汕头地区15年强直性脊柱炎的临床分析  

Ankylosing spondylitis in Shantou :clinical experience in fifteen years

作　　者：曾庆馀[1] 陈肃标[1] 许杰洲[1] 肖征宇[1] 林玲[1] 刘源[1] 黄少弼[1] 谢素和[1] 

机构地区：[1]广东省汕头大学医学院第一附属医院风湿科,515041

出　　处：《中华内科杂志》1999年第7期444-447,共4页Chinese Journal of Internal Medicine

摘　　要：目的　了解本地区强直性脊柱炎 (AS)的临床特点 ,提高诊治水平。方法　回顾性分析1983～ 1997年 3 70例专科门诊诊治的AS病人的一般临床资料、治疗及随访结果。结果　 94 %的病例隐匿发病。腰痛、外周关节炎、“4”字试验阳性、骶髂关节压痛和腰椎压痛为常见症状和体征。骶髂关节受累程度、髋关节和脊柱受累均与病程有关 ;儿童AS髋关节受累与病程关系不大 ;也有病程 16年但骶髂关节炎仍为Ⅱ级者。治疗头 2年症状、体征改善较明显 ,以后改善不显著 ,但停药后多加重。治疗 1、2和 5年以上坚持率分别为 3 4.6%、2 8.4 %和 10 .3 %。放射学随访变化与临床表现不一定平行。结论　AS的早期诊断有利于改善预后。坚持慢作用抗风湿药治疗有利于控制病情。疗效判定应随访 3年以上 ,且有放射学依据。本病是一种异质性疾病 ,影响预后的因素尚待继续探讨。Objective To evaluate the clinical features of ankylosing spondylitis (AS) in Shantou area and improve the diagnostic level and therapeutic effect. Methods Clinical and laboratory data, and the methods and effects of therapy were analyzed. Some patients were followed up. Results 94% of the cases had an insidious onset. Low back pain or discomfort, peripheral arthritis, positive “4” test and pressing tenderness over the sacroiliac joints and lumbar spine were the frequent symptoms and signs. The degree of sacroiliitis and involvement of hip and spine were related to the disease duration. However, hip joint involvement in juvenile onset AS did not relate to the disease duration. Some cases with disease duration as long as 16 years still remained at Ⅱ of degree sacroiliitis. Clinical improvement was more obvious in the first two years of treatment. Although some patients came to a standstill condition after this period, yet the disease activity might still relapse with withdrawal of the treatment. The rate of adhering to the treatment for 1, 2, and over 5 years was 34.6%, 28.4%, and 10.3% respectively. The radiological changes frequently did not parallel with the clinical manifestations. Conclusion Early diagnosis is of importance in improving the prognosis of AS and adherence to slow acting anti rheumatic drug therapy is beneficial in disease controlling. A follow up of more than 3 years is necessary to estimate the therapeutic efficacy, and the radiological change is the key indicator. AS is a heterogenic disease and the risk factors for prognosis should be further studied.

关 键 词：强直性脊柱炎 诊断 治疗 预后 

分 类 号：R593.23[医药卫生—内科学]