摘要
目的探讨特应质对幼年特发性关节炎（JIA）病情变化的影响。方法收集2008年7月至2013年7月于上海交通大学医学院附属仁济医院儿科住院或门诊就诊的JIA患儿117例，通过回顾性队列研究的方法，分为JIA特应质组34例和JIA非特应质组83例；再从JIA特应质组分为患有变应性鼻炎（AR）患儿19例和无AR15例，分别记录每组患儿入组时临床及实验室相关资料，通过数据分析和统计，分别比较JIA特应质组与JIA非特应质组、JIA并AR组和JIA无AR组之间美国风湿病学会（儿科）标准（ACRPedi）30／50／70缓解情况及JIA并AR组中AR评分与28个关节疾病活动度（DAS28）的相关性。结果1．JIA特应质组起病时医师疾病严重度评价（VAS）、患儿或监护人VAS、关节活动受限数目以及儿童健康评估问卷（CHAQ）评分均高于JIA非特应质组（P均〈0．05）；JIA特应质组在发病3个月达ACRPedi30、50，发病6个月达ACRPedi50、70的比例均低于JIA非特应质组（P均〈0．05）；在发病3、6个月后，JIA特应质组单位体质量糖皮质激素累积剂量大于JIA非特应质组，差异均有统计学意义（P均〈0．05）。2．在JIA并AR组和JIA无AR组中发现：入组时JIA并AR组的医师VAS、患儿或监护人VAS、关节活动受限数目以及CHAQ评分均高于无AR组（P均〈0．05）；在确诊后的3个月，JIA并AR组达ACRPedi30、50的比例比较低；确诊后的6个月发现JIA并AR组单位体质量糖皮质激素累积剂量大于JIA无AR组，而达ACRPedi30、50、70比例低于JIA无AR组，差异均有统计学意义（P均〈0．05）；JIA并AR组患儿入组时、3个月、6个月发现AR评分和DAS28均呈正相关（r=0．671、0．518、0．496，P均〈0．05）。结论JIA患儿合并特应质或者AR可能对JIA病情产生不利影响。
Objective To evaluate the influence of atopy on juvenile idiopathic arthritis （JIA）. Methods The study involved 117 cases with JIA from Department of Pediatrics, Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from Jul. 2008 to Jul. 2013. These patients were enrolled for retrospective cohort study, and subdivided into JIA and atopic group or JIA and non-atopic group. There were 34 cases combined with atopy, 83 cases without atopy. Based on the diagnosis of allergic rhinitis（AR） ,those JIA children in the atopic group were organized in- to AR group（ 19 cases） and non-AR group（ 15 cases）. The clinical and laboratory data were recorded and analyzed to compare the differences of the remission of American College of Rheumatology Pediatric （ACR Pedi）30/50/70 between atopic group and non-atopic group, AR group and non-AR group. In AR group, the correlation between AR scores and disease activity score（DAS28） was analyzed. Results 1. The physician＇s and patients＇/parents＇ general assessment on a 100 mm visual-analogue scale（VAS） , number of joints with restriction of movement and childhood health assessment questionnaire（CHAQ） were significantly elevated in atopic group compared with controls at the beginning（ all P 〈 0.05 ）. In the follow-up 3 months after disease onset , the proportion of reaching ACR Pedi 30,50 and the proportion of reaching ACR Pedi 50,70 in 6 months later in JIA with atopy were lower than JIA children without atopy （ all P 〈 0.05 ） ; In the follow-up 3 and 6 months, the cumulative glucocorticoid dose was higher in atopy group compared with Non-atopy, which showed a statistical significance （ all P 〈 0.05 ）. 2. Among the AR group, at the disease onset, the phy- sician＇s and patients＇/parents＇ VAS, number of joints with restriction of movement and CHAQ were elevated in AR group compared with controls with statistical significance （ all P 〈 0.05 ）. In the follow-up 3 months, the proportion of reaching ACR Pedi 30 and 50 was lower in AR group compared with non-AR group. In the follow-up 6 months, the cu- mulative glucocorticoid dose was higher in AR group compared with non-AR, which showed a statistical significance. But the ratio of ACR Pedi 30,50 and 70 were lower in AR group compared with non-AR group（ all P 〈 0.05 ）. Among JIA combined with AR, at the beginning, follow-up 3 and 6 months after disease onset, the scores of AR positively correlated with DAS28 （r = 0. 671,0. 518,0. 496, all P 〈0. 05 ）. Conclusion Atopy or AR may exert an adverse influence on JIA.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2014年第9期663-667,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
上海市中医药事业发展三年行动计划第二批重大研究项目（ZYSNXD-CC-ZDYJ030）
作者简介
通信作者：孔宪明，Email：prokxm@163．com
