Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (6): 966-974. doi: 10.19723/j.issn.1671-167X.2023.06.003

Previous Articles     Next Articles

Clinical characteristics and diagnostic indicators of macrophage activation syndrome in patients with systemic lupus erythematosus and adult-onset Still's disease

Hai-hong YAO1,Fan YANG1,2,Su-mei TANG1,Xia ZHANG1,Jing HE1,Yuan JIA1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
    2. Department of Rheumatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Received:2023-09-01 Online:2023-12-18 Published:2023-12-11
  • Contact: Yuan JIA E-mail:jiayuan1023@sina.com
  • Supported by:
    the National Natural Science Foundation of China(81801618)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To analyze and compare the clinical and laboratory characteristics of macrophage activation syndrome (MAS) in patients with systemic lupus erythematosus (SLE) and adult-onset Still's disease (AOSD), and to evaluate the applicability of the 2016 European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organization classification criteria for MAS complicating systemic juvenile idiopathic arthritis (sJIA) in different auto-immune diseases contexts and to propose new diagnostic predictive indicators. Methods: A retrospective analysis was conducted on the clinical and laboratory data of 24 SLE patients with MAS (SLE-MAS) and 24 AOSD patients with MAS (AOSD-MAS) who were hospitalized at Peking University People's Hospital between 2000 and 2018. Age- and sex-matched SLE (50 patients) and AOSD (50 patients) diagnosed in the same period without MAS episodes were selected as controls. The cutoff values for laboratory indicators predicting SLE-MAS and AOSD-MAS were determined using receiver operating characteristic (ROC) curves. Furthermore, the laboratory diagnostic predictive values for AOSD-MAS were used to improve the classification criteria for systemic juvenile idiopathic arthritis-associated MAS (sJIA-MAS), and the applicability of the revised criteria for AOSD-MAS was explored. Results: Approximately 60% of SLE-MAS and 40% of AOSD-MAS occurred within three months after the diagnosis of the underlying diseases. The most frequent clinical feature was fever. In addition to the indicators mentioned in the diagnosis criteria for hemophagocytic syndrome revised by the International Society for Stem Cell Research, the MAS patients also exhibited significantly elevated levels of aspartate aminotransferase and lactate dehydrogenase, along with a significant decrease in albumin. Hemophagocytosis was observed in only about half of the MAS patients. ROC curve analysis demonstrated that the optimal discriminative values for diagnosing MAS was achieved when SLE patients had ferritin level≥1 010 μg/L and lactate dehydroge-nase levels≥359 U/L, while AOSD patients had fibrinogen levels≤225.5 mg/dL and triglyceride levels≥2.0 mmol/L. Applying the 2016 sJIA-MAS classification criteria to AOSD-MAS yielded a diagnostic sensitivity of 100% and specificity of 62%. By replacing the less specific markers ferritin and fibrinogen in the 2016 sJIA-MAS classification criteria with new cutoff values, the revised criteria for classifying AOSD-MAS had a notable increased specificity of 86%. Conclusion: Secondary MAS commonly occurs in the early stages following the diagnosis of SLE and AOSD. There are notable variations in laboratory indicators among different underlying diseases, which may lead to misdiagnosis or missed diagnosis when using uniform classification criteria for MAS. The 2016 sJIA-MAS classification criteria exhibit high sensitivity but low specificity in diagnosing AOSD-MAS. Modification of the criteria can enhance its specificity.

Key words: Macrophage activation syndrome, Hemophagocytic lymphohistiocytosis, Systemic lupus erythematosus, Adult-onset Still's disease, Diagnosis

CLC Number: 

  • R593.2

Table 1

Demographic, clinical and laboratory characteristics of HLH patients"

