127例未分化脊柱关节病五年随访  

An Five Year Follow Up Study of 127 Patients with Undifferentiated Spondyloarthropathies

作　　者：侯睿宏[1] 张莉芸[1] 李小峰[1] 李军霞[1] 

机构地区：[1]山西医科大学第二医院风湿免疫科,太原030001

出　　处：《中华临床免疫和变态反应杂志》2009年第2期107-111,共5页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的了解未分化脊柱关节病(undifferentiated spondyloarthropathies,uSpA)的临床特点及发展规律。方法分析127例uSpA患者临床特点及5年随访结果。结果127例uSpA患者:(1)男女比例为1.8∶1,女性患者起病晚,病情轻,预后较好;(2)病程中腰背部疼痛(93.7%)和外周关节肿痛者(96.0%)最多见;(3)女性腰背部疼痛的首发率明显高于男性(P<0.05),男性髋关节、臀区或足跟及其他附着点部位疼痛起病的首发率均高于女性(P<0.05);(4)7例以手关节受累为首发症状者均为女性;(5)家族史阳性率42.5%,HLA-B27阳性率52.8%,两性间差异无统计学意义(P>0.05);(6)首诊影像学特点,CT对诊断uSpA较X线敏感,两者骶髂关节炎阳性率分别为75.0%(78/104)和60.0%(51/85)。两者诊断骶髂关节炎分级符合率45.6%(31/68)。男性骶髂关节破坏的阳性率高于女性(P<0.05);(7)5年随访,18例发展为强直性脊柱炎(ankylosing spondylitis,AS),1例为炎性肠病关节炎,1例为银屑病关节炎(psoriatic arthritis,PsA),20例仍为uSpA,16例症状消失。18例确诊AS的患者中男性13例,占72.2%。5年内骶髂关节CT示Ⅱ级以上骶髂关节破坏进展明显,初诊和5年后阳性率分别为3.6%和48.2%。结论uSpA是一组常见的临床症状多样的脊柱关节病,有遗传倾向;男性骶髂关节受累较女性严重;部分患者可进展为AS、PsA及炎性肠病关节炎等其他脊柱关节病。对uSpA患者应密切随访,定期行骶髂关节CT检查有助于早期诊断。Objective To investigate the prevalence, clinical features and the law of development of undifferentiated spondylarthropathies （uSpA）. Methods Within five years, 127 uSpA patients were registered in rheumatology outpatient clinic of Second Hospital Shanxi Medical University. The clinical, laboratory and follow-up datas of uSpA patients were collected and analyzed. Results （1） The male female ratio is 1.8： 1, and the female late onset. （2） The chief symptoms of 127 uSpA patients were lumbar and back pain （93.7%） and joints pain （96.0%）. （3） Female patients lower back pain was significantly higher than that of the first male （P 〈 0.05）. Some patients with region coxae, hip and heel or other attachment sites pain onset, there first rates of men were higher than female （P 〈 0.05）. （4） Seven cases of hand joints involvement as the first symptoms were women. （5） The positive rate of family history and HLA-B27 were 42.5% and 52.8%, there was no significant difference between male and female. （6） The sensitivity of sacroiliac joints CT in the diagnosis of uSpA was higher than X-ray, the two positive rates of Sacroiliitis were 75.0% （78/104）, 60% （51/85）. The emergence rates of sacroiliac joints damage of male was higher than women （P 〈 0.05）. （7） In five years 56 cases developed to 18 cases ankylosing spondylitis （AS）, 1 enteropathic arthropathy, 1 psoriatic arthritis （PsA）, 20 uSpA, 16 cases with symptomatic disappear. In 18 cases confirmed AS there were 13 male patients, accounting for 72.2%. In 5 years the positive rates of all sacroiliac joint CT signs had increased, the grade Ⅱ sacroiliac joint destruction progress evidently, the destruction positive rates of the examinations in initial and 5 year later were 3.6% and 48.2%. Conclusions uSpA were a group of a variety of spondyloarthropathy, which had a genetic predisposition. The sacroiliac joint involvement of men was more serious than women. Some patients can progress to ankylosing spondy

关 键 词：未分化脊柱关节病 诊断 随访 

分 类 号：R593.23[医药卫生—内科学]