Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Korea.
Data Science for Knowledge Creation Research Centre, Seoul National University, Korea.
Clin Exp Rheumatol. 2018 Nov-Dec;36(6 Suppl 115):74-79. Epub 2018 Nov 14.
To perform unbiased analysis of fever patterns and to investigate their association with clinical manifestations and outcome of patients with adult-onset Still's disease (AOSD).
AOSD patients who were treated as in-patients from 2004 through 2015 were grouped according to 24-hour body temperature (BT) by hierarchical clustering using a Euclidean distance metric with complete linkage. The clinical and laboratory characteristics of the groups were then examined.
Hierarchical clustering partitioned 70 AOSD patients into three distinct groups. Group 1 (n=14) had the highest mean BT (38.1± 0.4°C) and the widest variation in BT (2.7±0.9°C). Group 2 (n=35) had a lower mean BT (37.4±0.3°C) and a smaller variation (2.1±0.7°C). Group 3 (n=21) had the lowest mean BT (36.7±0.3°C) and the smallest variation (1.5±0.6°C). Clinical features and extent of organ involvement did not differ significantly between groups. However, Group 1 had lower platelet counts and higher lactate dehydrogenase, ferritin levels, and prothrombin time than the other groups. In addition, Group 1 exhibited higher risk of having a macrophage activation syndrome (MAS) and tended to require more intense treatment with corticosteroids and immunosuppressant to achieve clinical remission as compared to other groups.
Hierarchical clustering identified three distinct fever patterns in patients with AOSD. Higher BT was associated with wider variations in diurnal temperature, higher risk of developing MAS, more intense treatment, and longer time to clinical remission, suggesting that fever pattern is a prognostic factor for AOSD.
对发热模式进行无偏分析，并探讨其与成人Still 病（AOSD）患者临床表现和结局的关系。
根据 24 小时体温（BT），采用欧几里得距离度量和完全连锁的层次聚类方法，将 2004 年至 2015 年住院治疗的 AOSD 患者分为不同组。然后检查各组的临床和实验室特征。
层次聚类将 70 例 AOSD 患者分为三组。第 1 组（n=14）的平均 BT 最高（38.1±0.4°C），BT 变化最大（2.7±0.9°C）。第 2 组（n=35）的平均 BT 较低（37.4±0.3°C），BT 变化较小（2.1±0.7°C）。第 3 组（n=21）的平均 BT 最低（36.7±0.3°C），BT 变化最小（1.5±0.6°C）。各组之间的临床特征和器官受累程度无显著差异。然而，第 1 组的血小板计数较低，乳酸脱氢酶、铁蛋白水平和凝血酶原时间较高。此外，与其他组相比，第 1 组发生巨噬细胞活化综合征（MAS）的风险更高，需要更强的皮质激素和免疫抑制剂治疗才能达到临床缓解。
层次聚类在 AOSD 患者中确定了三种不同的发热模式。较高的 BT 与昼夜温度变化更大、发生 MAS 的风险更高、治疗更强烈以及达到临床缓解的时间更长有关，提示发热模式是 AOSD 的预后因素。
