幼年特发性关节炎患儿生长状态及骨密度检测

发布时间：2018-07-26 12:32

【摘要】：目的：了解JIA患儿生长发育及骨密度现状。方法：选择2011.7-2012.2期间重庆医科大学附属儿童医院风湿免疫科门诊及住院的JIA患儿50名作为研究组，其中女26例，男24例，年龄范围3-17岁，平均年龄9.97±3.98岁。人体测量包括患儿身高、体重，同时计算身高和体重的Z值。矮小和低体重均定义为Z值-2。青春期性发育评估参照Tanner分期，记录每个青春期女性患儿的初潮年龄。同时由定量超声骨密度仪测量骨密度。检测C反应蛋白（CRP）、红细胞沉降率（ESR）。患儿的用药情况通过询问以及查看既往病例记录获得。同时设立年龄和性别与研究组相似的健康对照组儿童50名。结果：50例JIA患儿中身材矮小17例（34%），低体重4例（8%）。JIA组身高的Z值比对照组显著降低（P0.0001）；JIA组体重Z值亦明显低于对照组（P0.01）；激素组JIA患儿的身高Z值低于非激素组（P0.05）；JIA活动组患儿身高Z值低于非活动组（P0.01）；身高Z值与病程呈负相关（r：-0.28；P0.05），与ESR也呈负相关（r：-0.48；P0.0001）；身高Z值与起病年龄、疾病分型之间未发现统计学差异。JIA组青春期女性患儿的初潮平均年龄与对照组之间亦未发现统计学差异。JIA组骨密度Z值与对照组相比有降低（p0.05）；JIA活动组患儿骨密度Z值低于非活动组（P0.001）；JIA患儿骨密度的Z值与病程呈负相关（r：-0.4；P0.01），，与ESR呈负相关(r:-4.9:P0.0001)。JIA患儿的骨密度Z值与起病年龄、疾病分型、以及是否应用激素之间未发现统计学差异。结论：JIA患儿普遍存在生长障碍和轻度的骨密度减低。JIA患儿应该定期检测骨密度，以助于早期发现骨质疏松。糖皮质激素对JIA患儿生长有抑制作用，合理应用激素对JIA的生长发育意义深远。早期诊断和控制疾病的活动对防止JIA患儿发生骨质疏松和生长迟滞非常重要。
[Abstract]:Objective: to investigate the status of growth and bone mineral density in children with JIA. Methods: a total of 50 children with JIA from the Department of Rheumatology and Immunology, affiliated Children's Hospital of Chongqing Medical University, were selected as the study group from January to February 2012.There were 26 females and 24 males, aged 3-17 years, with an average age of 9.97 卤3.98 years. Anthropometric measurements included height and weight, and Z values of height and weight were calculated. Both short and low body weight are defined as Z-2. According to the Tanner stage, the puberty sexual development assessment recorded the menarche age of each adolescent female child. Bone mineral density (BMD) was measured by quantitative ultrasound absorptiometry. Detection of erythrocyte sedimentation rate of C-reactive protein (CRP), (ESR). The medication was obtained by questioning and reviewing past cases. At the same time, 50 healthy children with similar age and sex were enrolled in the study group. Results among 50 cases of JIA, 17 cases (34%) were short, 4 cases (8%) were low weight, Z value of JIA group was significantly lower than that of control group (P0.0001), Z value of JIA group was lower than that of control group (P0.01), Z value of JIA group was lower than that of non-hormone group (P0.05). The Z value of height in JIA active group was lower than that in inactive group (P0.01), the Z value of height was negatively correlated with the course of disease (r: -0.28 P 0.05), and negatively correlated with ESR (r: -0.48 P 0.0001), and the height Z value was associated with onset age. The mean age of menarche in JIA group was not significantly different from that in control group. The Z value of bone mineral density in JIA group was lower than that in control group (p0.05). The Z value of BMD in the active group of JIA was lower than that in the inactive group (P0.001). The Z value of BMD was negatively correlated with the course of disease (r: -0.4 P 0.01), and negatively correlated with the ESR (r:-4.9:P0.0001). The Z value of BMD was correlated with the onset age and the type of disease. No statistical difference was found between the use of hormones and whether or not they were used. Conclusion growth disorder and slight decrease of bone mineral density are common in children with JIA. Bone mineral density should be measured regularly in order to help early detection of osteoporosis. Glucocorticoids can inhibit the growth of children with JIA. The rational use of glucocorticoids has a profound effect on the growth and development of JIA. Early diagnosis and control of disease activities are important to prevent osteoporosis and growth retardation in children with JIA.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.9

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