Items AOSD-MAS (n=24) SLE-MAS (n=24) LYM-HLH (n=20)
Epidemiological features
  Female 21/24 (87.5) 20/24 (83.3) 9/20 (45.0)*#
  Age at diagnosis of HLH/years 34.7±15.2 40.0±15.2 49.1±20.0*
  Age at diagnosis of AD or LYM/years 33.0±16.9 38.5±16.5 48.3±20.2*
  Disease duration before HLH/months 22.7±66.9 21.4±43.0 11.3±26.9
Clinical and laboratory characteristics
  Fever (>38.5 ℃) 24/24 (100.0) 23/24 (95.8) 20/20 (100.0)
  Splenomegaly 18/24 (75.0) 13/24 (54.2) 15/20 (75.0)
  Hepatomegaly 1/24 (4.2) 4/24 (16.7) 5/20 (25.0)
  Lymphadenopathy 9/24 (37.5) 10/24 (41.7) 13/20 (65.0)
  Neurological involvement 4/24 (16.7) 3/24 (12.5) 7/20 (35.0)
  Disseminated intravascular coagulation 7/24 (29.2) 1/24 (4.2) 1/20 (5.0)
Cytopenia
  HB < 90 g/L 17/24 (70.8) 20/24 (83.3) 16/20 (80.0)
  PLT < 100×109/L 16/24 (66.7) 22/24 (91.7) 20/20 (100.0)*
  NE < 1×109/L 10/23 (43.5) 15/22 (68.2) 13/19 (68.4)
Hyperferritinemia (SF>500 μg/L) 24/24 (100.0) 23/24 (95.8) 18/19 (94.7)
Hypofibrinogenemia (FIBC < 1.5 g/L) 15/24 (62.5) 12/23 (52.2) 16/20 (80.0)
Hypertriglyceridemia (TG≥3 mmol/L) 14/24 (58.3) 13/23 (56.5) 10/10 (100.0)*#
LDH>250 U/L 23/24 (95.8) 24/24 (100.0) 18/20 (90.0)
Elevated aminotransferases
  ALT>40 U/L 23/24 (95.8) 15/23 (65.2)* 15/20 (75.0)
  AST>40 U/L 23/24 (95.8) 19/23 (82.6) 16/20 (80.0)
Hypoalbuminemia (ALB < 40 g/L) 23/24 (95.8) 24/24 (100.0) 19/20 (95.0)
Elevated ESR (>20 mm/h) 14/23 (60.7) 22/24 (91.7)* 19/20 (95.0)*
Elevated CRP(>8 mg/dL) 23/24 (95.8) 20/24 (83.3) 18/20 (90.0)
Hemophagocytosis in bone marrow 12/23 (52.2) 13/24 (54.2) 8/18 (44.4)
Low NK cell activity 8/21 (38.1) 9/17 (52.9) 6/10 (60.0)
Serum soluble CD25 receptor≥2 400 U/mL 16/17 (94.1) 14/17 (82.4) 9/10 (90.0)

Figure 1

Distribution of disease course in SLE and AOSD when MAS occurs AD, autoimmune disease; AOSD, adult-onset Still's disease; SLE, systemic lupus erythematosus; MAS, macrophage syndrome."

Table 2

Comparison of laboratory data in patients with HLH secondary to different diseases"

