110例幼年特发性关节炎患儿临床表现及磁共振成像特征分析

Analysis of clinical manifestations and magnetic resonance imaging characteristics of 110 children with juvenile idiopathic arthritis

目的总结幼年特发性关节炎(JIA)患儿临床表现及膝关节磁共振成像(MRI)特点。方法收集2017年1月至2019年10月在首都儿科研究所附属儿童医院住院的110例膝关节受累的JIA患儿临床和实验室资料,并对受累膝关节进行MRI评分。分析不同亚型JIA患儿MRI征象特点并进行评分,比较治疗前后受累膝关节MRI征象改善情况。结果110例JIA患儿中,合并感染总例数为35例(31.8%),其中结核感染9例(8.2%),EB病毒感染12例(10.9%),抗链球菌溶血素O(ASO)升高14例(12.7%);MRI征象中,滑膜增生101例(91.8%),关节积液99例(90.0%),骨髓水肿18例(16.4%),软骨损伤16例(14.6%),骨质破坏2例(1.2%)。各亚型受累膝关节MRI征象以滑膜增生和关节积液为主,受累部位以髌上囊多见。治疗后滑膜增生、关节积液及骨髓水肿征象均有改善,MRI评分明显降低,与治疗前差异具有统计学意义(P=0.001,0.001,0.001,均P<0.05),软骨损伤和骨质破坏无改善。结论JIA诊治过程中需关注排查各种病原感染并积极治疗。膝关节受累MRI征象主要表现为滑膜增生及关节积液,MRI评分可辅助了解关节病变情况及作为治疗评估的重要参考指标。

Objective To summarize the clinical manifestations and magnetic resonance imaging(MRI)features of knee joint involvement in children with Juvenile idiopathic arthritis(JIA).Methods The clinical and laboratory data of 110 JIA patients with knee involvement in the Children′s Hospital Affiliated to Capital Institute of Pediatrics from January 2017 to October 2019 were collected and scored according to the JIA MRI scoring system.The clinical indicators,course of disease and MRI scores of different subtypes of JIA were compared,and the MRI improvement of the affected knee joint before and after treatment was evaluated.Results Among the 110 JIA patients,35 cases(31.8%)had infections,including 9 cases(8.2%)with tuberculosis infection,12 cases(10.9%)with EB virus infection,and 14 cases(12.7%)with elevated anti-streptolysin O;there were 101 cases(91.8%)of synovial hyperplasia,99 cases(90.0%)of joint effusion,18 cases(16.4%)of bone marrow edema,16 cases(14.6%)of cartilage injury,and 2 cases(1.2%)of bone erosion.Synovial hyperplasia and joint effusion were the main MRI findings of the affected knee in each subtype,and the suprapatellar bursa is the most common involved site.After treatment,the signs of synovial hyperplasia,joint effusion,and bone marrow edema improved,and the MRI scores significantly decreased compared with those before treatment(P=0.001,0.001,0.001,all P<0.05),cartilage damage and bone destruction were not improved.Conclusions During the diagnosis and treatment of JIA,attention should be paid to the screening of various pathogenic infections and treatment.MRI imaging of knee joint involvement in JIA mainly shows synovial hyperplasia and joint effusion.MRI score can help further understanding of joint lesions,and it is also an important reference index for treatment evaluation of JIA children.