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目的探讨幼年特发性关节炎(JIA)多关节型、少关节型临床特征、药物治疗及效果。方法回顾性分析重庆医科大学附属儿童医院2006年1月至2011年1月间收治的89例多关节型、少关节型JIA患儿临床病例资料,分析其临床特征、辅助检查、药物治疗及疗效。结果 89例JIA中男42例、女47例,男女比例约为1∶1.1,其中少关节型37例(41.57%),均为持续型;多关节型52例(58.42%),其中类风湿因子(RF)阳性10例(19.23%),RF阴性42例(80.77%);学龄期组(>8岁)占患儿总数48.31%。少关节型JIA易受累关节依次为膝(28.00%)、踝(21.33%)及髋关节(17.33%);而多关节型JIA主要累及膝(20.00%)、踝(18.50%)、指间(18.00%)及腕关节(16.00%)。4例出现眼虹膜睫状体炎,均不伴抗核抗体(ANA)阳性。5例(27.78%)HLA-B27阳性。61例(80.26%)采用非甾体类抗炎药(NSAID)、缓解病情抗风湿药(DMARD)联合治疗,其中60例均口服甲氨蝶呤(MTX),其中疗效欠佳的28例多关节型JIA使用肿瘤坏死因子(TNF)受体抗体融合蛋白治疗,采用欧洲风湿病协会疾病活动性评分(DAS28)下降均>1.2分,且未见明显副反应。结论多关节型JIA较少关节型多见,均以学龄期儿童发病为高,在多关节型中女性患儿显著多于男性。本组JIA中虹膜睫状体炎发病率低,且均不伴ANA阳性,HLA-B27阳性率较高。DAS28可用于评价JIA药物治疗效应。目前MTX已成为治疗多关节型JIA基础药物,TNF受体抗体融合蛋白等生物制剂的应用对改善症状及预后起积极作用。
Objective To investigate the multi-joint and juvenile joint clinical features, drug treatment and effect of juvenile idiopathic arthritis (JIA). Methods A retrospective analysis of clinical data of 89 children with polyarticular and less articular JIA admitted to Children’s Hospital Affiliated to Chongqing Medical University from January 2006 to January 2011 was retrospectively analyzed and analyzed for clinical features, auxiliary examination, drug treatment and therapeutic effect . Results There were 42 males and 47 females in 89 cases of JIA, the ratio of male to female was about 1: 1.1. Among them, 37 cases (41.57%) had less joint types, all of them were persistent type. Fifty-eight cases (58.42%) had multi-joint type, There were 10 cases (19.23%) positive for RF and 42 cases (80.77%) for RF negative. The age group (> 8 years old) accounted for 48.31% of the total children. Arthroscopic JIA vulnerable joints were followed by knee (28.00%), ankle (21.33%) and hip (17.33%), while polyarticular JIA mainly involved knee (20.00%), ankle (18.50% 18.00%) and wrist (16.00%). 4 cases of eye iridocyclitis, were not associated with anti-nuclear antibody (ANA) positive. 5 cases (27.78%) HLA-B27 positive. Sixty-one patients (80.26%) received non-steroidal anti-inflammatory drugs (NSAIDs) and combined anti-rheumatic drugs (DMARD). 60 of them were treated with methotrexate (MTX) Arterial JIA was treated with tumor necrosis factor (TNF) receptor antibody fusion protein and its decline was> 1.2 points using the European Rheumatism Association’s Disease Activity Score (DAS28), with no apparent side effects. Conclusions Multi-joint type JIA is less common in joints, both of them are of high incidence in school-age children. There are more women than in men in multi-joint type. This group of JIA in the incidence of iridocyclitis is low, and are not associated with ANA-positive, HLA-B27-positive rate higher. DAS28 can be used to evaluate JIA’s drug treatment effects. MTX has now become the treatment of multi-joint JIA basic drugs, TNF receptor antibody fusion protein and other biological agents to improve the symptoms and prognosis play an active role.