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目的探讨影响成人斯蒂尔病(AOSD)预后的相关因素及与疾病复发的相关因素。方法采用队列研究的策略,研究样本为1996年3月至2004年9月住院的AOSD连续性病例。采用Logistic回归方法,分析影响预后的因素;COX回归方法分析与疾病复发的相关因素。结果本研究入组96例,失访9例。在87例的随访中,11例(12.6%)最终被诊断为其他风湿免疫病(5例)、肿瘤(4例)和感染(2例)。76例AOSD中,3例(3.9%)死亡,33例(43.4%)获得持续缓解1年以上。Logistic回归分析显示,脾脏肿大(OR=3.14,95%CI=1.01～9.74)和甲氨蝶呤治疗(OR=0.22,95%CI=0.07～0.67)与预后相关。COX回归分析显示,与疾病复发相关的因素包括血清铁蛋白(RR=1.05。95%CI=1.01～1.08)和甲氨蝶呤治疗(RR= 0.13,95%CI=0.02～0.76)。结论AOSD的患者中约12.6%的患者在随访中被诊断为另一个疾病:甲氨蝶呤的治疗,不但可以提高疗效,还有利于防止病情的复发。
Objective To explore the related factors that affect the prognosis of adult patients with Still’s disease (AOSD) and the related factors of relapse. METHODS: A cohort study was conducted to determine the presence of AOSD inpatients from March 1996 to September 2004. Logistic regression method was used to analyze the factors affecting the prognosis; COX regression analysis of the factors associated with disease recurrence. Results The study enrolled 96 cases, 9 cases were lost to follow-up. Of the 87 patients followed, 11 (12.6%) were eventually diagnosed with other rheumatoid immunity (5), tumor (4) and infection (2). Of the 76 AOSD cases, 3 (3.9%) died and 33 (43.4%) sustained remission for more than 1 year. Logistic regression analysis showed that splenomegaly (OR = 3.14, 95% CI = 1.01-9.74) and methotrexate treatment (OR = 0.22, 95% CI = 0.07-0.67) were correlated with prognosis. COX regression analysis showed that the factors associated with disease recurrence were serum ferritin (RR = 1.05.95% CI = 1.01-1.08) and methotrexate treatment (RR = 0.13, 95% CI = 0.02-0.76). Conclusions About 12.6% of patients with AOSD were diagnosed with another disease at follow-up: Methotrexate did not only improve efficacy but also prevent recurrence.