儿童感染性骶髂关节炎临床及影像学分析

Clinical and imaging features of infective sacroiliitis in children

目的:总结儿童感染性骶髂关节炎的临床、影像学特点及预后。方法:病例对照研究,纳入2018年6月至2023年6月在首都儿科研究所附属儿童医院风湿免疫科就诊的12例感染性骶髂关节炎为病例组,同期同科室28例幼年型特发性关节炎累及骶髂关节患儿为对照组,收集并分析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,组间比较采用独立样本t检验、χ^(2)检验。结果:病例组12例中男5例,女7例,病程0.8(0.5,1.2)个月,发热9例,跛行1例,人类白细胞抗原B27(HLA-B27)阳性1例,无强直性脊柱炎家族史。对照组28例中男19例,女9例,病程7.0(3.0,17.0)个月,发热1例(4%),跛行14例(50%),HLA-B27阳性18例(64%),强直性脊柱炎家族史18例(64%);病例组白细胞计数(WBC)、中性粒细胞比例、红细胞沉降率(ESR)、C反应蛋白(CRP)、磁共振成像单侧受累及CT骨质破坏比例均高于对照组[(11.1±6.2)×109比(7.3±2.3)×109/L、0.64±0.10比0.55±0.12、72(34,86)比18(5,41)mm/1 h、24.6(10.1,67.3)比3.6(0.8,15.0)mg/L、11/12比36%(10/28),9/12比11%(3/28),t=2.90、3.07,Z=-2.94、-3.28,χ^(2)=10.55、16.53,均P<0.05]。结论:儿童感染性骶髂关节炎多表现为单侧受累,病史短,白细胞计数、CRP、ESR升高,骨质破坏比例高。

Objective To summarize the clinical,radiological characteristics,and prognosis of infectious sacroiliitis in children.Methods A case-control study was conducted,including 12 cases of infectious sacroiliitis diagnosed in the Rheumatology and Immunology Department of the Children′s Hospital affiliated with the Capital Institute of Pediatrics from June 2018 to June 2023.These cases comprised the case group.Concurrently,28 cases of pediatric idiopathic arthritis involving the sacroiliac joint in the same department served as the control group.Basic patient information,clinical features,laboratory parameters,and clinical treatment outcomes for both groups were collected and analyzed.Independent sample t-tests and chi-squared tests were used for inter-group comparisons.Results Among the 12 cases in the case group,there were 5 males and 7 females,with a disease duration of 0.8(0.5,1.2)months.Nine patients presented with fever,and 1 patient had limping gait.Human leukocyte antigen(HLA)-B27 positivity was observed in 1 case,and there was no family history of ankylosing spondylitis.In the control group of 28 cases,there were 19 males and 9 females,with a disease duration of 7.0(3.0,17.0)months.One patient(4%)had fever,and 14 cases(50%)exhibited limping gait.HLA-B27 positivity was found in 18 cases(64%),and 18 cases(64%)had a family history of ankylosing spondylitis.The case group had higher white blood cell count(WBC),neutrophil ratio,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)levels,as well as a higher proportion of unilateral involvement on magnetic resonance imaging and bone destruction on CT compared to the control group((11.1±6.2)×109vs.(7.3±2.3)×109/L,0.64±0.10 vs.0.55±0.12,72(34,86)vs.18(5,41)mm/1 h,24.6(10.1,67.3)mg/L vs.3.6(0.8,15.0)mg/L,11/12 vs.36%(10/28),9/12 vs.11%(3/28),t=2.90,3.07,Z=-2.94,-3.28,χ^(2)=10.55,16.53,all P<0.05).Conclusions Pediatric infectious sacroiliitis often presents as unilateral involvement with a short disease history.Elevated WBC,CRP,and ESR,as well as a high rate of bone destruction,are also common characteristics.