全身型幼年特发性关节炎并发巨噬细胞活化综合征的危险因素分析  

The risk factors of macrophage activation syndrome in children with systemic onset juvenile idiopathic arthritis

作　　者：赵亚玲[1] 梁琨[1] 徐静[1] 黄永坤[1] 莫亚雄[1] 张瑛[1] 丁臻博[1] 

机构地区：[1]昆明医学院第一附属医院儿科,云南昆明650032

出　　处：《云南医药》2011年第1期9-12,共4页Medicine and Pharmacy of Yunnan

摘　　要：目的分析全身型幼年特发性关节炎(systemic juvenile idiopathic arthritis,SJIA)并发巨噬细胞活化综合征(macrophageactivationsyndrome,MAS)的危险因素。方法回顾性分析我院2000年月1月～2009年5月期间诊治的SOJIA和SOJIA-MAS195例患儿的临床及试验室资料,采用Cox模型多因素分析法分析SOJIA发生SOJIA-MAS的危险因素。结果 (1)本组195例SOJIA病例中,MAS的发生率为4.1%(8/195)。(2)SOJIA-MAS组患儿热程,肝脾肿大及淋巴结肿大的程度明显高于SOJIA组,差异有统计学意义。(3)SOJIA-MAS组MAS发生前1周平均血小板(PLT)计数、平均白细胞(WBC)计数、血沉(ESR)、血红蛋白(Hb)、血清白蛋白(ALB)、纤维蛋白原(Fib)明显低于SOJIA组患儿,差异有统计学意义;SOJIA-MAS组平均谷丙转氨酶(ALT)、谷草转氨酶(AST)、甘油三酯(TG)、血清铁蛋白(SF)高于SOJIA组,差异有统计学意义;SOJIA-MAS组患儿NK细胞计数明显低于SOJIA组患儿,差异有统计学意义。(4)多因素回归分析显示持续高热,WBC<9×109,PLT<250×109,ESR<10mm/h,Fib<1.5g/L,ALT>55u/L,AST>60u/L,LDH>1000μ/L,Fib>500μg/L,TG≥3mmol/L以及NK细胞计数降低是SOJIA患儿发生MAS的临床危险因素。结论通过分析SOJIA患儿发生MAS的临床危险因素,确立可能发生MAS的高危人群,对于早期发现及治疗MAS,改善其预后具有重要意义。Objective To investigate the risk factors of macrophage activation syndrome（MAS） in children with systemic onset juvenile idiopathic arthritis （SOJIA）. Methods A retrospective study was performed to analyze the clinical and laboratory data of 195 SOJIA children from January 2000 - May 2009. Then logistic regression was used to identify he risk factors of macrophage activation syndrome in children with SOJIA. Results （1）In 195 SOJIA patients, 8 patients（4.1%） were found to have a codiagnosis of MAS and SOJIA; （2） the days of fever, the degree of hepatosplenomegaly and lymphadenopathy were high in MAS patients; （3） the level of PLT, WBC, ESR, Hb, ALB, Fib in MAS patients were lower than SOJIA patients.All MAS patients had elevated ALT, elevated AST, elevated LDH, elevated TG, and elevated SF, there were signifcant differences between two groups. The level of natural killer cell were lower than SOJIA patients; （4） Multivariate logisitic regression analysis showed that the risk factors of macrophage activation syndrome in children with SOJIA were lasting fever 〉 10 days, PLT〈250 × 10 9, ALT 〉 55 u/L, AST 〉 60 u/L, LDH 〉 1000 u/L, SF 〉 500 u g/L, TG ≥ 3mmol/L and low level of natural killer cell. Conclusion High-rlsk groups of MAS can be established by analyzing the clinical risk factors of occurrence of MAS in children with SOJIA, so that we can take measures to prevent the occurrence of MAS, which will improve the prognosis and reduce mortality significantly in patients with SOMA.

关 键 词：幼年特发性关节炎全身型 巨噬细胞活化综合征 危险因素 

分 类 号：R593[医药卫生—内科学]