幼年特发性关节炎肺胸膜病变的相关因素分析

Risk factors for pleural lung disease in children with juvenile idiopathic arthritis

目的探讨幼年特发性关节炎(JIA)患儿肺胸膜病变(PLD)的高危因素,为临床判断病情、及时处理提供依据。方法回顾分析360例JIA患儿的临床资料,所有患儿均行胸部X线影像学检查,将患儿分为合并PLD组和无PLD组,分析JIA伴肺胸膜病变(JIA-PLD)患儿的临床、影像学及相关实验室指标。结果 360例JIA患儿中,JIA-PLD共43例(11.9%),其中有呼吸系统症状者9例(21%)。胸部影像学异常主要表现为间质性肺炎(53.5%),其次为胸膜炎和/或胸腔积液(38.1%)。43例JIA-PLD中胸片正常而胸部CT异常者4例(9.3%)。<3岁或≥12岁年龄组PLD发生率较高。全身型JIA患儿PLD发生率较高。与无PLD组比较,PLD组患儿贫血、外周血白细胞及免疫球蛋白G升高、类风湿因子或抗核抗体阳性发生率更高(P<0.05)。结论 JIA-PLD多发生于全身型JIA;PLD好发于年龄<3岁或≥12岁者;伴有贫血、外周血WBC及免疫球蛋白G升高、类风湿因子或抗核抗体阳性者PLD发生率高。PLD影像学多表现为间质性肺炎,但由于患儿多缺乏呼吸系统表现,建议常规高分辨率胸部CT检查以便临床早期发现、及时处理。

Objective To investigate the risk factors for pleural lung disease （PLD） in children with juvenile idiopathic arthritis （JIA） and to provide a basis for the early diagnosis and timely treatment of this disease. Methods A total of 360 children with a confirmed diagnosis of JIA were enrolled, and their clinical data were retrospectively analyzed. All patients underwent a chest X-ray. The patients with PLD were assigned to PLD group, while those without PLD were assigned to non-PLD group. The clinical, imaging, and laboratory results of JIA patients with PLD were analyzed. Results Among the 360 JIA patients, 43 （11.9%） had PLD, and 9 （21%） of them had respiratory symptoms. Chest X-ray findings mainly included interstitial pneumonitis （53.5%） and pleurisy and/or pleural effusion （38.1%）. In the 43 cases of JIA-PLD, 4 （9.3%） had normal chest X-ray findings but abnormal chest CT findings. The incidence of PLD was relatively high in patients aged under 3 years and those aged 12 years or above. Children with systemic JIA had a relatively high incidence of PLD. Compared with the non-PLD group, the PLD group had a significantly higher incidence of anemia, elevated white blood cell （WBC） count and IgG levels in peripheral blood, and positive rheumatoid factors or antinuclear antibodies （P〈0.05）. Conclusions Among children with JIA, PLD is mostly seen in patients with systemic JIA or aged 〈3 years or 〉12 years, especially those with anemia, elevated WBC count and IgG levels, and positive rheumatoid factors or antinuclear antibodies. For JIA patients with PLD, interstitial pneumonitis is usually seen on chest X-ray or CT, but respiratory symptoms are rarely observed. Routine use of high-resolution chest CT is recommended for early diagnosis and timely, treatment of PLD in children with JIA.