幼年特发性关节炎并发葡萄膜炎的临床特征及危险因素分析  

Clinical characteristics and risk factors of juvenile idiopathic arthritis-associated uveitis

作　　者：张燕[1] 肖欢[1] 罗冲[1] 唐雪梅[1] 周娟[1,2] ZHANG Yan;XIAO Huan;LUO Chong;TANG Xuemei;ZHOU Juan(Department of Rheumatology and Immunology,National Clinical Research Center for Child Health and Disorders,Chongqing Key Laboratory of Child Infection and Immunity,Key Laboratory of Child Development and Disorders of Ministry of Education,Children’s Hospital of Chongqing Medical University,Chongqing,400014;Department of Allergy,Rheumatology and Immunology,Women and Children’s Medical Center of Guangzhou Medical University,Guangzhou,Guangdong Province,511399,China)

机构地区：[1]重庆医科大学附属儿童医院风湿免疫科,国家儿童健康与疾病临床医学研究中心,儿童感染免疫重庆市重点实验室/儿童发育疾病研究教育部重点实验室,重庆2400014 [2]广州医科大学附属妇女儿童医疗中心过敏风湿免疫科,广州511399

出　　处：《陆军军医大学学报》2024年第20期2346-2351,共6页Journal of Army Medical University

基　　金：国家重点研发计划项目(2021YFC2702003);重庆医科大学未来医学青年创新团队支持计划(W0114);重庆渝中区科技局科研项目(20210136)。

摘　　要：目的 分析幼年特发性关节炎(juvenile idiopathic arthritis, JIA)患儿并发葡萄膜炎的危险因素及临床特征。方法 采用病例-对照研究设计方案,纳入2016年6月至2023年6月重庆医科大学附属儿童医院收治的JIA相关性葡萄膜炎(juvenile idiopathic arthritis-associated uveitis, JIA-U)患儿30例,以及同期年龄、性别相匹配的诊断为JIA的患儿36例。分析患儿一般情况、实验室检测指标及影像学诊断结果等临床特征;通过单因素及多因素回归分析,验证幼年特发性关节炎并发葡萄膜炎的危险因素。结果 JIA-U大多为双眼发病(63.3%,19/30),以前葡萄膜炎为主(86.7%,26/30),起病隐匿,大多于JIA确诊后发生(60.0%,18/30),仅30%有眼部不适或视力下降表现。单因素分析显示:少关节型JIA、类风湿因子(rheumatoid factor, RF)阴性、抗环瓜氨酸肽抗体(anti-cyclic citrullinated peptide antibody, anti-CCP)阴性患儿更易并发JIA-U,2组间差异有统计学意义(P<0.05)。多因素Logistic回归分析表明:RF阴性为JIA-U发生的独立危险因素(OR=5.400,95%CI:1.033~28.227,P=0.046)。结论 JIA-U常双眼发病,前葡萄膜炎最常见,早期一般无明显眼部症状,不易识别。少关节型、RF阴性、anti-CCP抗体阴性是JIA患儿并发JIA-U高危因素。ObjectiveTo analyze the risk factors and clinical characteristics of uveitis in children with juvenile idiopathic arthritis(JIA).MethodsA retrospective case-control study was conducted on 30 children with JIA-associated uveitis(JIA-U)and 36 age-and gender-matched children diagnosed as simple JIA admitted to Children’s Hospital of Chongqing Medical University from June 2016 to June 2023.The clinical data,laboratory indicators and radiological findings were collected,and analyzed for the risk factors for JIA-U with univariate and multivariate analysis.ResultsIn this study,JIA-U mostly occurred in both eyes(63.3%,19/30),with anterior uveitis as the main cause(86.7%,26/30),insidious onset,and mostly occurred after JIA diagnosis(60.0%,18/30),and only 30%showing ocular discomfort or visual impairment.Univariate analysis showed that the JIA children with oligoarthritis JIA,negative rheumatoid factor(RF)and negative anti-cyclic citrullinated peptide antibody(anti-CCP)were prone to be complicated with uveitis(P<0.05).Multivariate logistic regression analysis indicated that RF negativity was an independent risk factor for development of JIA-U(OR=5.400,95%CI:1.033~28.227,P=0.046).ConclusionJIA-U often develops in both eyes,anterior uveitis is the most common,and it mostly diagnosed after JIA.It has no obvious eye symptoms in the early stage and thus is not easily recognized.Oligoarthritis JIA,RF-negative,and anti-CCP antibody-negative are the high-risk factors for the complication of JIA-U in children with JIA.

关 键 词：幼年特发性关节炎 幼年特发性关节炎相关性葡萄膜炎 危险因素 

分 类 号：R181.23[医药卫生—流行病学] R725.932[医药卫生—公共卫生与预防医学] R773.9