摘要
目的比较类风湿因子(RF)阳性(+)和阴性(-)多关节型幼年特发性关节炎(PJIA)患儿的临床特点、疗效和药物不良反应。方法回顾性分析2013年1月至2018年12月华中科技大学同济医学院附属同济医院收治的67例PJIA患儿临床资料,根据RF滴度分为RF(+)组(23例)和RF(-)组(44例),比较2组患儿临床特征、实验室指标及临床疗效。结果1.受累关节分布情况:RF(+)组前3位依次为指关节(16例,69.57%)、腕关节(15例,65.22%)和踝关节(13例,56.52%),RF(-)组受累关节依次为膝关节(33例,75.00%)、踝关节(29例,65.91%)和髋关节(26例,59.09%),RF(+)组腕关节受累明显高于RF(-)组,而膝关节受累者低于RF(-)组,差异均有统计学意义(均P<0.01)。2.受累关节磁共振改变:2组关节腔积液(54例,84.38%)、滑膜增厚(44例,68.75%)及骨质水肿(26例,40.63%)常见,RF(+)组骨质破坏(7例,70.00%)及软组织水肿(7例,70.00%)发生率高于RF(-)组(2例,18.18%和2例,18.18%),差异均有统计学意义(均P<0.05)。3.实验室指标变化:RF(+)组C反应蛋白以及红细胞沉降率、抗环瓜氨酸肽抗体和抗核抗体阳性率明显高于RF(-)组(均P<0.05)。4.幼年型关节炎疾病活动评分(JADAS27评分)情况:RF(+)组和RF(-)组组间评分差异无统计学意义[(22.83±5.60)分比(23.07±6.66)分,t=0.148,P>0.05]。5.疗效分析:2例患儿出院后失访,余65例给予传统治疗,其中30例初次住院即予生物制剂以及9例传统治疗失败后改生物制剂治疗,35例生物制剂治疗后疾病活动控制,在不同给药方案中,RF(-)组疾病缓解率普遍高于RF(+)组。结论PJIA患者关节受累情况多样化,RF(+)患者容易出现关节破坏,传统治疗疗效差,生物制剂能够有效改善重症PJIA尤其是有预后不良因素患儿的症状,改善预后。
Objective To compare the clinical characteristics,clinical efficacy and adverse drug reactions of rheumatoid factor(RF)positive(+)and negative(-)polyarticular juvenile idiopathic arthritis(PJIA).Methods The clinical data of 67 PJIA patients admitted into Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,from January 2013 to December 2018 were analyzed retrospectively.They were divided into RF-positive PJIA group[RF(+)group,23 cases]and RF-negative PJIA group[RF(-)group,44 cases]according to RF titer.The clinical characteristics,laboratory indexes and clinical efficacy evaluation of the two groups were compared.Results(1)Distribution of affected joints:the top 3 affected joints in the RF(+)group were the knuckles(16 cases,69.57%),the wrists(15 cases,65.22%)and the ankles(13 cases,56.52%),and those in the RF(-)group were the knees(33 cases,75.00%),ankle joints(29 cases,65.91%)and hip joints(26 cases,59.09%).The wrist joint involvement of the RF(+)group was significantly higher than that of the RF(-)group,while the knee joint involvement was lower than that of the RF(-)group.The difference was statistically significant(all P<0.01).(2)Magnetic resonance changes of the affected joints:articular cavity effusion(54 cases,84.38%),synovial thickening(44 cases,68.75%)and bone edema(26 cases,40.63%)are common in both groups.The incidence of bone destruction(7 cases,70.00%)and soft tissue edema(7 cases,70.00%)in the RF(+)group was higher than that in the RF(-)group(2 cases,18.18%and 2 cases,18.18%),the difference was statistically significant(all P<0.05).(3)Changes in laboratory indicators:the positive rates of C-reactive protein,erythrocyte sedimentation rate,anti-cyclic citrullinated peptide antibody and anti-nuclear antibody in the RF(+)group were significantly higher than those in the RF(-)group,the difference was statistically significant(all P<0.05).(4)Juvenile arthritis disease activity score 27(JADAS27):the score difference between RF(+)group and RF(-)group was not statistically significant[(22.83±5.60)scores vs.(23.07±6.66)scores,t=0.148,P>0.05].(5)Efficacy analysis:2 patients were lost to follow-up after discharge,and the remaining 65 patients were treated with traditional therapy,of which 30 were given biologics at the first hospitalization,9 cases were treated with biologics after the failure of traditional treatments,and 35 patients were treated with biologics to control disease activity.In different dosage regimens,the disease remission rate in the RF(-)group is generally higher than that in the RF(+)group.Conclusions PJIA patients have complicated joint involvement,RF-positive patients are more prone to joint destruction,and traditional treatments are less effective.Biological agents can effectively improve the symptoms of severe PJIA patients,especially those with poor prognosis.
作者
凌加云
温宇
何璐
卢慧玲
卢平
张莎莎
胡秀芬
Ling Jiayun;Wen Yu;He Lu;Lu Huiling;Lu Ping;Zhang Shasha;Hu Xiufen(Department of Pediatrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Rheumatology and Immunology,Shenzhen Children′s Hospital,Shenzhen 518038,Guangdong Province,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2021年第17期1320-1324,共5页
Chinese Journal of Applied Clinical Pediatrics
关键词
幼年特发性关节炎
多关节型
临床诊疗
回顾性研究
Juvenile idiopathic arthritis,polyarthritis
Clinical diagnosis and treatment
Retrospective study
作者简介
通信作者:胡秀芬,Email:xfhu2007@163.com。
