早发性抗核抗体阳性幼年特发性关节炎的临床观察

Clinical observation of early-onset antinuclear antibody-positive juvenile idiopathic arthritis

目的观察早发性抗核抗体(antinuclear antibody, ANA)阳性幼年特发性关节炎(juvenile idiopathic arthritis, JIA)患儿的临床特点和治疗随诊情况。方法获取2017年1月—2019年12月首都儿科研究所附属儿童医院收治的初发年龄小于6岁的少关节型JIA患儿临床资料, 根据ANA滴度分为ANA阳性组(44例)和ANA阴性组(42例), 对两组患儿的基本资料、临床特征、实验室指标及临床治疗转归情况进行统计学分析。结果 ANA阳性组和ANA阴性组患儿男女比例分别为7∶37和15∶27, 两组性别比例差异有统计学意义(P=0.035)。两组C反应蛋白升高比例分别为18.18%(8/44)和16.67%(7/42), 红细胞沉降率升高比例分别为29.55%(13/44)和19.05%(8/42), 组间比较差异均无统计学意义(P均>0.05)。ANA阳性组最常见受累关节依次为膝关节(95.45%, 42/44)、踝关节(20.45%, 9/44)和腕关节(18.18%, 8/44), 单侧非对称性关节受累36例(81.82%);ANA阴性组依次为膝关节(85.71%, 36/42)、踝关节(14.29%, 6/42)、腕关节(14.29%, 6/42)和髋关节(11.90%, 5/42), 单侧非对称性关节受累27例(64.29%), 两组间各指标比较差异均无统计学意义(P均>0.05)。两组常规眼科检查及随诊发现合并葡萄膜炎患儿分别为7例(15.91%)和2例(4.76%), 两组间比较差异有统计学意义(P=0.045)。治疗前ANA阳性组疾病活动评分(JADAS27)高于ANA阴性组[14.43±2.87vs 12.09±3.32, P=0.002], 治疗后两组均明显降低(P均<0.05);治疗随访6个月, 两组临床缓解率差异无统计学意义[70.45% (31/44)vs 76.19% (32/42), P>0.05]。结论早发性ANA阳性JIA女性患儿多见, 临床上非对称性膝关节受累最为常见, 眼科合并症发生率高, 早期积极治疗预后良好。ANA阳性不是JIA关节预后不良的危险因素。

Objective To investigate the clinical features,treatment and follow-up of children with early-onset antinuclear antibody(ANA)-positive juvenile idiopathic arthritis(JIA).Methods Eighty-six oligoarticular JIA patients with early-onset arthritis(≤6 years old)admitted to the Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2017 to December 2019 were included in this study.According to ANA titer,these patients were divided into two groups:ANA-positive group(44 cases)and ANA-negative group(42 cases).Clinical data including demographic data,clinical features,laboratory testing results,treatment and follow-up data were statistically analyzed.Results The ratio of male to female was 7∶37 in the ANA-positive group and 15∶27 in the ANA-negative group and there was significant difference between the two groups(P=0.035).The proportions of patients with increased C-reactive protein and erythrocyte sedimentation rate were higher in the ANA-positive group than in the ANA-negative group[18.18%(8/44)vs 16.67%(7/42)and 29.55%(13/44)vs 19.05%(8/42),both P>0.05].The most commonly involved joints in the ANA-positive group were knee(95.45%,42/44),ankle(20.45%,9/44)and wrist(18.18%,8/44),and unilateral asymmetric joint involvement accounted for 81.8%(36/44).In the ANA-negative group,the involved joints were knee(85.71%,36/42),ankle(14.29%,6/42),wrist(14.29%,6/42)and hip(11.90%,5/42),and 27 out of the 42 cases(64.29%)had unilateral asymmetric joint involvement.There was no significant difference in the above indexes between the two groups(all P>0.05).There were seven cases(15.91%)with uveitis in the ANA-positive group and two cases(4.76%)in the ANA-negative group,and the difference between the two groups was significant(P=0.045).Before treatment,the ANA-positive group had a significantly higher disease activity score(JADAS27)than the ANA-negative group(14.43±2.87 vs 12.09±3.32,P=0.002).After treatment,the JADAS27 score in both groups decreased(both P<0.05).After six months of treatment,the two groups had similar clinical remission rates[70.45%(31/44)vs 76.19%(32/42),P>0.05].Conclusions Early-onset ANA-positive JIA was more common in female children,and asymmetric knee joint involvement was the most common clinical manifestation.The incidence of ophthalmic complications was high,and ophthalmological examination should be performed more frequently during follow-up.The prognosis of early-onset ANA-positive JIA was good with early treatment.Positive ANA was not a risk factor for poor prognosis.