链球菌感染在儿童与附着点炎症相关关节炎中的临床意义  

Clinical significance of group A streptococcal infection in pediatric patients with enthesitis related arthritis

作　　者：马靖 张俊梅[1] 檀晓华[1] 李妍[1] 李超[1] 朴玉蓉 李士朋[1] 孙佳鹏 韩彤昕[1] 邝伟英[1] 李彩凤[1] Ma Jing;Zhang Junmei;Tan Xiaohua;Li Yan;Li Chao;Piao Yurong;Li Shipeng;Sun Jiapeng;Han Tongxin;Kuang Weiying;Li Caifeng(Department of Rheumatology and Immunology,China National Center for Children's Health,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院,北京100045

出　　处：《中华风湿病学杂志》2022年第7期456-460,共5页Chinese Journal of Rheumatology

摘　　要：目的:研究链球菌感染在与儿童附着点炎症相关的关节炎(ERA)中的临床意义。方法:选取2016年1月至2018年1月北京儿童医院风湿免疫科ERA患儿136例,幼年特发性关节炎(JIA)少关节型和RF阴性多关节型患儿272例,比较2组链球菌感染差异,并将ERA患儿分为抗链球菌溶血素O(ASO)阳性组、阴性组,对2组间临床资料进行统计学分析,分析链球菌感染在ERA患儿中的意义。统计学方法主要包括 t检验、秩和检验、 χ^(2)检验,Spearman相关性分析。 结果:纳入的136例ERA患儿中链球菌感染率高于同期272例JIA(少关节型和RF-多关节型)患儿(17.6%与9.5%, χ^(2)=5.52, P=0.019)。在ERA患儿中,ASO阳性组和ASO阴性组进行组间临床资料分析,2组间HLA-B27的阳性率差异有统计学意义[(75.0%(18/24)与49.1%(55/112), χ^(2)=5.33, P=0.021],2组间四字征的阳性率差异有统计学意义[100%与67.0%(75/112), χ^(2)=10.61, P=0.001],2组间骶髂关节X线/CT影像学分级差异有统计学意义,ASO阳性组骶髂关节影像学Ⅲ级改变患儿明显多于ASO阴性组[68.2%(15/22)与28.4%(29/102), χ^(2)=12.49, P<0.001]。ASO(对数)与骶髂关节影像学分级改变有弱相关性( r=0.26, P=0.005)。 结论:ERA患儿对链球菌易感,链球菌感染后患儿容易出现骶髂关节受累,且受累程度可能更重,提示A族溶血性链球菌可能在ERA骶髂关节破坏的发生发展中起到一定的作用。Objective To demonstrate the clinical significance of group A streptococcal infection(GAS)in patients with enthesitis related arthritis(ERA).Methods A retrospective study was conducted on ERA(136)and PolyRF-/Oligo juvenile idiopathic arthritis(JIA)(272)patients in Beijing Children's Hospital from 2016 to 2018.Anti-streptococcal hemolysin"O"(ASO)was tested and documented in all patients.The infection rate of GAS was compared between patients with ERA and PolyRF-/Oligo JIA.Patients with ERA were divided to two groups according to the result of ASO(ASO positive and ASO negative).All the clinical data were documented and compared within the two groups.The statistical methods used mainly include t test,rank sum test,chi-square test,and Spearman correlation analysis.Results The GAS infection rate of patients with ERA was higher than patients with PolyRF-/Oligo JIA(17.6%vs 9.5%,χ^(2)=5.52,P=0.019).In ERA patients,clinical data were analyzed,and a statistical significant difference was observed in the presence of human leukocyte antigen(HLA)-B27 between ASO positive and ASO negative group[75.0%(18/24)vs 49.1%(55/112),χ^(2)=5.329,P=0.021].Statistical differences were found in Patrick's sign positive rate between the two groups[100%(24/24)vs 67.0%(75/112),χ^(2)=10.61,P=0.001].There was statistically significant difference between the two groups regarding the radiogr-aphic grading at the sacroiliac joint.More patients with positive ASO had gradeⅢdamage at the sacroiliac joint compare to patients with negative ASO[68.2%(15/22)vs 28.4%(29/102),χ^(2)=12.49,P<0.001].The logarithmic of the ASO was slightly correlated with the radiographic grade of sacroiliac joint(r=0.26,P=0.005).Conclusion Patients with ERA are prone to be infected by GAS.It's probably related to HLA-B27 postivity for antigen presentation.Patients who were infected by GAS fre-quently have sacroiliac joint involvement,and tend to be more sever.This indicates that GAS may play an important role in the pathogenesis of sacroiliac joint destruction.

关 键 词：抗链球菌溶血素 HLA-B27抗原 骶髂关节炎 与附着点炎症相关的关节炎 

分 类 号：R725.9[医药卫生—儿科]