儿童髋关节莱姆关节炎：难以辨别的病症？

Pediatric Lyme Arthritis of the Hip: The Great Imitator?

作者信息

Cruz Aristides I, Aversano Francis J, Seeley Mark A, Sankar Wudbhav N, Baldwin Keith D

机构信息

*Hasbro Children's Hospital, The Warren Alpert Medical School at Brown University, Providence, RI †The Children's Hospital of Philadelphia, Philadelphia ‡Geisinger Health System, Danville, PA.

出版信息

J Pediatr Orthop. 2017 Jul/Aug;37(5):355-361. doi: 10.1097/BPO.0000000000000664.

DOI:10.1097/BPO.0000000000000664

PMID:26469686

Abstract

BACKGROUND

Lyme arthritis (LA) of the hip can present similarly to septic arthritis (SA) and transient synovitis (TS). The primary purpose of this study was to determine clinical and laboratory parameters differentiating LA of the hip from SA or TS among children who had undergone hip aspiration during the evaluation of hip pain.

METHODS

This was a retrospective review of all patients who underwent hip aspiration for the evaluation of hip pain at a tertiary care children's hospital in a Lyme endemic area. Clinical and laboratory data were reviewed and comparative analyses were performed between those diagnosed with LA, SA, and TS. Independent samples t test, ANOVA, and χ test were used to compare clinical and laboratory variables as appropriate. Multivariable logistic regression was used to elucidate independent predictors of LA. Statistical significance was set at P<0.05.

RESULTS

Ninety-three hip aspirations (93 patients) were included in the final analysis. Seventeen patients were diagnosed with LA, 40 with SA, and 36 with TS. Multivariable logistic regression revealed febrile history (OR=16.3; 95% CI, 2.35-113.0) and increased peripheral white blood cell (WBC) count (OR=1.26; 95% CI, 1.01-1.58) to be significantly associated with increased odds of being diagnosed with SA versus LA. Increased erythrocyte sedimentation rate (ESR) was significantly associated with increased odds of being diagnosed with LA versus TS (OR=1.06; 95% CI, 1.02-1.10), whereas febrile history (OR=0.06; 95% CI, 0.01-0.49) and increased peripheral WBC count (OR=0.8; 95% CI, 0.65-0.98) were associated with decreased odds of LA.

CONCLUSIONS

Children presenting in a Lyme endemic area with an isolated hip effusion are more likely to have LA versus SA if they have no history of fever and a decreased peripheral WBC count. Compared with TS, patients with LA are more likely to have an elevated ESR. This study adds to existing knowledge because there are few investigations examining isolated LA of the hip.

LEVEL OF EVIDENCE

Level III-retrospective case-control study.

摘要

背景

髋关节莱姆关节炎（LA）的表现可能与化脓性关节炎（SA）和暂时性滑膜炎（TS）相似。本研究的主要目的是确定在因髋关节疼痛接受评估时进行了髋关节穿刺的儿童中，区分髋关节LA与SA或TS的临床和实验室参数。

方法

这是一项对莱姆病流行地区一家三级儿童专科医院所有因髋关节疼痛接受髋关节穿刺评估的患者的回顾性研究。回顾临床和实验室数据，并对诊断为LA、SA和TS的患者进行比较分析。适当情况下，使用独立样本t检验、方差分析和χ检验来比较临床和实验室变量。使用多变量逻辑回归来阐明LA的独立预测因素。统计学显著性设定为P<0.05。

结果

最终分析纳入了93次髋关节穿刺（93例患者）。17例患者诊断为LA，40例为SA，36例为TS。多变量逻辑回归显示，发热史（OR=16.3；95%CI，2.35-113.0）和外周血白细胞（WBC）计数增加（OR=1.26；95%CI，1.01-1.58）与诊断为SA而非LA的几率增加显著相关。红细胞沉降率（ESR）升高与诊断为LA而非TS的几率增加显著相关（OR=1.06；95%CI，1.02-1.10），而发热史（OR=0.06；95%CI，0.01-0.49）和外周血WBC计数增加（OR=0.8；95%CI，0.65-0.98）与LA的几率降低相关。