Clinical features and hyperferritinemia diagnostic cutoff points for AOSD based on ROC curve: a Chinese experience
Clinical features and hyperferritinemia diagnostic cutoff points for AOSD based on ROC curve: a Chinese experience
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DOI：
10.1007/s00296-010-1601-4
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发表时间：
2012-01-01
影响因子：
4
通讯作者：
Liang, Liuqin
中科院分区：
文献类型：
--
作者：
Lian, Fan;Wang, Yu;Liang, Liuqin
据报道，成人起病斯蒂尔病(AOSD)中存在高铁蛋白血症。本研究旨在探讨中国人群AOSD的临床特点以及基于ROC曲线的不同高铁血症界点对AOSD的诊断价值。纳入2002-10/2007-02中山大学第一附属医院风湿科收治的AOSD患者48例。共有86名患者从同一科室获得作为对照的患者，主要症状是发烧>；39A℃超过一周，符合山口标准，但经其他血清学或病理检查证实为非AOSD。入院时测定血清总铁蛋白水平。中国人群AOSD的临床特征与以往的研究相似。AOSD患者血清总铁蛋白水平(8100.7+/-A 13678.5)显著高于非AOSD对照组(448.3+/-A 539.4)(P<；0.01)。不同类型的非AOSD患者血清铁蛋白水平差异无统计学意义(P>；0.05)。受试者工作特征曲线(ROC曲线)下面积值高，提示铁蛋白对AOSD的诊断有较高的预测性。根据临床实践和ROC曲线选取3个临界点。铁蛋白水平2,500微克/L对AOSD的诊断具有很高的特异性，但这种低敏感性可能会错误地排除真正的AOSD患者。炎症性疾病或实体瘤中，高铁血症以千分之750微克/L少见。高铁蛋白血症1千分之1250A/L可基本排除其他自身免疫性疾病和血液病。结合Yamaguchi标准和高铁蛋白血症对AOSD有较好的预测作用。结论：在ROC曲线上观察到不同的高铁蛋白血症界点有助于优化诊断和治疗策略。
Hyperferritinemia has been reported in adult-onset Still's disease (AOSD). This study aims to investigate clinical features of AOSD in Chinese population and diagnostic value of different hyperferritinemia cutoff points based on ROC curve. A total of 48 patients from October 2002 to February 2007 diagnosed AOSD in the department of rheumatology, the first affiliated hospital of Sun Yat-set University were enrolled. A total of 86 patients mainly complaining fever > 39A degrees C for over one week and meeting Yamaguchi criteria but confirmed as non-AOSD by other serological or pathological tests were obtained from the same department as controls. Total serum ferritin levels were determined at the time of admission. Clinical features of AOSD in Chinese population were similar to previous studies. Significantly higher levels of total serum ferritin were presented in patients with AOSD (8100.7 +/- A 13678.5) compared with non-AOSD controls (448.3 +/- A 539.4) (P < 0.01). No differences were found in serum ferritin level between different categories of non-AOSD patients (P > 0.05). High value of area under receiver operating characteristic curve (ROC curve) suggested that ferritin was very predictive in AOSD diagnosis. Three cutoff points were picked based on clinical practice and ROC curve. Ferritin level a parts per thousand yen2,500 A mu g/L appeared to be highly specific for a diagnosis of AOSD, yet the low sensitivity may falsely ruled out patients with true AOSD. Hyperferritinemia a parts per thousand yen750 A mu g/L was seldom observed in inflammatory diseases or solid tumor. Hyperferritinemia a parts per thousand yen1,250 A mu g/L could mostly rule out other autoimmune diseases and hematologic diseases. Combined Yamaguchi criteria and hyperferritinemia gave better prediction for AOSD. In conclusion, different hyperferritinemia cutoff points observed in ROC curve help to optimize diagnostic and therapeutic strategy.