摘要
目的探讨幼年特发性关节炎(JIA)多关节型、少关节型临床特征、药物治疗及效果。方法回顾性分析重庆医科大学附属儿童医院2006年1月至2011年1月间收治的89例多关节型、少关节型JIA患儿临床病例资料,分析其临床特征、辅助检查、药物治疗及疗效。结果 89例JIA中男42例、女47例,男女比例约为1∶1.1,其中少关节型37例(41.57%),均为持续型;多关节型52例(58.42%),其中类风湿因子(RF)阳性10例(19.23%),RF阴性42例(80.77%);学龄期组(>8岁)占患儿总数48.31%。少关节型JIA易受累关节依次为膝(28.00%)、踝(21.33%)及髋关节(17.33%);而多关节型JIA主要累及膝(20.00%)、踝(18.50%)、指间(18.00%)及腕关节(16.00%)。4例出现眼虹膜睫状体炎,均不伴抗核抗体(ANA)阳性。5例(27.78%)HLA-B27阳性。61例(80.26%)采用非甾体类抗炎药(NSAID)、缓解病情抗风湿药(DMARD)联合治疗,其中60例均口服甲氨蝶呤(MTX),其中疗效欠佳的28例多关节型JIA使用肿瘤坏死因子(TNF)受体抗体融合蛋白治疗,采用欧洲风湿病协会疾病活动性评分(DAS28)下降均>1.2分,且未见明显副反应。结论多关节型JIA较少关节型多见,均以学龄期儿童发病为高,在多关节型中女性患儿显著多于男性。本组JIA中虹膜睫状体炎发病率低,且均不伴ANA阳性,HLA-B27阳性率较高。DAS28可用于评价JIA药物治疗效应。目前MTX已成为治疗多关节型JIA基础药物,TNF受体抗体融合蛋白等生物制剂的应用对改善症状及预后起积极作用。
Objective To investigate characteristics of clinical manifestation and therapy in children with oligoarticular and polyarticular juvenile idiopathic arthritis (JIA). Methods The medical records of 89 children with polyarticular or oligoarticular JIA in Children's Hospital of Chongqing Medical University from 2006 to 2011 were retrospectively re- viewed. Results Totally 42 boys and 47 girls (M:F ratio, 1:1.1 ) were included in the study, nearly a half (48.31% ) were older than the age of 8 years.There were 37 cases of oligoarticular JIA, no case of extended oligoarthritis, and 52 cas- es of polyarticular JIA, consisting of 10 cases of rheumatoid factor positive (RF+) and 42 cases of rheumatoid factor neg- ative(RF-). Oligoarticular and polyarticular JIA were mainly characterized with joint symptoms, while systemic and ex- tra-articular symptoms were rare. Oligoarthritis predominantly involved legs, with the knee joints (28.00%) mostly af- fected, followed by the ankles (21.33%) and hips (17.33%). Polyarthritis also affected the large joints at onset, knees (20.00%) and ankles (18.50%) , but usually in association with small joints of the hands (18.00%) and wrist joints (16.00%). Chronic uvitis was recognized in 4 cases (4.50%), without ANA positive. Laboratory investigations were justused to help differential diagnosis. There was a high posi- tive rate of HLA-B27 (27.78%). Sixty-one patients were treated with a combination therapy of NSAIDs and DMARDs. For the 28 refractory cases, the treatment with tumor necrosis factor receptor-antibody fusion protein was effective without adverse reaction. Conclusion Pa- tients suffering from polyarthritis are more than thosefrom oligoarthritis, which both mostly affect the school-age children. The females with polyarthritis are significantly more than males.There is a high positive rate of HLA-B27, and low rate of antinuclear antibody and occurrence of irido- cyclitis. DAS28 is a suitable criteria to evaluate clinical response in JIA. Metbotrexate has been proved safe and effective for polyarthritis. Tumor necrosis factor receptor - antibody fusion protein is safe and effective to relieve the joint symp- tom, which helps to improve the prognosis of JIA.
出处
《中国实用儿科杂志》
CSCD
北大核心
2013年第5期361-365,共5页
Chinese Journal of Practical Pediatrics
基金
重庆市卫生局中医药科技项目资助(项目编号:渝中医[2011]57号-2011-2-129)