早期骶髂关节炎和致密性髂骨炎的鉴别(附33例临床分析)  

Differential diagnosis between osteitis condensanse ilii and early sacroiliitis:a clinical analysis of 33 cases.

作　　者：王庆文[1] 曾庆馀[1] 肖征宇[1] 

机构地区：[1]汕头大学医学院第一附属医院风湿病研究室,广东汕头515041

出　　处：《中国实用内科杂志：临床前沿版》2006年第1期130-132,共3页

基　　金：广东省医学科研基金资助项目(No.A2004422);广东省医学科研基金资助项目(No.2000100);汕头市重点科技计划项目(2004年度)

摘　　要：目的 了解早期骶髂关节（SLI）炎和致密性髂骨炎（OCI）的鉴别诊断要点。方法 对1997～2004年汕头大学医学院第一附属医院经X线诊断的33例OCI全部进行SUCT扫描，CT未能确诊的病例进行SU细针穿刺活栓。记录临床、实验室、影像学、病理检查资料，进行分析。结果 33例中，17例经CT或病理检查证实SU炎症。这些病例的临床特点包括：（1）80％以上HLA—B27阳性。（2）年龄较OCI病例轻。（3）有1／3左右病例为男性，女性多为未婚或未育者。（4）临床上都有SU炎的症状和（或）体征。（5）实验室检查多有1球蛋白、血沉（ESR）、C反应蛋白（CRP）、碱性磷酸酶（ALT）升高。而OCI病例HLA—B27阳性率同一般人群，均为女性，且多为经产妇，少有SLI炎体征或实验室检查异常。结论 X线OCI中，不少病例可能是早期SU炎，应注意深入检查以除外之。Objective To understand the key points of the differential diagnosis between osteitis condensanse ilii （OCI） and early sacroiliitis. Methods From 1997 to 2004, 33 cases of OCI were examined with HLA - B27 determination and sacroiliac joint CT scan, and needle biopsy was performed in some cases when needed. Data of clinical history, laboratory, CT scan, as well as pathological examination were collected and analyzed. Results Sacroiliitis was diagnosed in 17 （51.5%） cases of the 33 X - ray OCI cases either by CT scan or by pathological examination. Clinical features of these 17 cases included： （ 1 ） HLA - B27 was positive in more than 80% of these cases; （2） The age in these cases was younger than that in the OCI cases; （3） About 1/3 of these cases were male, and most of the female were unmarried and nanparous; （4） Most of the cases were with the signs of sacroiliits; （5） γ globulin/ESR/CRP/alkali phosphatase were elevated in most cases. However, among OCI cases, the prevalence of HLA - B27 was similar to general population; all of the cases were female; most of them were pluripara, and few cases were with the signs of sacroiliitis or laboratory abnormalities. Conclusion In X - ray OCI, many cases might be early sacroiliitis. Attention should be paid to avoid misdiagnosis.

关 键 词：致密性髂骨炎 骶髂关节炎 

分 类 号：R5[医药卫生—内科学]