幼年型与成人型Still 病的临床对比研究

    胡燕青,左晓霞,游运辉,罗卉

    (中南大学湘雅医院风湿科 ,湖南 长沙 410008)

    【摘要】 目的 探讨幼年型 Still 病与成人型 Still 病的临床特点及治疗经验。方法 采用回顾性研究方法比较分析 42 例幼年

    型 Still 病与47例成人型 Still 病的临床表现、实验室检测指标及治疗方案。结果 幼年型 Still 病患者淋巴结肿大、咽痛、腹痛的发生

    率明显高于成人患者( P < 0105) ,而成人 Still 病患者的肌痛、脾肿大发生率明显高于幼年患者( P < 0105) ;实验室检查两组患者均

    有不同程度的贫血及白细胞、血小板增高 ,骨髓细胞学检查表现为粒系增生活跃 ,中性粒细胞内有中毒颗粒 ,类似感染的骨髓象。

    血沉(ESR)与 C反应蛋白(CRP)在疾病活动期显著升高 ,类风湿因子(RF)与抗核抗体(ANA)多为阴性。治疗上 ,普遍应用肾上腺皮

    质激素及非甾体类抗炎药 ,慢作用药的使用较少。结论 Still 病幼年型与成人型临床表现各有特点 ,掌握特点以利于早期诊断。药

    物治疗要注意毒副作用 ,以达到良好的治疗效果。

    [关键词] Still 病 ,对比研究

    [中图分类号] R59311 [文献标识码] A [文章编号]1008 - 1372(2003) 01 - 0037 - 03

    Clinical Characteristic comparision of Still Disease in Juvenile and Adult Patients

    HU Yan - qing . Department of Clinical Rheumatology , Xiangya Hospital , Central South University , Changsha ,410008 , China

    【Abstract】 Objective To investigate the clinical characteristics of still’ s disease in juvenile and adult patients.Methods The clinical and

    laboratory manifestations and drug treatment of 42 juvenile patients with still’ s disease were analysed , and compared with that of 47 adult patients

    with still’ s diseases. Results The incidence of swelling of lymph nodes , pharyngalgia and abdominalgia were significantly higher in juvenile patients

    than that in the adult patients ( P < 0105) ,but the incidence of muscle ache , splenomegaly were significantly higher in adult patients than that in the

    juvenile patients. Both these patients had different degree anemia and notable elevation of the leucocyte ,platelete bone marrow cytological examina 2

    tivon showed that active granulocytosis toxic granulation was found in neutrophilic granulocyte ,it was similar to that of infected bone marrow picture.

    Erythrocyte sedimentation rate(ESR) and C reactive protein were remakable raised in active phase , but rhenumatoid factor and antinuclear antibody

    were both negative. In drug treatment , adrenal cortical hormone and non - steroid anti - inflammatory drug were widespread , slow rude action drug

    was less used. Conclusions We should grasp the clinical feature of still’ s diseas ,give a diagnosis as early as possible ,drug therapy must pay atten 2

    tion to side effect . So doing ,we can gain a satisfactory therapeutic efficacy.

    【Key words】 Still disease ;Contrast study

    Still 病是一组病因和发病机制不明 ,以高热、皮

    疹、关节病变和白细胞升高为主要特征的临床症候群。

    1896年 Still 最初描述的病例 ,以后报道增多并有不同

    名称 ,如20世纪40年代的 Wissler - Fanconi 综合征 ,以

    及“subsepsis allergica” (变应性亚败血症)等 ,这些都是

    对儿童患者而言。真正使用成人 Still 病一名来自 1971

    年Bywater的报告;国内长时间用“变应性亚败血症” ,已是50年前旧名。目前 ,国家自然科学名词审定委员

    会公布的医学名词认定 Still 病一词 ,成人患者为成人

    Still 病[1 ]。Still 病病程多样 ,呈异质性表现 ,机体免疫

    降低难产率; ⑶在分娩镇痛的过程中应注意 ,第一产程

    结束后及时停止用药 ,并指导孕妇正确使用腹压 ,在防

    止第二产程延长 ,降低难产率上有一定意义。

    综上所述 ,持续硬膜外阻滞运用于分娩镇痛 ,效果

    确实 ,产妇无痛感 ,能取得产妇的主动配合 ,且必要时

    可满足手术的需要 ,临床意义大 ,值得推广。但对于这

    种方法所带来的分娩影响 ,应进一步研究。

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    [收稿日期:2002 - 05 - 09 ]

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