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ENGLISH ABSTRACT
成人型Still病确诊前经验性或试验性用药安全性问题的调查与分析
丛珊
刘一鸣
魏显苹
侯继秋
陈俊俊
王冬雪
作者及单位信息
·
DOI： 10.3760/cma.j.cn114015-20240603-00410
Investigation and analysis on safety of empirical or experimental medication for adult-onset Still disease before diagnosis
Cong Shan
Liu Yiming
Wei Xianping
Hou Jiqiu
Chen Junjun
Wang Dongxue
Authors Info & Affiliations
Cong Shan
Department of Nephrology, the Second Hospital of Jilin University, Changchun 130041, China
Liu Yiming
Department of Pharmacy, the Second Hospital of Jilin University, Changchun 130041, China
Wei Xianping
Clinical Research Department, the Second Hospital of Jilin University, Changchun 130041, China
Hou Jiqiu
Department of Pharmacy, the Second Hospital of Jilin University, Changchun 130041, China
Chen Junjun
Department of Pharmacy, the Second Hospital of Jilin University, Changchun 130041, China
Wang Dongxue
Department of Pharmacy, the Second Hospital of Jilin University, Changchun 130041, China
·
DOI： 10.3760/cma.j.cn114015-20240603-00410
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摘要

目的调查和分析成人型Still病（AOSD）确诊前经验性或试验性用药（EEM）中的安全问题。

方法通过医院信息系统收集吉林大学第二医院2019年1月1日至2023年12月31日收治的AOSD住院患者，筛选出入院时被误诊的患者。对误诊患者的主要临床特征、实验室检查、误诊情况、EEM使用情况及其相关药物不良反应（ADR）和潜在相互作用等进行描述性分析。

结果设定时段内医院共收治49例AOSD患者，其中16例在入院时被误诊为其他疾病（32.7%）。16例误诊患者中，男性10例，女性6例，中位年龄53岁；主要临床表现为发热（15例）、关节痛/关节炎（10例）、淋巴结肿大（10例）、皮疹（9例）、胸腔或心包积液（6例）、肺炎（5例）、脾大（4例）和咽痛（4例）。实验室检查异常包括白细胞计数升高（13例）、血小板计数升高（8例）、血清铁蛋白升高（>500 μg/L，12例）和肝功能异常（9例）。16例误诊患者入院前外院诊治的中位时间为5.5个月，从入院至确诊AOSD的中位时间12 d。在AOSD确诊前均接受了较长时间的EEM治疗，其中使用了抗菌药物、中药制剂、保肝药物、抗过敏药和抗病毒药的患者分别为15、12、11、3和2例。4例发生与EEM相关的ADR，均为抗菌药物所致。4例患者的治疗药物中存在潜在相互作用。

结论AOSD的误诊率较高，患者在明确诊断前往往接受了多种EEM，存在ADR和发生药物相互作用的风险。

Still病，成年型;误诊;药品误用;药物相关性副作用和不良反应;患者安全
ABSTRACT

ObjectiveTo investigate and analyze the safety of empirical or experimental medication (EEM) for adult-onset Still disease (AOSD) before diagnosis.

MethodsThe AOSD inpatients admitted to the Second Hospital of Jilin University from January 1, 2019 to December 31, 2023 were collected through hospital information system, and those who were misdiagnosed on admission were screened out. The main clinical characteristics, laboratory tests, misdiagnosis situation, the use of EEM and their adverse drug reactions (ADR), and the potential drug-drug interactions in the misdiagnosed patients were analyzed by descriptive statistics.

ResultsDuring the set time period, a total of 49 patients with AOSD were admitted to the hospital, of which 16 (32.7%) were misdiagnosed with other diseases on admission. Among the 16 patients, 10 were male and 6 were female, with a median age of 53 years. The main clinical manifestations were fever (in 15 patients), arthralgia/arthritis (in 10 patients), lymphadenopathy (in 10 patients), rash (in 9 patients), pleural or pericardial effusion (in 6 patients), pneumonia (in 5 patients), splenomegaly (in 4 patients) and sore throat (in 4 patients). Abnormalities in laboratory tests included white blood cell count elevation (in 13 patients), platelets count elevation (in 8 patients), serum ferritin elevation (>500 μg/L, in 12 patients), and abnormal liver function (in 9 patients). The median time of treatment before admission was 5.5 months (11 days to 27.0 months), and the median time from admission to diagnosis of AOSD was 12 days. Before the diagnosis of AOSD, all patients received a long time of EEM, including antibiotics, traditional Chinese medicine preparations, liver-protection drugs, anti-allergic drugs and antiviral drugs in 15, 12, 11, 3 and 2 patients, respectively. Four patients experienced ADRs related to EEM, all of which were caused by antibiotics. There were potential interactions in the therapeutic drugs in 4 patients.

