中国实用儿科杂志

中国实用儿科杂志 ›› 2022, Vol. 37 ›› Issue (7): 512-515.DOI: 10.19538/j.ek2022070609

• 论著 • 上一篇    下一篇

幼年特发性关节炎相关葡萄膜炎42例临床特征及视力预后因素分析

  

  1. 深圳市儿童医院  a 眼科，b 风湿免疫科，广东  深圳  518038
  • 出版日期:2022-07-06 发布日期:2022-08-25
  • 通讯作者: 方旺，电子信箱：ifangwang@139.com
  • 基金资助:
    深圳市科技计划基础研究（面上项目）［JCY20190809171207530］

Clinical characteristics and visual prognosis factors of uveitis associated with juvenile idiopathic arthritis：an analysis of 42 cases

  1. *Department of Ophthalmology，Shenzhen Children’s Hospital，Shenzhen  518038，China
  • Online:2022-07-06 Published:2022-08-25

摘要： 目的　分析幼年特发性关节炎（JIA）相关葡萄膜炎的临床特征，探讨影响其发病及视力预后的相关危险因素。方法　收集2014年11月至2021年3月深圳市儿童医院眼科及风湿免疫科16周岁以下JIA相关葡萄膜炎患者的临床资料进行统计分析。结果　共收集JIA相关葡萄膜炎42例（单眼计71只），其中男16例（单眼计28只），女26例（单眼计43只），男∶女＝1∶1.625。葡萄膜炎发病年龄4～16岁，平均发病年龄（8.8±2.6）岁。随访时间2个月至6.3年，中位随访时间2.7（1.0，4.1）年。急性病程单眼计5只（7.0%），慢性病程单眼计66只（93.0%），复发性病程单眼计11只（15.5%）。前葡萄膜炎单眼计60只（84.5%），全葡萄膜炎单眼计11只（15.5%）；单侧葡萄膜炎13例（31.0%），双侧葡萄膜炎29例（69.0%）。少关节型35例（83.3%），RF（-）多关节型6例（14.3%），RF（+）多关节型1例（2.4%）。血白细胞（WBC）、红细胞沉降率（ESR）、C反应蛋白（CRP）、类风湿因子（RF）检查，不同性别比较差异无统计学意义（均P＞0.05）；抗核抗体（ANA）（+）女20例，男7例，两者比较差异有统计学意义（χ2=4.747.P＜0.05）。发病年龄≤6岁、病程＞4年、初诊最佳矫正视力（BCVA）≤0.4、并发症＞2个与视力预后不佳有关（均P＜0.05）。结论　JIA相关葡萄膜炎慢性多见，常双眼发病。前葡萄膜炎是最常见的解剖类型。虹膜后粘连为最常见眼部并发症。少关节炎型JIA、ANA（+）、RF（-）的JIA患儿更易发生葡萄膜炎。视力预后与发病年龄、病程长短、初诊BCVA及出现并发症数量相关。

关键词: 葡萄膜炎, 幼年特发性关节炎, 临床特征, 危险因素

Abstract: Objective　To analyze the clinical features of uveitis associated with juvenile idiopathic arthritis（JIA）and to explore the risk factors affecting its incidence and visual prognosis.Methods　The clinical data of patients under 16 years of age with JIA-associated uveitis in the Department of Ophthalmology and Rheumatology in Shenzhen Childrens Hospital from November 2014 to March 2021 were collected and analyzed statistically.Results　Totally 42 patients（71 eyes）with JIA-associated uveitis were collected，including 16 males（28 eyes）and 26 females（43 eyes）.The male to female ratio equaled 1：1.625.The age of onset of uveitis ranged from 4 to 16 years，with an average age of（8.8±2.6）years.The follow-up time ranged from 2 months to 6.3 years，with a media follow-up time of 2.7（1.0，4.1）years.The acute disease course was in 5 eyes（7.0%），chronic course 66 eyes（93.0%）and recurrent course 11 eyes（15.5%）.Anterior uveitis was found in 60 eyes （84.5%）and panuveits in 11 eyes（15.5%）.There were 13 cases（31.0%）of unilateral uveitis，29 cases（69.0%）of bilateral uveitis.There were 35 cases of oligoarticular type（83.3%），6 cases of rheumatoid factor（RF）negative polyarticular type（14.3%）and 1 case of RF positive polyarticular type（2.4%）.In the tested white blood cell（WBC）number，erythrocyte  sedimentation rate（ESR），C-reactive protein（CRP）and rheumatoid factor（RF），there was no significant difference between male and female（all P＞0.05）.There were 20 female and 7 male patients with antinuclear antibody（ANA）（+），and the difference was statistically significant（χ2=4.747.P＜0.05）.The following factors were related to poor visual prognosis：the onset age≤6 years old，the course of disease＞4 years old，the best correlated visual acuity（BCVA）≤0.4 and the complications＞2（all P＜0.05）.Conclusion　Chronic JIA-associated uveitis is common，and it often occurs in both eyes.Anterior uveitis is the most common anatomical type.Posterior synechia is the most common ocular complication.Children with oligoarticular type JIA，ANA（+）and RF（-）JIA are more prone to uveitis.The prognosis of visual acuity is correlated with age of onset，duration of disease，initial diagnosis of BCVA and number of complications.

Key words: uveitis, juvenile idiopathic arthritis, clinical feature, risk factor