Items SLE (n=50) AOSD (n=50) SLE-MAS (n=24) AOSD-MAS (n=24) LYM-HLH (n=20)
WBC/(×109/L) 5.2
(1.0, 12.8)		 15.1
(4.9, 38.0)*#		 2.1
(0.2, 13.4)*		 3.8
(0.3, 27.0)		 1.7
(0.1, 6.4)
NE/(×109/L) 3.4
(0.7, 8.6)		 12.6
(3.3, 35.1)*#		 1.2
(0, 7.4)*		 2.6
(0, 24.2)		 1.1
(0, 5.5)
HB/(g/L) 107.8
(46.0, 180.0)		 107.3
(84.0, 129.0)#		 70.5
(40.0, 104.2)*#		 82.5
(49.0, 122.0)△		 70.4
(47.0, 136.0)
PLT/(×109/L) 155.8
(5.0, 381.0)		 305.0
(84.0, 576.0)*#		 42.8
(2.0, 134.0)*#△		 88.4
(7.0, 296.0)△		 23.6
(2.0, 90.0)
ESR/(mm/h) 31.8
(3.0, 92.0)		 72.3
(1.0, 133.0)*#		 66.6
(7.0, 120.0)*#		 32.0
(2.0, 78.0)		 44.6
(3.0, 129.0)
CRP/(mg/dL) 9.6
(0.3, 50.2)		 89.9
(4.0, 339.0)*		 60.4
(2.3, 364.0)*		 67.8
(7.5, 272.0)		 77.9
(3.0, 211.0)
ALT/(U/L) 33.0
(5.0, 215.0)		 19.8
(5.0, 73.0)*#		 109.4
(5.0, 619.0)*#		 715.8
(28.0, 3 550.0)△		 132.2
(11.0, 286.0)
AST/(U/L) 36.4
(9.0, 477.0)		 58.1
(11.0, 873.0)#		 308.5
(8.0, 1 424.0)*		 682.0
(14.0, 2 174.0)△		 203.5
(13.0, 665.0)
LDH/(U/L) 233.8
(120.0, 867.0)		 421.8
(140.0, 1 269.0)*#		 930.3
(360.0, 2 185.0)*#		 1 814.1
(244.0, 5 099.0)		 1 934.7
(170.0, 8 517.0)
TG/(mmol/L) 1.9
(0.4, 6.9)		 1.4
(0.7, 2.6)*#		 4.0
(1.4, 10.7)*		 3.2
(1.3, 5.8)△		 4.3
(1.0, 9.6)
ALB/(g/L) 34.9
(17.2, 46.8)		 33.1
(20.4, 41.0)*#		 24.6
(16.3, 34.2)*#		 29.3
(20.0, 40.0)△		 26.0
(19.0, 41.0)
FIBC/(mg/dL) 292.2
(123.0, 465.0)		 348.8
(178.0, 737.0)*#		 165.1
(26.0, 436.0)*		 139.0
(55.0, 307.0)		 129.6
(55.0, 349.0)
SF/(μg/L) 308.0
(11.0, 1 665.0)		 5 214.6
(522.0, 21 133.0)*#		 10 968.8
(455.0, 83 039.0)*#		 37 098.8
(2 000.0, 100 000.0)△		 18 364.7
(101.0, 63 917.0)

Table 3

Significant laboratory indicators and their cutoff values for the diagnosis of SLE-MAS"

Items AUC Cutoff value Sensitivity Specificity
SF 0.983 ≥1 010 μg/L 0.95 0.96
LDH 0.973 ≥359 U/L 0.90 1.00
AST 0.898 ≥33.5 U/L 0.82 0.96
PLT 0.887 ≤93.5×109/L 0.86 0.92
WBC 0.869 ≤2.5×109/L 0.86 0.79
NE 0.864 ≤1.6×109/L 0.84 0.83
HB 0.859 ≤85 g/L 0.82 0.83
FIBC 0.857 ≤183.5 mg/dL 0.94 0.71
CRP 0.836 ≥23.5 mg/dL 0.90 0.63
ALB 0.830 ≤29.7 g/L 0.82 0.79
TG 0.823 ≥1.9 mmol/L 0.58 0.96
ALT 0.807 ≥30.5 U/L 0.72 0.83
ESR 0.804 ≥57.0 mm/h 0.86 0.63

Table 4

Significant laboratory indicators and their cutoff values for the diagnosis of AOSD-MAS"

Items AUC Cutoff value Sensitivity Specificity
FIBC 0.988 ≤225.5 mg/dL 0.98 0.92
TG 0.953 ≥2.0 mmol/L 0.84 0.92
WBC 0.948 ≤6.3×109/L 0.96 0.92
NE 0.946 ≤4.3×109/L 0.98 0.92
AST 0.943 ≥110.0 U/L 0.97 0.96
PLT 0.941 ≤164.5×109/L 0.94 0.88
ALT 0.938 ≥74.5 U/L 0.86 0.92
LDH 0.915 ≥667.5 U/L 0.90 0.83
HB 0.900 ≤97.5 g/L 0.76 0.92
ESR 0.862 ≥59.5 mm/h 0.64 0.92
SF 0.833 ≥13 283.5 μg/L 0.88 0.63
ALB 0.758 ≤31.7 g/L 0.70 0.79
CRP 0.636 ≥54.9 mg/dL 0.72 0.58

Table 5

Application of the 2016 sJIA-MAS criteria in AOSD-MAS patients"

