Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Ann Palliat Med. 2020 Sep;9(5):2786-2792. doi: 10.21037/apm-20-268. Epub 2020 Aug 24.
The aim of this study is to establish a clinical diagnosis model as a new evaluation indicator for the differentiation of adult-onset Still's disease (AOSD) and other fever of unknown origin disease (FUO).
This is an observational case-control study between January 2010 and December 2018. Laboratory parameters of AOSD group (N=91), FUO group (N=89) and control group (N=81) including procalcitonin, C-reactive protein (CRP), ferritin, leukocyte, lymphocyte, neutrophil, lymphocyte proportion, neutrophil proportion, red blood cell distribution width (RDW), platelet and platelet parameters were collected. Descriptive statistics and logistic regression were performed to establish a model based on these laboratory variables.
After univariate screening, the variables including CRP, leukocyte, neutrophil, lymphocyte proportion, neutrophil proportion, ferritin and mean platelet volume (MPV) showed significant difference between AOSD and FUO groups, then a stepwise regression analysis was performed to establish a model based on these screened variables, at last ferritin, neutrophil and MPV were significantly different in the model. The results suggested that the higher value of ferritin and neutrophil, the lower value of MPV in the model indicated the higher risk to diagnose AOSD. Area under the curve (AUC) of the model was 0.909 (95% CI: 0.855-0.947), which showed high differential diagnostic value (sensitivity: 86.6%, specificity: 82.0%).
The diagnosis model of AOSD and other FUO was established, with an outstanding performance for differential diagnosis.
本研究旨在建立一种临床诊断模型，作为成人Still 病（AOSD）与其他发热待查疾病（FUO）鉴别诊断的新评价指标。
这是一项 2010 年 1 月至 2018 年 12 月间的观察性病例对照研究。收集 AOSD 组（N=91）、FUO 组（N=89）和对照组（N=81）的实验室参数，包括降钙素原、C 反应蛋白（CRP）、铁蛋白、白细胞、淋巴细胞、中性粒细胞、淋巴细胞比例、中性粒细胞比例、红细胞分布宽度（RDW）、血小板和血小板参数。采用描述性统计和逻辑回归对这些实验室变量建立模型。
单因素筛选后，CRP、白细胞、中性粒细胞、淋巴细胞比例、中性粒细胞比例、铁蛋白和平均血小板体积（MPV）在 AOSD 和 FUO 两组间差异有统计学意义，然后对这些筛选变量进行逐步回归分析，最终建立基于这些筛选变量的模型，结果显示模型中 ferritin、neutrophil 和 MPV 有显著差异。结果表明，模型中 ferritin 和中性粒细胞值越高，MPV 值越低，提示 AOSD 诊断风险越高。模型的曲线下面积（AUC）为 0.909（95%CI：0.855-0.947），具有较高的鉴别诊断价值（灵敏度：86.6%，特异度：82.0%）。
建立了 AOSD 与其他 FUO 的诊断模型，具有较好的鉴别诊断性能。
