幼年特发性关节炎患儿肾脏受累的观察

Renal involvement in children with juvenile idiopathic arthritis

目的观察幼年特发性关节炎(JIA)患儿肾脏受累的特点以及与临床分型、病程、用药之间的关系。方法回顾性分析60例JIA患儿的临床表现,并进行血沉、C反应蛋白、类风湿因子、血生化、免疫球蛋白、补体、抗核抗体、尿常规、尿系列蛋白等辅助检查。其中2例患儿接受肾穿刺活检。结果17例(28.3%)患儿出现尿常规异常,依次为全身型7例(7/18,占38.9%)、多关节型6例(6/22,占27.3%)、少关节型4例(4/20,占20.0%)。表现为孤立性血尿和(或)蛋白尿,其中1例全身型患儿合并肾小管损害,另有5例(8.3%)伴血清尿素氮增高。肾脏受累的JIA患儿中病程<1个月者12例(70.6%),初发未用药和短期(<2周)口服非甾体抗炎药者10例(58.8%)。结论血尿、蛋白尿是JIA患儿肾脏累及最常见的临床表现,以全身型较多见,其中原发疾病所致肾损害可能性较大。随访尿常规和肾功能,积极治疗原发病,将有助于减少肾脏病变的发生。

Objectives To investigate the characteristics of renal involvement in children with juvenile idiopathic arthritis （JIA）. Methods Sixty patients with JIA were included in the study. The clinical manifestations and laboratory data of these children were collected and analyzed. Results Isolated hematuria and/or proteinuria were presented in 17 patients （28.3%）, including 7 with systemic onset JIA （SOJIA）, 6 with polyarticular and 4 with oligoarticular. The level of Retino! Binding Protein （RBP） and N-acetyl-β-D-glucosa-minidase （NAG） in urine were higher than normal in one patient with SOJIA and 5 children had high blood urea nitrogen in serum. The course of 12 patients （70.6%） was less than 1 month. Ten patients （58.8%） were new DS cases or had accepted non-steroidal anti-inflammatory drugs for short period （ 〈 2 weeks）. Results Hematuria and/or proteinuria were the common manifestations of renal involvement in children with JIA, especially in SOJIA. Primary kidney damage may be the possible reason. Urinalysis and renal function should be monitored routinely. Rational utilization of drugs was helpful to improve prognosis.