曲安奈德关节腔内注射治疗幼年特发性关节炎的临床疗效

Clinical efficacy of intra-articular injection with Triamcinolone acetonide in patients with juvenile idiopathic arthritis

目的观察曲安奈德关节腔内注射治疗幼年特发性关节炎(JIA)的临床疗效。方法回顾性分析2018年10月至2019年12月于首都儿科研究所附属儿童医院确诊的26例JIA患儿的临床资料,对病变部位肿痛明显的关节予曲安奈德关节腔内注射治疗,检测患儿治疗前后红细胞沉降率(ESR)和C反应蛋白(CRP)在血清中的水平,并详细记录症状、体征及临床表现,采用Kruskal-Wallis秩和检验比较不同治疗时间临床评价指标及实验室检查变化情况的差异。结果26例患儿中,男8例,女18例。曲安奈德关节腔注射治疗后,9例(34.62%)关节症状达到完全缓解,15例(57.69%)关节症状得到部分缓解,2例(7.69%)无效;总体治疗有效率达92.31%。与治疗前相比,从治疗后4周开始,医师及患儿父母对疾病活动度的评价逐渐好转,患儿活动性关节个数逐渐减少,ESR逐渐下降,幼年关节炎疾病活动评分27(JADAS 27)评分逐渐下降,差异均有统计学意义(均P<0.05)。治疗及随访期间均未见药物不良反应。结论关节腔内注射曲安奈德治疗JIA,控制关节症状效果显著,不良反应小。

Objective To observe the clinical efficacy of intra-articular injection with Triamcinolone acetonide on the treatment of juvenile idiopathic arthritis(JIA).Methods The clinical data of 26 children diagnosed with JIA undergoing the intra-articular injection of Triamcinolone acetonide for the joints with obvious swelling and pain at the Children′s Hospital Affiliated to Capital Institute of Pediatrics from October 2018 to December 2019 who were retrospectively analyzed.Erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were tested before and after the application of Triamcinolone acetonide.Detailed clinical manifestations were recorded.The nonparametric Kruskal-Wallis test was used to compare the differences in clinical evaluation indicators and changes in laboratory tests at diffe-rent treatment times.Results Among the 26 children,8 were boys and 18 were girls.After the intra-articular injection of Triamcinolone acetonide,9 cases(34.62%)achieved complete remission,15 cases(57.69%)achieved partial remission,and 2 cases(7.69%)were not responsive to the intra-articular injection.The overall therapeutic efficacy was 92.31%.Compared with pre-treatment period,from 4 weeks after treatment,assessment of disease activity by the physicians and parents of the children was significantly improved after 4-week treatment,and the number of active joints,ESR and CRP and the Juvenile Arthritis Disease Activity Score with 27 joints(JADAS 27)gradually decreased,and the differences were statistically significant(all P<0.05).No adverse drug reactions were seen during the treatment and follow-up period.Conclusions Intra-articular injection of Triamcinolone acetonide is effective in contro-lling joint symptoms of JIA with less adverse events.