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

Abstract

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

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.

Figures/Tables 3

References 20

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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	-

Clinical characteristics and related factors of pulmonary involvements in patients with systemic juvenile idiopathic arthritis

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