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

doi:10.12372/jcp.2022.22e0462

摘要/Abstract

摘要：

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。

关键词: 幼年特发性关节炎, 肺部疾病, 临床特点, 相关因素

Abstract:

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.

Key words: systemic juvenile idiopathic arthritis, lung involvement, clinical characteristics, related factor

檀晓华, 李彩凤, 赵文甲, 邝伟英, 邓江红, 张俊梅. 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[J]. 临床儿科杂志, 2022, 40(11): 864-868.

TAN Xiaohua, LI Caifeng, ZHAO Wenjia, KUANG Weiying, DENG Jianghong, ZHANG Junmei. Clinical characteristics and related factors of pulmonary involvements in patients with systemic juvenile idiopathic arthritis[J]. Journal of Clinical Pediatrics, 2022, 40(11): 864-868.

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项目	肺受累sJIA组(n=41)	无肺受累sJIA组(n=32)	统计量	P
男[n(%)]	21(51.2)	19(59.4)	χ²=0.47	0.494
年龄[M(P₂₅~P₇₅)]/岁	5.5(2.8~9.3)	5.6(3.3~8.6)	Z=0.65	0.513
合并MAS[n(%)]	28(68.3)	4(12.5)	χ²=32.09	<0.001
发热[n(%)]	41(100)	32(100)	-	-
皮疹[n(%)]	36(87.8)	26(81.3)	χ²=0.59	0.444
关节痛[n(%)]	9(22.0)	6(18.8)	χ²=0.11	0.741
关节肿胀[n(%)]	13(31.7)	6(18.8)	χ²=1.56	0.216
乏力[n(%)]	19(46.3)	2(6.3)	χ²=16.99	<0.001
胸闷[n(%)]	17(41.5)	2(6.3)	χ²=16.99	<0.001
呼吸浅快[n(%)]	25(61.0)	4(12.5)	χ²=22.62	<0.001
呼吸困难[n(%)]	3(7.3)	1(3.1)	χ²=0.60	0.442
肝脾肿大[n(%)]	7(17.1)	1(3.1)	χ²=3.67	0.060
浅表淋巴结肿大[n(%)]	11(26.8)	4(12.5)	χ²=2.27	0.136
多浆膜腔积液[n(%)]	3(7.3)	3(9.4)	χ²=0.10	0.755
心脏增大[n(%)]	2(4.9)	1(3.1)	χ²=0.14	0.713
心功能异常[n(%)]	0(0)	0(0)	-	-
烦躁[n(%)]	5(12.2)	1(3.1)	χ²=1.96	0.166
易激惹[n(%)]	3(7.3)	1(3.1)	χ²=0.60	0.442
抽搐[n(%)]	0(0.0)	1(3.1)	χ²=1.29	0.261

项目	肺受累sJIA组(n=41)	无肺受累sJIA组(n=32)	统计量	P
WBC[M(P₂₅~P₇₅)]×10⁹·L^-1	18.3(15.6~22.2)	19.0(11.1~21.8)	Z=0.47	0.640
中性粒细胞[M(P₂₅~P₇₅)]/%	75.0(67.0~80.0)	73.0(60.3~85.8)	Z=0.09	0.930
PLT[M(P₂₅~P₇₅)]×10⁹·L^-1	496.0(318.5~668.5)	512.5(383.0~642.3)	Z=0.22	0.822
Hb(x±s)/g·L^-1	100.6±15.7	100.7±14.9	t=0.00	0.979
SF[M(P₂₅~P₇₅)]/ng·mL^-1	1 428.0(723.7~3 213.5)	1 641.0(733.75~4 391.0)	Z=0.51	0.614
ESR[M(P₂₅~P₇₅)]/mm·h^-1	87.0(62.0~101.5)	87.5(32.3~103.5)	Z=0.22	0.822
CRP[M(P₂₅~P₇₅)]/mg·L^-1	92.2(60.0~169.0)	93.1(55.5~172.0)	Z=0.31	0.758
CK[M(P₂₅~P₇₅)]/U·L^-1	29.0(20.0~77.0)	33(20.3~95.3)	Z=0.07	0.948
CKMB[M(P₂₅~P₇₅)]/U·L^-1	14.0(9.0~37.0)	15.5(8.0~42.5)	Z=0.10	0.918
LDH[M(P₂₅~P₇₅)]/U·L^-1	437.0(322.3~714.8)	543.0(314.0~736.5)	Z=0.08	0.940
AST[M(P₂₅~P₇₅)]/U·L^-1	85.0(41.5~487.5)	65(29.3~270.3)	Z=0.88	0.379
ALT[M(P₂₅~P₇₅)]/U·L^-1	98.0(30.4~481.8)	64.5(19.8~397.0)	Z=0.61	0.544
Na⁺(x±s)/mmol·L^-1	136.6±5.4	134.4±6.3	t=0.38	0.792
ALB(x±s)/g·L^-1	33.5±6.3	32.3±6.1	t=0.65	0.424
BUN[M(P₂₅~P₇₅)]/mmol·L^-1	6.0(5.0~6.9)	5.7(3.6~6.6)	Z=0.20	0.845
Cr(x±s)/μmol·L^-1	41.4±10.4	41.6±13.2	t=0.01	0.937
TG[M(P₂₅~P₇₅)]/mmol·L^-1	1.1(0.8~2.1)	1.3(0.9~1.8)	Z=0.37	0.708
FIb[M(P₂₅~P₇₅)]/g·L^-1	3.7(2.6~5.9)	5.0(2.7~6.4)	Z=1.68	0.192
D二聚体[M(P₂₅~P₇₅)]/mg·L^-1	1.1(0.7~1.5)	1.3(0.9~1.8)	Z=1.24	0.214
IL-18[M(P₂₅~P₇₅)]/pg·mL^-1	46.4(36.9~61.1)	34.5(26.4~43.9)	Z=3.67	<0.001
IL-6[M(P₂₅~P₇₅)]/pg·mL^-1	134.4(48.1~136.9)	134.7(39.3~138.3)	Z=0.08	0.933
胸片阳性改变[n(%)]	22(53.7)	4(12.5)	χ²=13.28	<0.001
肺部高分辨CT阳性改变[n(%)]	34(82.9)	5(15.6)	χ²=32.72	<0.001

因素	偏回归系数	标准误	χ²值	P	OR(95%CI)
IL-18	0.23	0.09	7.71	0.006	1.27(1.07~1.49)
胸片阳性改变	2.55	1.07	5.67	0.017	12.83(1.56~104.96)
肺高分辨CT阳性改变	0.18	0.09	4.19	0.041	1.19(1.01~1.41)
胸闷	2.41	1.22	3.88	0.049	11.15(1.01~122.72)
乏力	3.05	1.28	5.67	0.017	21.08(1.71~258.85)
合并MAS	1.98	1.02	3.77	0.052	7.23(0.98~52.21)
常量	-12.87	4.11	9.37	0.002	-