幼年与成年脊柱关节病临床特征的对比研究  

The comparative analysis of clinical characters of juvenile and adult onset spondyloarthropathies

作　　者：张江林[1] 朱剑[1] 郭军华[1] 黄烽[1] 

机构地区：[1]解放军总医院风湿科,北京100853

出　　处：《中华风湿病学杂志》2005年第10期594-597,共4页Chinese Journal of Rheumatology

基　　金：国家自然科学基金资助项目(A30271233);国家杰出青年科学基金资助项目(30025041);总后"十五"计划面上项目基金资助项目(01MB080)

摘　　要：目的提高对幼年和成年发病的脊柱关节病临床特征的认识。方法通过与399例成年发病的脊柱关节病(SpA)患者对比,研究219例幼年脊柱关节病(JSpA)患者的临床特点。结果JSpA与SpA均有明显的男性优势,男女比分别为5.801和5.501;JSpA组的发病年龄平均12.5岁,SpA组为19.7岁;JSpA组的病程为4.2年,SpA组为4.3年(P>0.05);JSpA组的受累关节数为4.7个,SpA组为4.1个(P<0.01);82%的JSpA患者在发病时有外周关节炎,而SpA患者仅有47%(P<0.01);45%的SpA患者发病时表现为下腰痛,而JSpA患者仅有11%(P<0.01);随着病程发展,70%的JSpA患者出现了腰背疼痛,而SpA出现腰背疼痛的占79%(P<0.05);98.6%的JSpA患者出现了外周关节受累,而SpA仅为88%(P<0.01)。JSpA的人类白细胞抗原(HLA)-B27阳性率为88%,SpA为83%。结论JSpA与SpA有相似的临床表现,但JSpA比SpA有更多的外周关节炎、更少的中轴关节受累表现。下肢为主的关节炎,所伴随的肌腱端病、色素膜炎等各种关节外表现、HLA-B27阳性是JSpA的主要特点。Objective To better recognize the clinical characters of juvenile and adult onset spondyloarthropathies （JSpA）. Methods The clinical data of 219 in-patients with JSpA and 399 in-patients with adult onset SpA were retrospectively analyzed and the diagnosis, and treatment of JSpA were discussed. Resuits There was a clear male predominance of 5.8：1 （187：32） in JSpA and 5.5：1 （338：61） in SpA patients. The average age was 12.5 years in JSpA, 19.7 years in adult SpA patients. The average disease duration in JSpA patients was 4.2 years and 4.3 years in SpA patients （P〉0.05）. Numbers of involved joints throughout the follow-up were from 0-15 （mean 4.7） in JSpA and 0-15 （mean 4.1） in SpA patients （P〈0.01）. Eighty-two percent JSpA patients had peripheral arthritis at onset compared to only 47% of the SpA patients （P〈0.01）. Forty-five percent SpA patients had low back pain at onset but less than 11% of the JSpA patients had it at onset （P〈0.01）. During the disease course, The involving peripheral arthritis was recorded in 99% JSpA and only in 88% SpA （P〈0.01）; Low back pain was found in 70% JSpA and in 79% SpA （P〈0.05）; HLA-B27 was positive in 88% JSpA and in 83% SpA （P〉0.05）. Conclusion The clinical characters in JSpA are similar to that in SpA, but more the involvement of peripheral joints, the less the low back pain are in JSpA. The JSpA is characterized by asymmetric, lower limb predominant oligoarthritis, a wide spectrum of extra-articular features and the presence of HLA-B27.

关 键 词：对比研究 疾病特征 误诊 脊柱关节病 幼年脊柱关节病 临床特征 成年 外周关节炎 JSpA 人类白细胞抗原 HLA-B27 发病年龄 病程发展 

分 类 号：R593.2[医药卫生—内科学]