成人斯蒂尔病与其他不明原因发热疾病的鉴别诊断指标OA北大核心CSTPCD
Differential diagnosis of adult-onset Still's disease with other fever of unknown origin causes
目的 探讨成人斯蒂尔病(AOSD)与其他不明原因发热(FUO)疾病的鉴别诊断指标.方法 收集2010年1月-2021年5月在陆军军医大学第一附属医院住院的177例AOSD患者及163例待鉴别FUO患者的临床资料及实验室指标,随机分为训练组及验证组.通过单因素分析提取有统计学意义的变量进行受试者工作特征(ROC)曲线分析并获取变量的最佳截断值,进一步通过多因素logistic回归分析筛选出具有鉴别诊断意义的指标,并构建列线图模型;采用ROC曲线、校准曲线及决策曲线分析列线图的准确性及稳定性.结果 单因素分析结果显示,4项临床特征(关节痛、皮疹、咽痛、肌痛)及14项实验室参数[白细胞计数(WBC)、单核细胞百分比、中性粒细胞百分比、淋巴细胞百分比、血小板计数、C反应蛋白、白细胞介素-6(IL-6)、铁蛋白、球蛋白、免疫球蛋白A、免疫球蛋白G(IgG)、肌酸激酶、肌酐、补体C3]差异均有统计学意义(P＜0.05).多因素分析结果显示,关节痛、WBC≥9.995×109/L、IL-6≥98.13 ng/L、铁蛋白≥507.37 ng/ml、球蛋白≤36.58 g/L、IgG≤13.59 g/L、补体C3≥1.27g/L均与AOSD相关(P＜0.05).训练组及验证组的曲线下面积(AUC)分别为0.917[95%可信区间(95%CI)0.883～0.951]、0.869(95%CI 0.802～0.936);校准曲线表现出良好的一致性;决策曲线分析表明,训练组及验证组分别在5%～85%、10%～85%广大风险范围内显示出较大的正向收益率.结论 该研究建立起一个相对准确的AOSD鉴别诊断模型,关节痛、WBC、IL-6、铁蛋白、球蛋白、IgG及补体C3多指标联合应用有助于鉴别AOSD与其他FUO病因.
Objective To explore the differential diagnostic indicators of adult-onset Still's disease(AOSD)from other fever of unknown origin(FUO).Methods The clinical data and laboratory indicators of 177 AOSD patients and 163 FUO patients who were hospitalized in the First Affiliated Hospital of Army Medical University from January 2010 to May 2021 were collected,and the patients were randomly divided into training group and verification group.Statistically significant variables were extracted from univariate analysis for receiver operating characteristic(ROC)curve analysis and the best cut-off value of the variables was obtained.The differential diagnostic indicators were extracted by multivariate logistic regression analysis and nomogram model was constructed.ROC curve,calibration curve,and decision curve analysis were used to evaluate the accuracy and stability of nomogram.Results Univariate analysis revealed that there were significant differences in 4 clinical features(arthralgia,rash,pharyngeal pain,myalgia)and 14 laboratory parameters[white blood cell count(WBC),monocyte percentage,neutrophil percentage,lymphocyte percentage,platelet count,C-reactive protein,interleukin-6(IL-6),ferritin,globulin,immunoglobulin A,and immunoglobulin G(IgG),creatine kinase,creatinine and complement C3].Multivariate analysis suggested that arthralgia,WBC≥9.995×109/L,IL-6≥98.13 ng/L,ferritin≥507.37 ng/ml,globulin≤36.58g/L,IgG≤13.59g/L,complement C3≥1.27 g/L were related with AOSD.The area under curve(AUC)values of training group and verification group were 0.917(95%CI 0.883-0.951)and 0.869(95%CI 0.802-0.936),respectively.The calibration curves showed good consistency.The decision curve analysis showed that training group and verification group had a large positive rate of return in the wide risk range of 5%-85%and 10%-85%,respectively.Conclusions This study has established a relatively accurate AOSD differential diagnosis model.The combination of arthralgia,WBC,IL-6,ferritin,globulin,IgG and complement C3 may help to distinguish AOSD from other causes of FUO.
汤影子;刘慧敏;郭建琼;夏杰
陆军军医大学第一附属医院感染科,重庆 400038
临床医学
成人斯蒂尔病不明原因发热鉴别诊断
adult-onset Still's diseasefever-of-unknown-origin-etiologydifferential diagnosis
《解放军医学杂志》 2024 (003)
308-315 / 8
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