ConclusionThe misdiagnosis rate of AOSD was high. Patients might had accepted multiple EEMs before the definite diagnosis, which posed risks of ADRs and drug interactions.

Still′s disease, adult-onset;Diagnostic errors;Drug misuse;Drug-related side effects and adverse reactions;Patient safety
Wang Dongxue, Email: nc.defudabe.uljxdw
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引用本文

丛珊,刘一鸣,魏显苹,等. 成人型Still病确诊前经验性或试验性用药安全性问题的调查与分析[J]. 药物不良反应杂志,2025,27(03)：176-181.

DOI:10.3760/cma.j.cn114015-20240603-00410

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成人型Still病（adult-onset Still disease，AOSD）是一组以高热、关节炎/关节痛、皮疹为主要表现的临床综合征，常伴有外周血粒细胞升高，肝、脾、淋巴结肿大等多系统损伤，其临床表现复杂多变且缺乏特异性诊断手段，临床极易误诊，常需要排除多种疾病，方能明确诊断 [ 1 ]。因此，大多数患者可能会在很长一段时间内被诊断为其他疾病，并接受多种经验性或试验性药物治疗（empirical or experimental medication，EEM） [ 2 , 3 ]。临床实践中，AOSD常常被误诊为肺炎、肝病、关节炎等疾病，收治于呼吸科、血液内科、骨康复疼痛科、肝胆内科等，并使用大量药物治疗。然而EEM对于AOSD患者不仅无效，还可能导致药物不良反应（adverse drug reactions，ADR）。为此，我们收集了吉林大学第二医院（我院）AOSD患者的临床资料，对AOSD患者在确诊前EEM中的安全性问题进行调查和分析，以提高临床对AOSD的认识，缩短诊断时间，减少EEM相关风险。
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参考文献
[1]
Leavis HL , van Daele P , Mulders-Manders C ,et al. Management of adult-onset Still′s disease: evidence-and consensus-based recommendations by experts[J]. Rheumatology (Oxford), 2024,63(6):1656-1663. DOI: 10.1093/rheumatology/kead461 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Carreño MA , Carvallo A , Trejo C ,et al. Adult Still′s disease. A great simulator. Retrospective review of 20 patients[J]. Rev Med Chil, 2009,137(8):1010-1016.
返回引文位置Google Scholar
百度学术
万方数据
[3]
缪媛媛,刘刚,张志强,等. 以不明原因发热为表现的成人Still病29例误诊原因分析[J]. 临床误诊误治, 2013,26(4):8-11. DOI: 10.3969/j.issn.1002-3429.2013.04.003 .
返回引文位置Google Scholar
百度学术
万方数据
Miao YY , Liu G , Zhang ZQ ,et al. Analysis of misdiagnosis causes of 29 cases of adult-onset Still′s disease with fever of unknown origin[J]. Cl inical Misdiagnosis & Mistherapy , 2013,26(4):8-11. DOI: 10.3969/j.issn.1002-3429.2013.04.003 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[4]
Yamaguchi M , Ohta A , Tsunematsu T ,et al. Preliminary criteria for classification of adult Still′s disease[J]. J Rheumatol, 1992,19(3):424-430.
返回引文位置Google Scholar
百度学术
万方数据
[5]
李施阳. 成人Still病临床诊治的研究进展[J]. 疑难病杂志, 2020,19(5):537-540. DOI: 10.3969/j.issn.1671-6450.2020.05.026 .
返回引文位置Google Scholar
百度学术
万方数据
Li SY . Progress in clinical diagnosis and treatment of adult Still′s disease[J]. Chin J Diffic and Compl Cas , 2020,19(5):537-540. DOI: 10.3969/j.issn.1671-6450.2020.05.026 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[6]
Giacomelli R , Caporali R , Ciccia F ,et al. Expert consensus on the treatment of patients with adult-onset still′s disease with the goal of achieving an early and long-term remission[J]. Autoimmun Rev, 2023,22(12):103400. DOI: 10.1016/j.autrev.2023.103400 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
孙洪良,谢文秀,马航航,等. 成人Still病26例误诊原因分析[J]. 临床误诊误治, 2015,28(7):25-27. DOI: 10.3969/j.issn.1002-3429.2015.07.008 .
