全身型幼年特发性关节炎合并肺受累临床特征及相关因素分析

Clinical characteristics and related factors of pulmonary involvements in patients with systemic juvenile idiopathic arthritis

目的探讨全身型幼年特发性关节炎(sJIA)合并肺部受累的临床特征及相关因素。方法回顾性分析2017年1月至2022年1月收治并初次诊断为sJIA患儿的临床资料。结果纳入sJIA患儿73例,男40例、女33例,中位年龄5.6(3.1~8.8)岁。其中无肺受累sJIA组32例、肺受累sJIA组41例。与无肺受累sJIA组相比,肺受累sJIA组合并巨噬细胞活化综合征(MAS)、乏力、胸闷、呼吸浅快的比例较高,IL-18水平较高,胸片与肺部高分辨CT阳性改变的比例较高,差异有统计学意义(P<0.05)。二元logistics回归分析结果发现,乏力、胸闷、胸片与肺部高分辨CT阳性改变、IL-18水平增高是sJIA合并肺受累发生的独立危险因素(P<0.05)。结论疾病早期临床症状、血清IL-18水平,肺部影像学检查对sJIA合并肺部病变的发生有一定预测价值。

Objective To investigate the clinical characteristics and related factors of systemic juvenile idiopathic arthritis(sJIA)complicated with lung involvement.Methods The clinical data of children who were initially diagnosed with sJIA from January 2017 to January 2022 were retrospectively analyzed.Results A total of 73 children(40 boys and 33 girls)with sJIA were enrolled and the median age was 5.6(3.1-8.8)years.There were 32 children in sJIA group without lung involvement and 41 children in sJIA group with lung involvement.Compared with sJIA group without lung involvement,the proportion of sJIA combined with macrophage activation syndrome,fatigue,chest tightness and rapid shallow breathing was higher,the level of IL-18 was higher,and the proportion of positive changes in chest radiography and lung high-resolution CT was higher,and the differences were statistically significant(P<0.05).The results of binary logistics regression analysis showed that fatigue,chest tightness,positive changes of chest radiograph and lung high-resolution CT,and increased IL-18 level were independent risk factors for sJIA complicated with lung involvement(P<0.05).Conclusion Early clinical symptoms,serum IL-18 level and pulmonary imaging examination have certain predictive value for the occurrence of sJIA complicated with lung involvement.