不同年龄儿童多发性大动脉炎临床特征比较  

Comparison of clinical features of Takayasu′s arteritis in children at different ages

作　　者：张丹[1] 康闽[1] 周志轩[1] 黄小兰[1] 赖建铭[1] Zhang Dan;Kang Min;Zhou Zhixuan;Huang Xiaolan;Lai Jianming(Department of Rheumatology and Immunology,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院风湿免疫科,北京100020

出　　处：《中华实用儿科临床杂志》2022年第7期526-529,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的分析总结不同年龄儿童多发性大动脉炎(TA)的临床特点,以提高对该病的认识及诊治水平。方法回顾性分析2010年1月至2020年5月于首都儿科研究所附属儿童医院住院确诊的41例TA患儿临床资料及随访情况,以3岁为界将患儿分为大年龄组、小年龄组,分析总结该病的临床特点,对冠状动脉受累情况、血压控制情况及生长发育受限情况进行统计学分析。计数资料以例数及百分比表示,组间比较采用χ2检验。结果17例小年龄组患儿中男8例,女9例;24例大年龄组患儿中男6例,女18例。小年龄组广泛型最常见,共10例(58.8%);大年龄组以胸腹主动脉型最为常见,共13例(54.2%)。小年龄组最常见的临床表现为发热,共13例(76.5%);大年龄组为高血压,共19例(79.2%)。小年龄组患儿均有血红蛋白(Hb)降低,均有白细胞、C反应蛋白(CRP)、红细胞沉降率(ESR)升高(100.0%);大年龄组白细胞升高6例(25.0%),ESR增快13例(54.2%),CRP升高11例(45.8%)。小年龄组受累最多为冠状动脉及其分支(前降支、回旋支),共16例(94.1%);大年龄组受累最多为锁骨下动脉,共15例(62.5%)。小年龄组患儿均处于疾病活动期,其中8例单用生物制剂,3例单用糖皮质激素治疗,5例为糖皮质激素和生物制剂联合治疗,1例先用糖皮质激素,因效果欠佳换用生物制剂治疗。大年龄组有18例活动期病例(75.0%),2例拒绝治疗;16例活动期病例和6例非活动期病例予糖皮质激素治疗,其中19例为糖皮质激素联合环磷酰胺,3例为糖皮质激素联合生物制剂。小年龄组有16例冠状动脉受累,大年龄组仅1例冠状动脉受累(P<0.01);小年龄组中9例存在生长发育受限,大年龄组均未出现生长受限(P<0.01);小年龄组血压均得到控制,大年龄组中16例血压控制不满意(P<0.01);小年龄组广泛型发生率高于大年龄组,且病情活动期发生率高于大年龄组,但差异无统计学意义(P>0.05)。结论不同年龄TObjective To improve the understanding of Takayasu′s arteritis(TA)and its diagnosis and treatment by analyzing and summarizing the clinical characteristics of TA in children at different ages.Methods Clinical and follow-up data of 41 children with TA admitted in Children′s Hospital,Capital Institute of Pediatrics between January 2010 and May 2020 were retrospectively analyzed.Based on the cut-off age of 3 years,children with TA were divided into older group and younger group.Clinical characteristics,involvement of the coronary artery,blood pressure control and growth restriction between 2 groups were analyzed.Counting data were expressed as percentage and case,and compared by the Chi-square test.Results Among the 17 children with TA in younger group,there were 8 males and 9 females.There were 6 males and 18 females in older group.The general type was most common in younger group,with 10 cases(58.8%).In older group,thoracic and abdominal aortic type was the most common,with 13 cases(54.2%).The most common clinical manifestation in younger group was fever,with 13 cases(76.5%).In older group,19 patients(79.2%)had hypertension.Lower hemoglobin(Hb)was detected in younger group.Leukocyte count,C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR)increased in all patients(100.0%).In older group,leukocyte count increased in 6 cases(25.0%),ESR increased in 13 cases(54.2%),and CRP increased in 11 cases(45.8%).The coronary artery and its branches(anterior descending branch and circumvolute branch)were the mostly affected in younger group,with 16 cases(94.1%).The subclavian artery was the most commonly involved in older group(15 cases,62.5%).All TA children in younger group were in the active stage.Among them,8 cases were treated with biological agents alone,3 cases were treated with glucocorticoid alone,5 cases were treated with the combination of glucocorticoid and biological agents,and 1 case was treated with glucocorticoid first,and then transferred to biological agents due to the poor effect.In older group

关 键 词：多发性大动脉炎 临床特点 治疗效果 不同年龄 儿童 

分 类 号：R725.4[医药卫生—儿科]