幼年特发性关节炎肺胸膜病变的相关因素分析

Risk factors for pleural lung disease in children with juvenile idiopathic arthritis

摘要:

目的 探讨幼年特发性关节炎（JIA）患儿肺胸膜病变（PLD）的高危因素，为临床判断病情、及时处理提供依据。方法 回顾分析360 例JIA 患儿的临床资料，所有患儿均行胸部X 线影像学检查，将患儿分为合并PLD 组和无PLD 组，分析JIA 伴肺胸膜病变（JIA-PLD）患儿的临床、影像学及相关实验室指标。结果 360 例JIA 患儿中，JIA-PLD 共43 例（11.9%），其中有呼吸系统症状者9 例（21%）。胸部影像学异常主要表现为间质性肺炎（53.5%），其次为胸膜炎和/或胸腔积液（38.1%）。43 例JIA-PLD 中胸片正常而胸部CT 异常者4 例（9.3%）。<3 岁或≥ 12 岁年龄组PLD 发生率较高。全身型JIA 患儿PLD 发生率较高。与无PLD 组比较，PLD 组患儿贫血、外周血白细胞及免疫球蛋白G 升高、类风湿因子或抗核抗体阳性发生率更高（P<0.05）。结论 JIA-PLD 多发生于全身型JIA；PLD 好发于年龄<3 岁或≥ 12 岁者；伴有贫血、外周血WBC 及免疫球蛋白G 升高、类风湿因子或抗核抗体阳性者PLD 发生率高。PLD 影像学多表现为间质性肺炎，但由于患儿多缺乏呼吸系统表现，建议常规高分辨率胸部CT 检查以便临床早期发现、及时处理。

Abstract:

Objective To investigate the risk factors for pleural lung disease (PLD) in children with juvenile idiopathic arthritis (JIA) and to provide a basis for the early diagnosis and timely treatment of this disease. Methods A total of 360 children with a confirmed diagnosis of JIA were enrolled, and their clinical data were retrospectively analyzed. All patients underwent a chest X-ray. The patients with PLD were assigned to PLD group, while those without PLD were assigned to non-PLD group. The clinical, imaging, and laboratory results of JIA patients with PLD were analyzed. Results Among the 360 JIA patients, 43 (11.9%) had PLD, and 9 (21%) of them had respiratory symptoms. Chest X-ray findings mainly included interstitial pneumonitis (53.5%) and pleurisy and/or pleural effusion (38.1%). In the 43 cases of JIA-PLD, 4 (9.3%) had normal chest X-ray findings but abnormal chest CT findings. The incidence of PLD was relatively high in patients aged under 3 years and those aged 12 years or above. Children with systemic JIA had a relatively high incidence of PLD. Compared with the non-PLD group, the PLD group had a significantly higher incidence of anemia, elevated white blood cell (WBC) count and IgG levels in peripheral blood, and positive rheumatoid factors or antinuclear antibodies (P<0.05). Conclusions Among children with JIA, PLD is mostly seen in patients with systemic JIA or aged <3 years or ≥12 years, especially those with anemia, elevated WBC count and IgG levels, and positive rheumatoid factors or antinuclear antibodies. For JIA patients with PLD, interstitial pneumonitis is usually seen on chest X-ray or CT, but respiratory symptoms are rarely observed. Routine use of high-resolution chest CT is recommended for early diagnosis and timely treatment of PLD in children with JIA.