返回引文位置Google Scholar
百度学术
万方数据
Sun HL , Xie WX , Ma HH ,et al. Analysis of misdiagnosis causes in 26 adult patients with Still disease[J]. Clinical Misdiagnosis & Mistherapy , 2015,28(7):25-27. DOI: 10.3969/j.issn.1002-3429.2015.07.008 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[8]
胡钦凤,顾美华. 血清铁蛋白在成人Still病诊疗中的临床价值[J]. 苏州大学学报（医学版）, 2008,28(1):119-120. DOI: 10.3969/j.issn.1673-0399.2008.01.038 .
返回引文位置Google Scholar
百度学术
万方数据
Hu QF , Gu MH . Clinical value of serum ferritin level in the adult onset Still disease[J]. J Soochow Univ Med Sci Ed, 2008,28(1):119-120. DOI: 10.3969/j.issn.1673-0399.2008.01.038 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[9]
李德坤. 关于中药注射剂企业开展药物警戒的思考[J]. 药物不良反应杂志, 2023,25(5):257-262. DOI: 10.3760/cma.j.cn114015-20221031-01002 .
返回引文位置Google Scholar
百度学术
万方数据
Li DK . Thoughts on the pharmacovigilance in traditional Chinese medicine injection enterprises[J]. ADRJ, 2023,25(5):257-262. DOI: 10.3760/cma.j.cn114015-20221031-01002 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[10]
孙雪,曾桦,次旦卓嘎,等. 长期口服甘草酸制剂致假性醛固酮增多症合并低钾性横纹肌溶解[J]. 药物不良反应杂志, 2021,23(11):609-611. DOI: 10.3760/cma.j.cn114015-20210222-00194 .
返回引文位置Google Scholar
百度学术
万方数据
Sun X , Zang H , Cidanzhuoga ,et al. Pseudoaldosteronism complicated with hypokalemic rhabdomyolysis induced by long-term use of oral glycyrrhizic acid preparations[J]. ADRJ, 2021,23(11):609-611. DOI: 10.3760/cma.j.cn114015-20210222-00194 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[11]
李德平,李燕,徐小军. 基于文献的甘草酸二铵不良反应分析[J]. 药品评价, 2023,20(2):147-150. DOI: 10.19939/j.cnki.1672-2809.2023.02.05 .
返回引文位置Google Scholar
百度学术
万方数据
Li DP , Li Y , Xu XJ . Literature analysis of adverse reactions induced by diammonium glycyrrhizinate[J]. Drug Eval, 2023,20(2):147-150. DOI: 10.19939/j.cnki.1672-2809.2023.02.05 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[12]
王旭亮,赵建刚. 美罗培南联合替加环素治疗耐药菌感染的效果分析[J]. 中国处方药, 2021,19(11):103-104. DOI: 10.3969/j.issn.1671-945X.2021.11.047 .
返回引文位置Google Scholar
百度学术
万方数据
Wang XL , Zhao JG . Analysis of the effect of meropenem combined with tigecycline in the treatment of drug-resistant bacterial infection[J]. J China Prescr Drug, 2021,19(11):103-104. DOI: 10.3969/j.issn.1671-945X.2021.11.047 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[13]
梁宝方,丁少波,何瑞荣,等. 替加环素与美罗培南联用对重症感染患者的临床分析[J]. 中国处方药, 2021,19(4):111-113. DOI: 10.3969/j.issn.1671-945X.2021.04.056 .
返回引文位置Google Scholar
百度学术
万方数据
Liang BF , Ding SB , He RR ,et al. Clinical analysis of tigecycline combined with meropenem in patients with severe infection[J]. J China Prescr Drug, 2021,19(4):111-113. DOI: 10.3969/j.issn.1671-945X.2021.04.056 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[14]
Bi S , Yao X , Huang C ,et al. Antagonistic effect between tigecycline and meropenem: successful management of KPC-producing Klebsiella pneumoniae infection [J]. Infection, 2019,47(3):497-500. DOI: 10.1007/s15010-019-01274-w .
