成人Still病活动度及复发风险与18F-FDG PET/CT代谢参数的相关性研究

doi:10.11958/20252530

天津医药 ›› 2026, Vol. 54 ›› Issue (3): 283-288.doi: 10.11958/20252530

成人Still病活动度及复发风险与¹⁸F-FDG PET/CT代谢参数的相关性研究

张文延(), 李祖贵, 贾永春, 江伟, 甄雨生, 许亮^△()

天津市人民医院，南开大学第一附属医院核医学科（邮编300121）

收稿日期:2025-07-18 修回日期:2025-10-20 出版日期:2026-03-15 发布日期:2026-03-17
通讯作者: △E-mail：jiarui053@aliyun.com
作者简介:张文延（1990），男，医师，主要从事肿瘤分子影像诊断方面研究。E-mail：1057969253@qq.com

Correlation between disease activity and recurrence risk of adult-onset Still's disease and ¹⁸F-FDG PET/CT metabolic parameters

ZHANG Wenyan(), LI Zugui, JIA Yongchun, JIANG Wei, ZHEN Yusheng, XU Liang^△()

Department of Nuclear Medicine, Tianjin Union Medical Center, the First Affiliated Hospital of Nankai University, Tianjin 300121, China

Received:2025-07-18 Revised:2025-10-20 Published:2026-03-15 Online:2026-03-17
Contact: △E-mail：jiarui053@aliyun.com

张文延, 李祖贵, 贾永春, 江伟, 甄雨生, 许亮. 成人Still病活动度及复发风险与¹⁸F-FDG PET/CT代谢参数的相关性研究[J]. 天津医药, 2026, 54(3): 283-288.

ZHANG Wenyan, LI Zugui, JIA Yongchun, JIANG Wei, ZHEN Yusheng, XU Liang. Correlation between disease activity and recurrence risk of adult-onset Still's disease and ¹⁸F-FDG PET/CT metabolic parameters[J]. Tianjin Medical Journal, 2026, 54(3): 283-288.

摘要/Abstract

摘要：

目的探讨¹⁸F-脱氧葡萄糖（FDG）PET/CT最大标准摄取值（SUV_max）与成人Still病（AOSD）活动度及复发风险之间的相关性。方法回顾性分析2019年6月—2023年12月在天津市人民医院接受¹⁸F-FDG PET/CT检查的17例AOSD患者资料。采用Spearman等级相关分析患者淋巴结、脾脏、骨髓SUV_max与实验室指标及系统性评分的相关性，淋巴结SUV_max与最大短径的相关性。根据随访结果将患者分为复发组与非复发组，比较2组SUV_max、系统性评分、临床特征的差异。结果 17例AOSD患者脾脏、骨髓及淋巴结均出现¹⁸F-FDG摄取增高，2例（11.76%）患者伴双侧腮腺（SUV_max2.3、4.3）、1例（5.88%）伴双侧肘关节、腕关节、手关节及左侧踝关节（SUV_max3.9）、1例（5.88%）伴双侧颌下腺（SUV_max3.4）¹⁸F-FDG摄取增高。脾脏及骨髓SUV_max与C反应蛋白水平呈正相关（r_s分别为0.575、0.549，P<0.05）。淋巴结SUV_max与最大短径呈正相关（r_s=0.522，P<0.05）。脾脏、骨髓及淋巴结SUV_max与系统性评分无相关性（r_s分别为-0.126、0.100、0.007，P>0.05）。复发组（9例）患者的脾脏SUV_max[5.20（4.45，6.05）]高于非复发组（8例）SUV_max[3.80（2.70，4.00），P<0.05]。结论 ¹⁸F-FDG PET/CT可作为评估AOSD活动度及预测疾病复发的有用工具，尤其是脾脏SUV_max在预测复发方面显示出潜在的临床价值。

关键词: Still病, 成年型, 正电子发射断层显像术, 体层摄影术, X线计算机, 脱氧葡萄糖, 复发

Abstract:

