断结果分析

目的 评价临床资料和现行诊断标准在成人斯蒂尔病(AOSD)中的诊断价值.方法 研究对象为2003年1月至2009年6月复旦大学附属中山医院诊断的AOSD患者,同期发热患者为对照.收集临床资料,分析诊断价值.采用美国风湿病学会(ARA)、Yamaguehi、Cush和Calabm标准诊断入选者,确定诊断效率.采用两样本均数的t检验,wricoxon秩和检验进行统计学处理.结果 皮疹、关节疼痛或肿胀、咽痛、肌肉疼痛、淋巴结或肝脾肿大、白细胞升高、中性粒细胞≥80%、铁蛋白≥2000 ng/ml特异度较高(65.87%～98.41%),阳性似然比2.00～5.00.高热(≥39.0℃)、抗核抗体(ANA)和类风湿因子(RF)阴性的敏感度较高(85.25%～93.65%).高热、皮疹、咽痛、白细胞升高、关节痛等指标任意3项组合,阳性似然比>10.00.ARA标准的特异度最高,Yamaguchi标准的敏感度和准确率最高.结论 单一表现诊断AOSD把握度小,不同项目联合可提高诊断效率.目前国际上通用的诊断标准具有较高特异度.

Diagnostic analysis of different index in adult onset Still's disease

Objective To evaluate the value of clinical findings and different diagnostic criteria for the diagnosis of adult onset Still's disease (AOSD). Methods The AOSD patients admitted to Zhongshan Hospital affiliated to Fudan University from 2003 to 2009 were enrolled. Non-AOSD patients with fever were selected. Different diagnostic criteria of AOSD were applied to all patients. Two indenpendent samples t test and wilco-xon test were used for statistical analysis. Results The clinical features such as rash, arthralgia, arthroncus, sore throat, myalgia, lymph node enlargement, hepatomegaly, splenomegaly, leuko-cytosis, neutrophil ≥80% and serum level of ferrin≥ 2000 ng/ml hadhigher specificity (65.87%~98.41%) with 2.00～5.00 of the positive likelihood ratio.High fever ( ≥39.0℃), negative of ANA and RF had higher sensi-tivity (85.25%~93.65%). Combinations of three parameters such as high fever, rash, sore throat, leukocy-tosis, arthralgia had higher positive likelihood ratio. The specificity of ARA criteria was the highest. The sensitivity and accuracy of Yamaguchi criteria were the highest. Conclusion There is no single parameter that could be specific to the identification of AOSD. Combing with several parameters can improve the diagnostic efficiency. The results of this study have shown that the commonly used diagnostic criteria has high specificity.