幼年类风湿关节炎患儿感染水痘的临床特征  

Clinical features of children with juvenile idiopathic arthritis and varicella

作　　者：赵扬 张新鑫 赵卫红[3] 庞琳 Zhao Yang;Zhang Xinxin;Zhao Weihong;Pang Lin(Department of Pediatrics,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Party Committee Office,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]首都医科大学附属北京地坛医院儿科,北京100015 [2]首都医科大学附属北京地坛医院党委办公室,北京100015 [3]北京大学第一医院儿科,北京100034

出　　处：《中华实验和临床感染病杂志（电子版）》2020年第4期340-344,共5页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的探讨幼年类风湿性关节炎(JIA)合并水痘患儿的临床特征。方法收集2015年1月1日~2019年12月31日于首都医科大学附属北京地坛医院就诊的9例JIA合并水痘感染患儿(JIA合并水痘组)及同期年龄性别相匹配的18例单纯水痘患儿(单纯水痘组)的发热时间、高热比例、皮肤结痂时间、皮肤感染、血常规和肝功能及心肌酶等临床资料进行回顾性病例对照研究。结果JIA合并水痘组患儿9例,平均年龄(6.1±4.0)岁,其中男4例,女5例;有水痘接触史者8例,高热者8例,体温最高41℃。单纯水痘组患儿均有明确水痘接触史,高热者4例,体温最高39℃。JIA合并水痘组患儿发热持续时间[(7.89±2.15)d]长于单纯水痘组[(4.50±1.20)d],差异有统计学意义(t=2.89、P<0.001)。JIA合并水痘组患儿有典型丘疹、疱疹、痂疹,皮疹全身密集分布,疱疹数量均超过50个,以颜面最多,枕部、前胸、后背及臀部明显,大部分斑丘疹融合成片,部分融合皮疹饱满透明,黏膜可见疱疹及糜烂。而单纯水痘组患儿较少见融合性疱疹、皮肤糜烂及感染。JIA合并水痘组患儿皮疹结痂时间[(10.78±2.17)d]长于普通水痘组[(5.72±1.02)d],差异有统计学意义(t=-4.24、P<0.001)。JIA合并水痘组患儿发生蜂窝织炎者4例(44.44%),血常规粒细胞缺乏者3例(33.33%),血小板减少者2例(22.22%),肝功能异常者4例(44.44%)及心肌酶异常者4例(44.44%)。普通水痘组患儿中发生皮肤感染1例(5.56%),粒细胞缺乏者1例(5.56%)及心肌酶异常者1例(5.56%),无血小板减少和肝功能异常者。JIA合并水痘组患儿中重症出血性水痘1例。JIA合并水痘组患儿以阿昔洛韦抗病毒、大剂量静脉用人血丙种球蛋白持续治疗3~5 d,水痘皮疹给予重组人干扰素α-1b凝胶搽豆治疗,治疗期间原发病JIA未出现活动表现。普通水痘患儿给予重组人干扰素α-1b凝胶搽豆治疗。结论幼年JIA合并水痘患儿多出现高热,且热程较Objective To investigate the clinical features of juvenile rheumatoid arthritis(JIA)complicated with varicella.Methods From January 1st,2015 to December 31st,2019,a total of 9 cases of JIA with varicella(JIA with varicella group)and 18 cases with pure varicella(varicella group)with age and sex matching treated in Beijing Ditan Hospital,Capital Medical University were collected,and the fever time,hyperthermia ratio,skin scab time,skin infection,blood routine and liver function and myocardial enzyme of the two groups were analyzed by retrospective case-control study.Results The mean age of 9 children in JIA with varicella group was(6.1±4.0)years old,among whom,4 cases were male and 5 cases were female;8 cases with varicella contact history,8 cases with high fever,the highest body temperature was 41℃.All the children in varicella group had definite contact history of varicella,among whom,4 cases with high fever,the highest body temperature was 39℃.The fever duration of cases in JIA with varicella group was significantly longer than that of varicella group[(7.89±2.15)d vs.(4.50±1.20)d],with significant difference(t=2.89,P<0.001).A typical papules,herpes and scab were found in JIA with varicella group,and the skin rash was densely distributed throughout the body,the number of herpes was more than 50,mostly on the face,and occipital,forechest,back and buttocks obviously visible;most of the papules fused into pieces,part of the fusion rash were full transparent,herpes and erosion may occur on mucous membrane.But the fusion herpes,skin erosion and infection were rare in children of varicella group.Cases in JIA with varicella group had longer scab time than children with varicella[(10.78±2.17)d vs.(5.72±1.02)d],with significant difference(t=-4.24,P<0.001).In JIA with varicella group,4 cases(44.44%)with cellulitis,3 cases(33.33%)with granulocyte deficiency,2 cases(22.22%)with thrombocytopenia,4 cases(44.44%)with abnormal liver function and 4 cases(44.44%)with abnormal myocardial enzymes.In varicella group,1 case(5

关 键 词：儿童 幼年类风湿性关节炎 水痘 皮疹 

分 类 号：R725[医药卫生—儿科]