Objective To investigate the correlation between the maximum standardized uptake value（SUV_max） of ¹⁸F-fluorodeoxyglucose（FDG）PET/CT and clinical disease activity score as well as recurrence risk of adult-onset Still's disease (AOSD). Methods A retrospective analysis was conducted on 17 patients with AOSD who underwent ¹⁸F-FDG PET/CT at Tianjin Union Medicine Center from June 2019 to December 2023. Spearman rank correlation analysis was performed to analyze the relationship between SUV_max of lymph nodes, spleen and bone marrow with clinical disease activity score and laboratory parameters, and those between lymph node SUV_max and maximum short-axis diameter. Patients were divided into the recurrent group and the non-recurrent group based on follow-up results. The differences in SUV_max, clinical disease activity score and clinical features were assessed between the two groups. Results All 17 patients showed ¹⁸F-FDG uptake in spleen, bone marrow and lymph nodes. Additionally, 2 patients (11.76%) showed increased ¹⁸F-FDG uptake in bilateral parotid glands (SUV_max 2.3, 4.3)，1 patient (5.88%) showed increased ¹⁸F-FDG uptake in bilateral elbows, wrists, hand joints, and left ankle（SUV_max 3.9), and 1 patient (5.88%) showed increased¹⁸F-FDG uptake in bilateral submandibular glands（SUV_max 3.4). The SUV_max of spleen and bone marrow were positively correlated with C-reactive protein levels（r_s value:0.575 and 0.549; both P<0.05), while the SUV_max of lymph nodes was positively associated with their maximum short-axis diameter（r_s value:0.522, P<0.05). There was no significant correlation between disease activity score and SUV_max in spleen, bone marrow, or lymph nodes (r_s value: -0.126, 0.100 and 0.007，P>0.05). The SUV_maxof spleen in the recurrence group (9 patients) was 5.20 (4.45, 6.05), which was significantly higher than that in the non-recurrence group [8 patients, 3.80 (2.70, 4.00), P<0.05]. Conclusion ¹⁸F-FDG PET/CT is a valuable tool for assessing AOSD disease activity and predicting disease recurrence, especially the SUV_max of spleen, which shows potential clinical value in predicting recurrence.

Key words: Still's disease, adult-onset, positron-emission tomography, tomography, X-ray computed, deoxyglucose, recurrence

中图分类号:

