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中国循证儿科杂志

中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (3): 191-195.

• 论著 • 上一篇    下一篇

幼年特发性关节炎患儿生长发育状况及生长迟缓影响因素的病例对照研究

李阳1,吴凤岐2,武华红1,李辉1   

  1. 1 首都儿科研究所生长发育研究室 北京，100020；2 首都儿科研究所附属儿童医院风湿免疫科 北京，100020
  • 收稿日期:2019-08-14 修回日期:2020-03-01 出版日期:2020-06-25 发布日期:2020-06-25
  • 通讯作者: 李辉

The growth status of juvenile idiopathic arthritis patients and influencing factors of growth retardation: A case-control study

LI Yang1, WU Feng-qi2, WU Hua-hong1, LI Hui1   

  1. 1 Department of Growth and Development, Capital Institute of Pediatrics, Beijing 100020, China；2 Department of Rheumatology, Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
  • Received:2019-08-14 Revised:2020-03-01 Online:2020-06-25 Published:2020-06-25
  • Contact: LI Hui

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摘要： 目的:了解幼年特发性关节炎（JIA）患儿生长发育状况和生长迟缓的影响因素。方法:病例对照研究，以JIA治疗随访中身高Z值(HAZ)＜-2 SD为生长迟缓组，HAZ≥-2 SD为生长正常组，通过问卷调查考察JIA患儿治疗中生长发育的影响因素，通过自制调查问卷采集基本情况、疾病史、饮食情况、生活习惯和家庭情况5个方面21个问题，风湿科医生在门诊对JIA患儿行诊断和治疗随访的同时，儿童保健科医生随诊中以面对面询问方式行问卷调查，并行体格测量。对调查问卷的问题行起病年龄、症状体征、缓解病情药物、确诊间隔、病程、父母亲文化程度和父母亲工作的整合，通过单因素和多因素Logistic回归分析JIA患儿生长迟缓的危险因素。结果:2018年9月至2019年4月符合纳入排除标准的221例JIA患儿进入本文分析，其中男103例（46.6%），平均年龄（7.8±3.7）岁，全身型58例、RF（-）多关节型16例、RF（+）多关节型36例、少关节型108例、点附着型2例、银屑病型1例。糖皮质激素（GCs）治疗88例，生物制剂治疗72例，其他治疗61例。33例（14.9%）合并生长迟缓，少关节型、全身型、多关节型的HAZ分别为-0.34 SD、-1.53 SD和-0.80 SD。单因素分析结果显示，影响JIA患儿线性生长的因素包括疾病亚型、病程、疾病活动度、GCs治疗、挑食和户外活动时间少（P＜0.05）；多因素Logistic回归分析结果显示，GCs治疗（OR=7.227，95%CI：1.877~27.817）、病程≥3年（OR=4.278，95%CI：1.322~13.843）和户外活动＜1 h（OR=4.078，95%CI：1.252~13.288）是JIA患儿生长迟缓的独立影响因素（P均＜0.05）。结论:JIA并发生长迟缓的发生率高，病程长、GCs治疗和户外活动时间少是影响患儿线性生长的危险因素。

Abstract: Objective:To investigate the growth status and influencing factors of growth retardation in children with juvenile idiopathic arthritis (JIA). Methods：The JIA patients with height-for-age Z-score (HAZ) <-2 SD during the follow up were enrolled as the case group, and patients with normal height (HAZ≥-2 SD) were enrolled as the control group. The factors affecting the growth of patients were investigated by a self-made questionnaire with 21 questions in 5 aspects including basic information, disease history, diet, lifestyle habits and family conditions. As rheumatologists performed diagnosis and follow-up treatment for children with JIA in the outpatient clinic, the child healthcare doctors carried out a face-to-face questionnaire survey and physical measurements during follow-up visits. Univariate and multivariate logistic regression models were used to analyze the risk factors of growth retardation in JIA patients after integrating the results of questionnaire in terms of age of onset, symptoms and physical signs, medications, diagnostic intervals, disease course, parents' education level and job. Results：From September 2018 to April 2019, 221 children with JIA who met the eligibility criteria were included in this analysis, including 103 males (46.6%) with the mean age of (7.8 ±3.7) years. JIA subtypes included oligoarthtiris (48.9%, n=108), systemic onset (26.2%, n=58), rheumatoid factor-negative polyarthritis (7.2%, n=16), rheumatoid factor-positive polyarthritis (16.3%, n=36), enthesitis-raleted arthritis (1.0%, n=2) and psoriatic arthritis (0.5%, n=1). Eighty-eight patients were treated by glucocorticoid (GCs), 72 were treated by biological preparations, and 61 were treated by other medicine. Thirty-three children (14.9%) were combined with growth retardation, and the HAZ among the subtype of oligoarthtiris, systemic-onset and polyarthritis was (-0.34 ±1.09) vs (-1.53 ±1.50) vs (-0.80 ±1.19), respectively. Univariate logistic regression showed clinical course, disease activity, glucocorticoid hormone therapy, pickiness, less outdoor activity time were factors influencing the linear growth of JIA. Multivariate logistic regression analysis showed that the GCs therapy(OR=7.227, 95%CI:1.877-27.817), the course more than 3 years(OR=4.278, 95%CI: 1.322-13.843) and outdoor activities less than 1 hour(OR=4.078, 95%CI: 1.252-13.288) were independent predictors of growth retardation in children with JIA (P＜0.05). Conclusion：Growth retardation was ubiquitous in JIA patients. The long disease course, GCs therapy and less outdoor activity time were main risk factors affecting the linear growth of JIA patients.