返回引文位置Google Scholar
百度学术
万方数据
[15]
Arend L , Telles JP , Tuon FF . Antagonistic effect between tigecycline and meropenem: from bed to bench to bed[J]. Infection, 2020,48(1):141-142. DOI: 10.1007/s15010-019-01353-y .
返回引文位置Google Scholar
百度学术
万方数据
[16]
闻超,刘锋,王敏. 万古霉素联合亚胺培南西司他丁钠或美罗培南抗感染治疗的急性肾损伤发生率的回顾性分析[J]. 中国医院药学杂志, 2024,44(4):447-450. DOI: 10.13286/j.1001-5213.2024.04.13 .
返回引文位置Google Scholar
百度学术
万方数据
Wen C , Liu F , Wang M . Retrospective analysis of acute kidney injury incidence in anti-infection therapy using vancomycin combined with imipenem/cilastatin sodium or meropenem[J]. Chin J Hosp Pharm, 2024,44(4):447-450. DOI: 10.13286/j.1001-5213.2024.04.13 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[17]
Sakai Y , Karakawa S , Koutaki T ,et al. Concomitant administration of vancomycin with a high dose of meropenem may cause acute kidney injury[J]. Case Rep Infect Dis, 2024,2024:7956014. DOI: 10.1155/2024/7956014 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Sussman MS , Mulder MB , Ryon EL ,et al. Acute kidney injury risk in patients treated with vancomycin combined with meropenem or cefepime[J]. Surg Infect (Larchmt), 2021,22(4):415-420. DOI: 10.1089/sur.2020.105 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
舒舟,蔡雪峰. 碘美普尔与塞来昔布联用致急性肾损伤1例[J]. 海峡药学, 2020,32(2):214-216. DOI: 10.3969/j.issn.1006-3765.2020.02.093 .
返回引文位置Google Scholar
百度学术
万方数据
Shu Z , Cai XF . A case of acute kidney injury caused by iodomeprazole combined with celecoxib[J]. Strait Pharm J, 2020,32(2):214-216. DOI: 10.3969/j.issn.1006-3765.2020.02.093 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[20]
Warth LC , Noiseux NO , Hogue MH ,et al. Risk of acute kidney injury after primary and revision total hip arthroplasty and total knee arthroplasty using a multimodal approach to perioperative pain control including ketorolac and celecoxib[J]. J Arthroplasty, 2016,31(1):253-255. DOI: 10.1016/j.arth.2015.08.012 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Li S , Ying S , Bai J ,et al. Clinical characteristics and outcome of elderly onset adult-onset Still′s disease: a 10-year retrospective study[J]. J Transl Autoimmun, 2023,6:100196. DOI: 10.1016/j.jtauto.2023.100196 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Borciuch C , Fauvernier M , Gerfaud-Valentin M ,et al. Still′s disease mortality trends in France, 1979―2016: a multiple-cause-of-death study[J]. J Clin Med, 2021,10(19):4544. DOI: 10.3390/jcm10194544 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Olliaro P , Torreele E . Managing the risks of making the wrong diagnosis: first, do no harm[J]. Int J Infect Dis, 2021,106:382-385. DOI: 10.1016/j.ijid.2021.04.004 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
王冬雪，Email： nc.defudabe.uljxdw
B

丛珊：文章撰写、病例信息收集及提取；刘一鸣、魏显苹、侯继秋、陈俊俊：病例信息收集及提取；王冬雪：研究设计

C
所有作者声明不存在利益冲突
D
吉林大学人工智能赋能本科教育教学改革专项课题 (24AI071Y，24AI069Y)
吉林省高教科研课题 (JGJX24D0045)
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