R593，R817.4

图/表 5

参考文献 27

[1]	蒋冲, 来瑞鹤, 滕月, 等. 成人Still病¹⁸F-FDG PET/CT影像特点及对疾病活动性的评估价值[J]. 中华核医学与分子影像杂志, 2020, 40(9):533-537.
	JIANG C, LAI R H, TENG Y, et al. Radiographic features of ¹⁸F-FDG PET/CT in the assessment of disease activity in adult-onset Still′s disease[J]. Chin J Nucl Med Mol, 2020, 40(9):533-537. doi:10.3760/cma.j.cn321828-20191101-00250.
[2]	LI X, DONG C, MA X, et al. ¹⁸F-FDG PET/CT associates with disease activity and clinical recurrence of AOSD patients[J]. Front Med, 2021, 8:668323. doi:10.3389/fmed.2021.668323.
[3]	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.
[4]	POUCHOT J, SAMPALIS J S, BEAUDET F, et al. Adult Still's disease:manifestations,disease course,and outcome in 62 patients[J]. Medicine, 1991, 70(2):118-136.
[5]	JIANG L, XIU Y, GU T, et al. Imaging characteristics of adult onset Still's disease demonstrated with 18F-FDG PET/CT[J]. Molecular Medicine Reports, 2017, 16(3):3680-3686. doi:10.3892/mmr.2017.7022.
[6]	NISHINA N, KANEKO Y, KAMEDA H, et al. The effect of tocilizumab on preventing relapses in adult-onset Still's disease:a retrospective,single-center study[J]. Mod Rheumatol, 2015, 25 (3):401-404. doi:10.3109/14397595.2014.973659.
[7]	GERFAUD-VALENTIN M, JAMILLOUX Y, IWAZ J, et al. Adult-onset Still's disease[J]. Autoimmun Rev, 2014, 13 (7):708-722. doi:10.1016/j.autrev.2014.01.058.
[8]	MARANINI B, CIANCIO G, GOVONI M. Adult-onset Still's disease:novel biomarkers of specific subsets,disease activity,and relapsing forms[J]. Int J Mol Sci, 2021, 22 (24):13320. doi:10.3390/ijms222413320.
[9]	BAGGIO C, BINDOLI S, GUIDEA I, et al. IL-18 in autoinflammatory diseases:focus on adult onset Still disease and macrophages activation syndrome[J]. Int J Mol Sci, 2023, 24(13):11125. doi:10.3390/ijms241311125.
[10]	RUSCITTI P, BERARDICURTI O, GIACOMELLI R, et al. The clinical heterogeneity of adult onset Still's disease may underlie different pathogenic mechanisms. Implications for a personalised therapeutic management of these patients[J]. Semin Immunol, 2021, 58:101632. doi:10.1016/j.smim.2022.101632.
[11]	SZEKANECZ Z, MCINNES I B, SCHETT G, et al. Autoinflammation and autoimmunity across rheumatic and musculoskeletal diseases[J]. Nat Rev Rheumatol, 2021, 17 (10):585-595. doi:10.1038/s41584-021-00652-9.
[12]	RAO S, TSANG L S, ZHAO M, et al. Adult-onset Still's disease:A disease at the crossroad of innate immunity and autoimmunity[J]. Front Med, 2022, 9:881431. doi:10.3389/fmed.2022.881431.
[13]	MITROVIC S, FAUTREL B. Clinical phenotypes of adult-onset Still's disease:new insights from pathophysiology and literature findings[J]. J Clin Med, 2021, 10(12):2633. doi:10.3390/jcm10122633.
[14]	BRISSET J, JAMILLOUX Y, DUMONTEIL S, et al. Characteristics and clinical value of ¹⁸F-FDG PET/CT in the management of adult-onset Still's disease:35 cases[J]. J Clin Med, 2021, 10(11):2489. doi:10.3390/jcm10112489.
[15]	朱小霞, 李芹, 王悦, 等. 成人斯蒂尔病诊疗规范[J]. 中华内科杂志, 2022, 61 (4):370-376.
	ZHU X X, LI Q, WANG Y, et al. Recommendations of diagnosis and treatment of adult-onset Still′s disease in China[J]. Chin J Intern Med, 2022, 61 (4):370-376. doi:10.3760/cma.j.cn112138-20211115-00806.
[16]	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.
[17]	DAGHOR ABBACI K, AIT HAMADOUCHE N, OTMANI F, et al. Validation of the neutrophil-to-lymphocyte ratio as a new simple biomarker of adult onset Still's disease:a STROBE-Compliant prospective observational study[J]. Medicine, 2022, 101 (32):e29970. doi:10.1097/md.0000000000029970.
[18]	RUSCITTI P, DI COLA I, DI MUZIO C, et al. Expanding the spectrum of the hyperferritinemic syndrome,from pathogenic mechanisms to clinical observations,and therapeutic implications[J]. Autoimmun Rev, 2022, 21 (7):103114. doi:10.1016/j.autrev.2022.103114.
[19]	YU F, QIN S Y, ZHOU C Y, et al. Atypical adult-onset Still's disease with an initial and sole manifestation of liver injury:a case report and review of literature[J]. World J Clin Cases, 2021, 9 (1):224-231. doi:10.12998/wjcc.v9.i1.224.
[20]	MULLER R, BRIANTAIS A, FAUCHER B, et al. Acute severe hepatitis in adult-onset Still's disease:case report and comprehensive review of a life-threatening manifestation[J]. Clin Rheumatol, 2021, 40 (6):2467-2476. doi:10.1007/s10067-020-05383-y.
[21]	RUSCITTI P, CIPRIANI P, MASEDU F, et al. Adult-onset Still's disease:evaluation of prognostic tools and validation of the systemic score by analysis of 100 cases from three centers[J]. BMC Med, 2016, 14(1):194. doi:10.1186/s12916-016-0738-8.
[22]	MENG J, CHI H, WANG Z, et al. Characteristics and risk factors of relapses in patients with adult-onset Still's disease:a long-term cohort study[J]. Rheumatology, 2021, 60(10):4520-4529. doi:10.1093/rheumatology/keab023.
[23]	YAMADA H, KANEKO Y, TAMAI H, et al. Biomarkers for disease flare in patients with adult-onset Still's disease undergoing treatment with tocilizumab[J]. Rheumatology, 2020, 59(2):440-442. doi:10.1093/rheumatology/kez392.
[24]	TAN S, CHEN Z, QIU Y, et al. Prognostic factors for adult-onset Still disease:a retrospective analysis of 90 patients in China[J]. Eur J Dermatol, 2022, 32(1):56-63. doi:10.1684/ejd.2022.4192.
[25]	AHN S S, HWANG S H, JUNG S M, et al. Evaluation of spleen glucose metabolism using ¹⁸F-FDG PET/CT in patients with febrile autoimmune disease[J]. J Nucl Med, 2017, 58 (3):507-513. doi:10.2967/jnumed.116.180729.
[26]	WONG A, CALLAHAN J, KEYAERTS M, et al. ¹⁸F-FDG PET/CT based spleen to liver ratio associates with clinical outcome to ipilimumab in patients with metastatic melanoma[J]. Cancer Imaging, 2020, 20(1):36. doi:10.1186/s40644-020-00313-2.
[27]	WAN L, GAO Y, GU J, et al. Total metabolic lesion volume of lymph nodes measured by ¹⁸F-FDG PET/CT:a new predictor of macrophage activation syndrome in adult-onset Still's disease[J]. Arthritis Res Ther, 2021, 23(1):97. doi:10.1186/s13075-021-02482-2.

