幼年附着点炎相关性关节炎148例临床特点分析

Clinical analysis of 148 cases of juvenile enthesitis related arthritis

目的探讨幼年附着点炎相关性关节炎(enthesitis related arthritis,ERA)早期临床诊疗特点及转归,以期通过早期诊断改善患儿预后。方法回顾性分析2006年1月至2010年12月,首都医科大学附属北京儿童医院住院的ERA患者148例,分别采集其住院及治疗不同时期的临床及辅助检查资料,分析疾病特点。结果本研究的研究对象男性124例,女性24例,所有患者均以外周大关节炎伴或不伴肌腱附着点炎为首发表现。可同时伴有非特异性症状。炎性指标轻中度升高,HLA-B27阳性率12.76%,虹膜睫状体炎发生率2.03%。结论 (1)ERA好发于年长儿童,男性发病高于女性;(2)发病年龄晚的ERA患者放射学改变较幼年发病者显著;(3)躯干中轴关节受累者较成人少见;(4)HLA-B27阴性的ERA在儿童多见,炎性指标轻中度升高;(5)合并症方面,色素膜炎较成人少见。

Objective To investigate the early clinical characteristics,diagnosis and treatments of enthesitis related arthritis（ ERA）,and to improve the prognosis through early diagnosis. Methods A retrospective analysis was performed on 148 ERA patients who were hospitalized in Beijing Children’s Hospital during the period from Jan. 1st 2006 to Dec. 31 st 2010. The clinical and laboratory data of the patients were collected for analysis of characteristics. Chi-square test and t test were used for comparisons of variables. Results In this study a total of 148 cases were included,and 124 cases were boys,24 were girls. All patients had peripheral arthritis with or without tendon enthesitis as first manifestation. Early ERA patients usually had nonspecific symptoms. Parameters of inflammation had mild to moderate increase,and the positive rate of HLA-B27 was 12. 76%. Uveitis occurred in 2. 03% children. Conclusion（ 1） ERA usually occurs in older children,the incidence among male is higher than that among female;（ 2） The serious radiological changes of ERA are consistent with the patients age of onset;（ 3） The trunk axial joint is less frequently involved than werethe adults;（ 4） Laboratory examination： HLA-B27 negative ERA is more common in children,Laboratory markers of Inflammation had a mild to moderate increase;（ 5） Complications： uveitis occur less frequently than adults.