摘要
目的分析成人Still病(adult onset still's disease,AOSD)的临床特征及误诊原因,以提高确诊率。方法对我院2001年1月—2013年9月收治的46例AOSD中26例误诊病例资料进行回顾性分析。结果本组误诊率56.5%。均有发热表现,22例出现皮疹,19例出现关节痛或关节炎。误诊为脓毒症8例,药疹5例,肺炎、风湿热各3例,伤寒、类风湿性关节炎各2例,恶性淋巴瘤、类白血病反应、肺结核各1例。24例血清铁蛋白增高,16例糖化铁蛋白比例下降(<20%);23例血白细胞增高,11例血小板升高,24例红细胞沉降率增快,18例C反应蛋白升高。本组均符合Yamaguchi的AOSD诊断标准。确诊后根据病情酌情应用非甾体类消炎药,联合糖皮质激素或免疫抑制剂治疗。18例完全缓解,5例1年后复发,3例2年后复发。结论 AOSD临床表现复杂,极易误诊,临床在不明原因发热的鉴别诊断中要考虑AOSD,糖化铁蛋白检测有助于AOSD的鉴别诊断。
Objective To analyze clinical characteristics of adult onset still＇s disease （ AOSD ） and explore misdiag- nosis causes in order to improve the accuracy of diagnosis. Methods We retrospectively analyzed 26 misdiagnosed cases with AOSD, admitted to our hospital during January 2001 and September 2013. Results 26 out of 46 patients were misdiagnosed and the misdiagnosis rate was 56.5%. All the misdiagnosed cases had a fever. Rash appeared in 22 cases and joint pain or arthritis in 19 cases. 8 cases were misdiagnosed as sepsis. 5 cases were misdiagnosed as drug eruption. 3 cases were misdiag- nosed as pneumonia. 3 cases were misdiagnosed as rheumatic fever. 2 were misdiagnosed as typhoid. 2 cases were misdiag- nosed as rheumatoid arthritis. 1 case was misdiagnosed as tymphoma. 1 case was misdiagnosed as leukemia reaction. 1 case was misdiagnosed as tuberculosis. Serum ferritin increased in 24 patients. The percentage of glycosylated ferritin was signifi- cantly decreased （ 〈 20% ） in 16 cases. White blood cells increased in 23 cases and thrombocytosis in 11 cases. Erythroeyte sedimentation rate was higher in 24 cases and C-reactive protein was elevated in 18 patients. All the cases met the Yamaguchi criteria published in Japan in 1992 by the AOSD research committee. After a definitive diagnosis, the treatment was undertak- en with application of nonsteroidal anti-inflammatory drugs combined with corticosteroids or immunosuppressants according to the condition of the cases. 18 patients were completely relieved. 5 cases relapsed after one year and 3 cases relapsed after two years. Conclusion The clinical manifestation of AOSD is complex and changeable, and it tends to be misdiagnosed. Clini- cians should be fully aware of response to AOSD. Detection of glycosylated ferritin is specific for diagnosis of AOSD, which is helpful in the differential diagnosis of AOSD.
出处
《临床误诊误治》
2015年第7期25-27,共3页
Clinical Misdiagnosis & Mistherapy
关键词
STILL病
成年型
误诊
脓毒症
药疹
肺炎
Still disease, adult onset
Misdiagnosis
Sepsis
Drug eruption
Pneumonia