指标	升高[例（%）]	降低[例（%）]
CRP	17（100.00）	0
ESR	17（100.00）	0
LDH	17（100.00）	0
中性粒细胞百分比	16（94.12）	0
ALT	7（41.18）	0
AST	6（35.29）	0
WBC	9（52.94）	0
Hb	0	12（70.59）
RBC	0	6（35.29）
PLT	0	1（5.88）
指标	范围（最小值~最大值）	测量值[$\bar{x} \pm s$/M（P₂₅，P₇₅）]
CRP	13.70~155.89 mg/L	39.00（20.16，63.60）mg/L
ESR	25.00~70.00 mm/1 h	（47.53±12.37） mm/1 h
LDH	276.00~702.00 U/L	（451.06±118.57） U/L
中性粒细胞百分比	68.70%~91.00%	82.44%±5.89%
ALT	10.00~346.80 U/L	32.30（22.50，127.15）U/L
AST	22.00~235.90 U/L	31.10（26.95，59.25）U/L
WBC	（5.14~21.45）×10⁹/L	（11.80±5.58）×10⁹/L
Hb	（65.00~138.00） g/L	（108.12±16.10） g/L
RBC	（2.55~4.53）×10¹²/L	（3.86±0.51）×10¹²/L
PLT	（100.00~339.00）×10⁹/L	（258.76±60.54）×10⁹/L