Items AOSD-MAS, n(%) AOSD, n(%) Sensitivity/% Specificity/% PPV/% NPV/%
Fulfilling criteria 24 (100.0) 19 (38.0) 100.0 62.0 56.0 100.0
SF>684 μg/L 24 (100.0) 46 (92.0) 100.0 8.0 34.0 100.0
PLT≤181×109/L 21 (87.5) 9 (18.0) 87.5 82.0 70.0 93.0
AST>48 U/L 23 (95.8) 15 (30.0) 95.8 70.0 61.0 97.0
TG>156 mg/dL 22 (91.7) 9 (18.0) 91.7 82.0 71.0 95.0
FIBC≤360 mg/dL 24 (100.0) 32 (64.0) 100.0 36.0 43.0 100.0

Table 6

Application of the revised 2016 sJIA-MAS criteria in AOSD-MAS patients"

Items AOSD-MAS, n(%) AOSD, n(%) Sensitivity/% Specificity/% PPV/% NPV/%
Fulfilling criteria 24 (100.0) 7 (14.0) 100.0 86.0 77.1 100.0
SF>2 000 μg/L 24 (100.0) 32 (64.0) 100.0 36.0 42.9 100.0
PLT≤181×109/L 21 (87.5) 9 (18.0) 87.5 82.0 70.0 93.0
AST>48 U/L 23 (95.8) 15 (30.0) 95.8 70.0 61.0 97.0
TG>156 mg/dL 22 (91.7) 9 (18.0) 91.7 82.0 71.0 95.0
FIBC≤225.5 mg/dL 23 (95.8) 1 (2.0) 95.8 98.0 95.8 98.0
1 Ravelli A , Minoia F , Davi S , et al. 2016 classification criteria for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative[J]. Ann Rheum Dis, 2016, 75 (3): 481- 489.
doi: 10.1136/annrheumdis-2015-208982
2 Henter JI , Horne A , Arico M , et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis[J]. Pediatr Blood Cancer, 2007, 48 (2): 124- 131.
doi: 10.1002/pbc.21039
3 Hochberg MC . Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus[J]. Arthritis Rheum, 1997, 40 (9): 1725.
4 Petri M , Orbai AM , Alarcon GS , et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus[J]. Arthritis Rheum, 2012, 64 (8): 2677- 2686.
doi: 10.1002/art.34473
5 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.
6 Vardiman JW , Harris NL , Brunning RD . The World Health Organization (WHO) classification of the myeloid neoplasms[J]. Blood, 2002, 100 (7): 2292- 2302.
doi: 10.1182/blood-2002-04-1199
7 Swerdlow SH , Campo E , Pileri SA , et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms[J]. Blood, 2016, 127 (20): 2375- 2390.
doi: 10.1182/blood-2016-01-643569
8 Crayne CB , Albeituni S , Nichols KE , et al. The immunology of macrophage activation syndrome[J]. Front Immunol, 2019, 10, 119.
doi: 10.3389/fimmu.2019.00119
9 Lenert A , Oh G , Ombrello MJ , et al. Clinical characteristics and comorbidities in adult-onset Still's disease using a large US administrative claims database[J]. Rheumatology (Oxford), 2020, 59 (7): 1725- 1733.
doi: 10.1093/rheumatology/kez622
10 Ramos-Casals M , Brito-Zeron P , Lopez-Guillermo A , et al. Adult haemophagocytic syndrome[J]. Lancet, 2014, 383 (9927): 1503- 1516.
doi: 10.1016/S0140-6736(13)61048-X
11 姚海红, 王旖旎, 张霞, 等. 67例成人巨噬细胞活化综合征的临床特征及治疗转归[J]. 北京大学学报(医学版), 2019, 51 (6): 996- 1002.
doi: 10.19723/j.issn.1671-167X.2019.06.003
12 Liu AC , Yang Y , Li MT , et al. Macrophage activation syndrome in systemic lupus erythematosus: A multicenter, case-control study in China[J]. Clin Rheumatol, 2018, 37 (1): 93- 100.
doi: 10.1007/s10067-017-3625-6
13 Kumakura S , Murakawa Y . Clinical characteristics and treatment outcomes of autoimmune-associated hemophagocytic syndrome in adults[J]. Arthritis Rheumatol, 2014, 66 (8): 2297- 2307.
doi: 10.1002/art.38672
14 Sen ES , Clarke SL , Ramanan AV . Macrophage activation syndrome[J]. Indian J Pediatr, 2016, 83 (3): 248- 253.
doi: 10.1007/s12098-015-1877-1
15 Knovich MA , Storey JA , Coffman LG , et al. Ferritin for the clinician[J]. Blood Rev, 2009, 23 (3): 95- 104.
doi: 10.1016/j.blre.2008.08.001
