同时的败血症和水晶关节病:在新西兰进行的一项单一中心10年后期观察性研究
Saptarshi Mukerji1, Padraig Ryan2, Harnah Simmonds3
1Emergency Medicine Consultant, Capital and Coast and Hutt Valley Hospitals, Wellington, New Zealand.
The New Zealand medical journal
|June 20, 2024
概括
同时存在的败血性关节炎 (SA) 和水晶性关节炎 (CA) 影响了一小群患者. 突液白细胞数量为32,000/mm3,有助于诊断SA和SACA,可能改善患者的治疗结果.
科学领域:
- 类风湿病学 类风湿病学
- 传染性疾病 传染性疾病
- 紧急医疗 紧急医疗
背景情况:
- 败血性关节炎 (SA) 和水晶性关节炎 (CA) 是常见的关节疾病.
- 同时存在的SA和CA (SACA) 在急诊室提出了诊断挑战.
- 准确的诊断对于适当的患者管理和结果至关重要.
研究的目的:
- 在急诊室 (ED) 量化和描述患有性关节炎 (SA) 和水晶性关节炎 (CA) 的患者.
- 评估突液白细胞计数 (SF WCC) 在区分SA和SACA的诊断效用.
- 为了确定SACA的诱导因素.
主要方法:
- 在一个主要的推中心进行了回顾性,10年观察性研究.
- 在ED中包括CA或SA阳性关节吸血症患者.
- 使用了SA定义的纽曼标准,并分析了SF WCC.
主要成果:
- 在567名患者中,427人患有CA,140人患有SA. 23.6%的SA患者同时患有CA,7.2%的CA患者同时患有SA.
- 对SACA的诱导因素包括痛风,类风湿性关节炎,免疫抑制或关节金属制品的病史.
- SF WCC表现出强大的预测能力 (SA的AUROC为0.81,SACA的0.87). 一个32,000/mm3的SF WCC切线为SA/SACA提供了100%的灵敏度.
结论:
- SACA是一个重要的亚组,有风险被误诊为单独的CA.
- 在诊断SA/SACA时,SF WCC的切线值为32,000/mm3可能比传统的50,000/mm3.3更为敏感.
- 这种切断可能会为假定SA调查和管理提供住院入院的理由.
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