指标	升高[例（%）]	降低[例（%）]
CRP	17（100.00）	0
ESR	17（100.00）	0
LDH	17（100.00）	0
中性粒细胞百分比	16（94.12）	0
ALT	7（41.18）	0
AST	6（35.29）	0
WBC	9（52.94）	0
Hb	0	12（70.59）
RBC	0	6（35.29）
PLT	0	1（5.88）
指标	范围（最小值~最大值）	测量值[$\bar{x} \pm s$/M（P₂₅，P₇₅）]
CRP	13.70~155.89 mg/L	39.00（20.16，63.60）mg/L
ESR	25.00~70.00 mm/1 h	（47.53±12.37） mm/1 h
LDH	276.00~702.00 U/L	（451.06±118.57） U/L
中性粒细胞百分比	68.70%~91.00%	82.44%±5.89%
ALT	10.00~346.80 U/L	32.30（22.50，127.15）U/L
AST	22.00~235.90 U/L	31.10（26.95，59.25）U/L
WBC	（5.14~21.45）×10⁹/L	（11.80±5.58）×10⁹/L
Hb	（65.00~138.00） g/L	（108.12±16.10） g/L
RBC	（2.55~4.53）×10¹²/L	（3.86±0.51）×10¹²/L
PLT	（100.00~339.00）×10⁹/L	（258.76±60.54）×10⁹/L

¹⁸F-FDG摄取	系统性评分	CRP	LDH	ALT	AST	ESR	WBC	RBC	Hb	PLT	中性粒细胞百分比
脾脏SUV_max	-0.126	0.575^＊	0.430	-0.097	-0.381	0.058	-0.038	-0.232	-0.055	-0.377	-0.026
骨髓SUV_max	0.100	0.549^＊	0.390	0.034	0.052	-0.143	0.201	0.049	0.274	0.171	0.275
淋巴结SUV_max	0.007	0.350	0.123	0.208	0.002	-0.318	-0.157	0.226	0.234	0.230	-0.308

¹⁸F-FDG摄取	系统性评分	CRP	LDH	ALT	AST	ESR	WBC	RBC	Hb	PLT	中性粒细胞百分比
脾脏SUV_max	-0.126	0.575^＊	0.430	-0.097	-0.381	0.058	-0.038	-0.232	-0.055	-0.377	-0.026
骨髓SUV_max	0.100	0.549^＊	0.390	0.034	0.052	-0.143	0.201	0.049	0.274	0.171	0.275
淋巴结SUV_max	0.007	0.350	0.123	0.208	0.002	-0.318	-0.157	0.226	0.234	0.230	-0.308

组别	n		脾脏SUV_max			淋巴结SUV_max		年龄/岁		ALT/（U/L）		AST/（U/L）
非复发组	8		3.80（2.70，4.00）			6.55（3.15，11.75）		33.00（28.25，54.25）		33.37（24.05，216.65）		42.00（29.75，90.58）
复发组	9		5.20（4.45，6.05）			6.10（5.30，11.30）		31.00（25.00，55.00）		32.30（19.10，81.30）		29.70（23.70，41.00）
Z			3.486^＊			0.385		0.433		0.481		1.347
组别		系统性评分		骨髓SUV_max			RBC/（×10¹²/L）		CRP/（mg/L）		LDH/（U/L）
非复发组		4.63±1.19		5.05±1.26			4.00±0.46		30.70±17.36		415.63±114.20
复发组		4.44±1.13		5.64±1.30			3.74±0.55		64.72±42.19		482.56±119.74
t		0.321		0.954			1.057		2.121		1.175
组别		中性粒细胞百分比/%			ESR/（mm/1 h）		WBC/（×10⁹/L）		PLT/（×10⁹/L）		Hb/（g/L）
非复发组		82.60±4.38			43.88±13.44		12.30±5.81		282.00±52.37		113.50±14.52
复发组		82.29±7.25			50.78±11.09		11.37±5.68		238.11±62.54		103.33±16.70
t		0.105			1.160		0.334		1.557		1.331

成人Still病活动度及复发风险与¹⁸F-FDG PET/CT代谢参数的相关性研究

Correlation between disease activity and recurrence risk of adult-onset Still's disease and ¹⁸F-FDG PET/CT metabolic parameters

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