儿童川崎病合并关节炎的患病率和临床特征比较

Prevalence and clinical characteristics of Kawasaki disease with arthritis in children

目的探讨川崎病合并关节炎的患病率、临床特征及其与冠状动脉病变的关系。方法2015年1月至2020年6月厦门市儿童医院心内科确诊的454例川崎病患儿,根据是否有关节受累分为合并关节炎组53例和未合并关节炎组401例,回顾性分析两组患儿的临床症状和实验室结果。结果454例儿童纳入研究,其中53例有关节受累,男32例,女21例,平均年龄(5.89±1.35)岁,未合并关节炎组的平均年龄(4.28±1.25)岁,差异有统计学意义(P=0.026)。53例关节受累患儿中,小关节受累36例(67.92%),髋关节14例(26.41%),腕关节10例(18.87%),膝关节8例(15.09),肘关节4例(7.55%),踝关节3例(5.66%)。合并关节炎组的53例患儿中静脉注射免疫球蛋白(intravenous immunogloblin,IVIG)无反应型川崎病14例(26.14%),比未合并关节炎组IVIG无反应型43例(10.72%)发生率明显升高,差异有统计学意义(P=0.002)。合并关节炎组患儿的炎症标记物水平(CRP、TNF-α、IL-6)较未合并关节炎组明显升高,差异有统计学意义(P<0.05),合并关节炎组冠状动脉病变发生率(60.38%,32/53)高于未合并关节炎组(52.37%,210/401),但差异无统计学意义(P>0.05)。结论儿童川崎病合并关节炎有自限性,一般没有后遗症。与未发生关节炎的患儿相比,合并关节炎组患儿更易对IVIG治疗无反应,炎症指标更高,但冠状动脉病变发生率未见明显差异。

Objective To investigate the incidence and clinical characteristics of Kawasaki disease complicated with arthritis,and explore the relationship with coronary artery disease.Methods Patients diagnosed with Kawasaki disease at Xiamen Children′s Hospital from January 2015 to June 2020 were included in this study.They were divided into the arthritis group(n=53)and the non-arthritis group(n=401),depending on whether complicated with arthritis.Demographic,clinical symptoms,and laboratory results were retrospectively analyzed.Results A total of 454 children were included in this study with 53 cases acomplicated with arthritis.There were 32 male cases and 21 female cases.The average age of arthritis group was(5.89±1.35)y,which was older than non-arthritis group[(4.28±1.25)y,P=0.026].Among the 53 cases of arthritis group,36 cases(67.92%)of small jiont arthritis,14 cases(26.41%)of coxitis,ten cases(18.87%)of carpitis,eight cases(15.09%)of gonitis,four cases(7.55%)of anconitis,and three cases(5.66%)of ankle arthritis were involved.There was a statistic difference in the prevalence of intravenous immunogloblin(IVIG)resistant between arthritis group and non-arthritis group(14 cases,26.14%vs.43 cases,10.72%,P=0.002).The inflammatory markers(CRP,TNF-α,IL-6)of the arthritis group were significantly higher than those in the non-arthritis group,and the differences were statistically significant(P<0.05,respectively).The incidence of coronary artery disease in the arthritis group(60.38%,32/53)was higher than that in the non-arthritis group(52.37%,210/401),but the difference was not statistically significant(P>0.05).Conclusion Kawasaki disease with arthritis in children is self-limited,with no sequelae.Patients in the arthritis group have a higher rate of IVIG resistance and higher levels of inflammatory markers,but no significant difference in the incidence of coronary artery disease compared with those without arthritis.