16 Ravelli A , Minoia F , Davi S , et al. Expert consensus on dynamics of laboratory tests for diagnosis of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis[J]. RMD Open, 2016, 2 (1): e000161.
doi: 10.1136/rmdopen-2015-000161
17 Gao Q , Yuan Y , Wang Y , et al. Clinical characteristics of macrophage activation syndrome in adult-onset Still's disease[J]. Clin Exp Rheumatol, 2021, 39 (5): 59- 66.
doi: 10.55563/clinexprheumatol/lp2u7g
18 Yang XP , Wang M , Li TF , et al. Predictive factors and prognosis of macrophage activation syndrome associated with adult-onset Still's disease[J]. Clin Exp Rheumatol, 2019, 37 (6): 83- 88.
19 Wang R , Li T , Ye S , et al. Macrophage activation syndrome associated with adult-onset Still's disease: A multicenter retrospective analysis[J]. Clin Rheumatol, 2020, 39 (8): 2379- 2386.
doi: 10.1007/s10067-020-04949-0
20 Di Benedetto P , Cipriani P , Iacono D , et al. Ferritin and C-reactive protein are predictive biomarkers of mortality and macrophage activation syndrome in adult onset Still's disease. Analysis of the multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort[J]. PLoS One, 2020, 15 (7): e0235326.
doi: 10.1371/journal.pone.0235326
21 Lehmberg K , McClain KL , Janka GE , et al. Determination of an appropriate cut-off value for ferritin in the diagnosis of hemophagocytic lymphohistiocytosis[J]. Pediatr Blood Cancer, 2014, 61 (11): 2101- 2103.
doi: 10.1002/pbc.25058
22 Minoia F , Davi S , Horne A , et al. Clinical features, treatment, and outcome of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: A multinational, multicenter study of 362 patients[J]. Arthritis Rheumatol, 2014, 66 (11): 3160- 3169.
doi: 10.1002/art.38802
23 Gauvin F , Toledano B , Champagne J , et al. Reactive hemophagocytic syndrome presenting as a component of multiple organ dysfunction syndrome[J]. Crit Care Med, 2000, 28 (9): 3341- 3345.
doi: 10.1097/00003246-200009000-00038
24 Wiwanitkit V . Bone marrow leishmaniasis: A review of situation in Thailand[J]. Asian Pac J Trop Med, 2011, 4 (10): 757- 759.
doi: 10.1016/S1995-7645(11)60188-0
25 刘燕鹰, 周姝含, 张莉, 等. 噬血细胞综合征77例临床分析[J]. 中华医学杂志, 2015, 95 (9): 681- 684.
doi: 10.3760/cma.j.issn.0376-2491.2015.09.011
26 Shimizu M , Mizuta M , Yasumi T , et al. Validation of classification criteria of macrophage activation syndrome in Japanese patients with systemic juvenile idiopathic arthritis[J]. Arthritis Care Res (Hoboken), 2018, 70 (9): 1412- 1415.
doi: 10.1002/acr.23482
27 Tada Y , Inokuchi S , Maruyama A , et al. Are the 2016 EULAR/ACR/PRINTO classification criteria for macrophage activation syndrome applicable to patients with adult-onset Still's disease?[J]. Rheumatol Int, 2019, 39 (1): 97- 104.
doi: 10.1007/s00296-018-4114-1
28 Bae CB , Jung JY , Kim HA , et al. Reactive hemophagocytic syndrome in adult-onset Still disease clinical features, predictive factors, and prognosis in 21 patients[J]. Medicine, 2015, 94 (4): e451.
doi: 10.1097/MD.0000000000000451
29 Hot A , Toh ML , Coppere B , et al. Reactive hemophagocytic syndrome in adult-onset Still disease clinical features and long-term outcome: A case-control study of 8 patients[J]. Medicine, 2010, 89 (1): 37- 46.
doi: 10.1097/MD.0b013e3181caf100
30 Lin SJ , Chao HC , Yan DC . Different articular outcomes of Still's disease in Chinese children and adults[J]. Clin Rheumatol, 2000, 19 (2): 127- 130.
doi: 10.1007/s100670050030
