CAJ | 학술논문

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反应蛋门(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≥182.5 mg/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≥182.5 mg/L的AOSD患者可能是难治性AOSD.
목적 탐토난치성성인사체이병(AOSD)적림상특점급상관인소,위기진단화치료제공림상경험.방법 대15례난치성AOSD화60례경증AOSD진행회고성분석.선장연구변량주단인소분석,재장유의의적계수자료형변량진행다인소비조건Logistic회귀분석,대유의의적계량자료형변량회제수시자공작특정곡선(ROC).결과 림상증상중,난치성AOSD조장막염화심폐수루발생빈솔화외주혈백세포계수화C반응단문(CRP)치현저고우경증AOSD조.Logistic회귀분석제시,심폐수루적환자경경향우난치성AOSD.근거ROC곡선분석득출:CRP≥182.5 mg/L(특이성98.3%,민감성86.7%)혹백세포계수＞23.4×10~9/L(특이성93.3%,민감성80.0%)시,난치성AOSD적가능성교대.결론 반유심폐수루,백세포≥23.4×10~9/L혹CRP≥182.5 mg/L적AOSD환자가능시난치성AOSD.
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.