Cheng Lin, Zong Hexiang, Li Dongxu, Qian Long
Department of Rheumatology and Immunology, The Second Affiliated Hospital of Anhui Medical University, Anhui, China.
J Coll Physicians Surg Pak. 2025 Jan;35(1):71-75. doi: 10.29271/jcpsp.2025.01.71.
To investigate the characteristics of Adult-onset Still's disease (AOSD) patients with macrophage activation syndrome (MAS) and explore the risk factors for the development of MAS.
A case-control study. Place and Duration of the Study: Department of Rheumatology and Immunology, the Second Hospital of Anhui Medical University, Anhui, China, from January 2008 to June 2024.
AOSD patients with MAS (AOSD-MAS) and without MAS (AOSD-nonMAS) were compared. Clinical features and laboratory results from two groups were analysed using the independent samples t-test or Mann-Whitney U test. Fisher's exact test or Pearson's Chi-square test was used to compare the variables between the two groups. The multivariable logistic regression analysis was applied to identify AOSD with MAS-associated factors. The value of risk factors in predicting MAS occurrence was carried out by a receiver operating characteristic validation analysis.
MAS patients showed higher prevalence of sore throat, splenomegaly and abnormal liver function, a lower prevalence of arthrodynia and higher levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, alanine aminotransferase, aspartate aminotransferase, lactic dehydrogenase, serum ferritin, D-Dimer levels, and a higher AOSD system score, along with a lower lymphocyte count (p <0.05). Multivariate logistic regression analysis identified NLR and AOSD system scores as predictors of MAS. An optimised threshold of 17.455 and 5.500 for NLR and AOSD system score yielded a sensitivity of 84.60% (38.50) and a specificity of 91.00%, (47.40).
Early detection of MAS in AOSD may be facilitated by monitoring these factors, particularly NLR and AOSD system scores.
Adult-onset still's disease, Macrophage activation syndrome, Risk factor.
探讨成人斯蒂尔病（AOSD）合并巨噬细胞活化综合征（MAS）患者的特征，并探索MAS发生的危险因素。
病例对照研究。研究地点和时间：2008年1月至2024年6月，中国安徽医科大学第二附属医院风湿免疫科。
比较AOSD合并MAS（AOSD-MAS）患者和不合并MAS（AOSD-nonMAS）患者。两组的临床特征和实验室结果采用独立样本t检验或曼-惠特尼U检验进行分析。采用Fisher精确检验或Pearson卡方检验比较两组间的变量。应用多变量逻辑回归分析确定与AOSD合并MAS相关的因素。通过受试者工作特征验证分析评估危险因素在预测MAS发生中的价值。
MAS患者咽痛、脾肿大和肝功能异常的发生率较高，关节痛的发生率较低，中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、乳酸脱氢酶、血清铁蛋白、D-二聚体水平较高，AOSD系统评分较高，淋巴细胞计数较低（p<0.05）。多变量逻辑回归分析确定NLR和AOSD系统评分是MAS的预测指标。NLR和AOSD系统评分的优化阈值分别为17.455和5.500，灵敏度为84.60%（38.50），特异度为91.00%（47.40）。
监测这些因素，特别是NLR和AOSD系统评分，可能有助于早期发现AOSD中的MAS。
成人斯蒂尔病；巨噬细胞活化综合征；危险因素