[1] Xiaofei TANG, Qiuling DING, Yang ZHANG, Yumei WANG, Meiyi TIAN, Zhuo SUN, Rongrong WANG, Yan CHEN, Jian LIU. Refractory systemic lupus erythematosus-associated thrombocytopenia treated with avatrombopag: A case report [J]. Journal of Peking University (Health Sciences), 2026, 58(2): 405-409.
[2] Ye ZHAO, Xiaoli DIAO, Yan XIONG. Application of cell transfer technology in pathological diagnosis of micro-volume cell fluid [J]. Journal of Peking University (Health Sciences), 2026, 58(1): 208-213.
[3] Yue WANG, Yuhong LIANG. Florid cemento-osseous dysplasia: A case report [J]. Journal of Peking University (Health Sciences), 2026, 58(1): 220-224.
[4] Yanting CHI, Hongjie JIANG, Yan CHEN, Zhixiu XU, Binbin LI. Value of direct immunofluorescence in the diagnosis of oral mucosal pemphigus vulgaris: A retrospective study based on multi-index combined analysis [J]. Journal of Peking University (Health Sciences), 2026, 58(1): 68-73.
[5] Xinyi LI, Jinxia ZHAO, Rong MU. Impact of aspirin use on pregnancy outcomes in patients with systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1074-1080.
[6] Xiaolin WANG, Shaoyi GUO, Dazhao CHEN, Xijie WEN, Yong HUA, Liang ZHANG, Qin ZHANG. A follow-up study on total hip arthroplasty in patients with systemic lupus erythematosus combined with osteonecrosis of femoral head [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1081-1088.
[7] Chun WEI, Yue YANG, Xinju ZHAO, Xu LIU, Yuan JIA. Systemic lupus erythematosus complicated by autoimmune nodopathy: A case report [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1174-1179.
[8] Kai ZHAO, Fu'ai LU, Yongfu WANG. Central nervous system infection mimicking neuropsychiatric systemic lupus erythematosus: A case report [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1188-1192.
[9] Jingyan GU, Xinyi LI, Jinxia ZHAO, Rong MU. Diabetic Charcot neuroarthropathy initially misdiagnosed as rheumatoid arthritis and gout: A case report [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1193-1197.
[10] Xiaodi XIAO, Youchen XIA, Jianying LIU, Peng FU. Left sided sternocleidomastoid interosseous intravascular papillary endothelial hyperplasia: A case report [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 1002-1004.
[11] Xiangyu SUN, Chao YUAN, Xinzhu ZHOU, Jing DIAO, Shuguo ZHENG. Application of salivary micro-ecosystem in early prevention and control of oral and systemic diseases [J]. Journal of Peking University (Health Sciences), 2025, 57(5): 859-863.
[12] Wenqiong WANG, Yuke HOU, Chun LI, Xuewu ZHANG. Predictors of adverse pregnancy outcomes in patients with systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 599-603.
[13] Zhao CHEN, Yongkang QIU, Lei KANG. Classical Sweet syndrome with multiple organ lesions by 18F-FDG PET/CT: A case report [J]. Journal of Peking University (Health Sciences), 2025, 57(2): 403-407.
[14] Guangyan YU, Xin PENG, Min GAO, Peng YE, Na GE, Mengqi JIA, Bingyu LI, Zunan TANG, Leihao HU, Wenbo ZHANG. Research progress in diagnosis and treatment of salivary gland tumors [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 1-6.
[15] Yuanyuan FANG, Fan XU, Jie LEI, Hao ZHANG, Wenyu ZHANG, Yu SUN, Hongxin WU, Kaiyuan FU, Weiyu MAO. Development and validation of a clinical automatic diagnosis system based on diagnostic criteria for temporomandibular disorders [J]. Journal of Peking University (Health Sciences), 2025, 57(1): 192-201.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd