溃疡性结肠炎合并强直性脊柱炎与溃疡性结肠炎相关骶髂关节炎的临床特点  

Clinical characteristics of ulcerative colitis with ankylosing spondylitis vs sacroiliitis with ulcerative colitis

作　　者：田雨[1] 李俊霞[1] 李懿璇[1] 王化虹[1] 刘新光[1] 

机构地区：[1]北京大学第一医院消化内科,北京市100034

出　　处：《世界华人消化杂志》2013年第14期1355-1359,共5页World Chinese Journal of Digestology

摘　　要：目的:比较溃疡性结肠炎(ulcerative colitis,UC)合并强直性脊柱炎(ankylosing spondylitis,AS)与UC相关骶髂关节炎两组患者临床特点的异同.分析UC合并AS的药物治疗效果.方法:回顾1995-01/2012-12在北京大学第一医院门诊就诊及住院治疗的UC患者病历,收集UC合并AS患者以及UC相关骶髂关节炎患者的发病情况、临床特点以及实验室检查结果.对UC合并AS患者进行随访,观察其药物治疗效果.结果:全部478例UC患者中合并AS有15例,发生率为3.1%,明显低于UC相关骶髂关节炎的发生率6.5%.15例UC合并AS患者有9例AS发病在先,有6例UC发病在先.本组UC合并AS患者以男性为主,男女比为6.5∶1,明显高于UC相关骶髂关节炎者的0.8∶1.UC合并AS患者的关节症状发病年龄明显低于UC相关骶髂关节炎者,平均年龄分别为26.9岁和38.8岁.两组患者的肠道情况无差异,而实验室检查中HLA-B27阳性对合并AS的诊断有重要提示作用.14例UC合并AS患者在确定诊断之后接受了足量的柳氮磺胺吡啶(sulfasalazine,SASP)治疗并且进行随访,平均随访3.5年.其中11例取得良好的治疗效果,关节疼痛消失,肠道炎症到达临床缓解,且未发生严重的不良反应.结论:UC合并AS并非罕见,本组患者的发生率为3.1%.AS的发病可在UC发病之前或之后.对于年轻的男性UC患者中轴关节症状较重者,应考虑到UC合并AS的诊断并及时筛查HLA-B27.足量的SASP既可以使关节症状得以改善,又可以使大部分肠道炎症达到临床缓解,故推荐作为UC合并AS的基础治疗.AIM： To compare the similarities and differences in clinical features of ulcerative colitis （UC） with ankylosing spondylitis （AS） vs sacroiliitis with UC. METHODS： Clinical data for 478 UC patients treated from January 1995 to December 2012 at Peking University First Hospital were retrospec- tively analyzed to assess the incidence, clinical features and laboratory findings of UC with AS and sacroiliitis with UC. The patients with UC with AS were followed to observe the effect of drug treatment. RESULTS： Of all 478 UC cases, 3.1% （15） had UC with AS, si~：nificantlv lower than the inci-dence of sacroiliitis with UC. Of 15 cases of UC with AS, AS onset was earlier in 9 cases and UC onset earlier in 6 cases. Patients with UC with AS were predominantly males, and the ratio of males to females was 6.5：1, which was signifi- cantly higher than that of sacroiliitis with UC. The onset age of joint symptoms in patients with UC with AS was significantly lower than that in patients with sacroiliitis with UC （26.9 years vs 38.8 years）. There was no difference in intestinal symptoms between the two groups. Laboratory tests, especially HLA-B27 positivity test, played a very important role in differential diagnosis between the two conditions. Fourteen patients with UC with AS had received a sufficient dose of sulfasalazine （SASP） and were followed. The average follow-up period was 3.5 years. Good therapeutic effect was achieved in 11 patients. Joint pain disappeared, and intestinal inflamma- tion clinically remitted. No significant adverse effect occurred. CONCLUSION： UC with AS is not uncommon. The attack of AS could be prior to or after the onset of UC. For young male UC patients whose vertebral joint symptoms are severe, especially when joint symptoms and intestinal inflamma- tion are not paralleled, UC with AS should be suspected and HLA-B27 test should be done immediately. Because of good clinical effect of SASP in relief of symptoms, it is recommended as the basic treatment for UC with AS.

关 键 词：溃疡性结肠炎 强直性脊柱炎 溃疡性结肠 炎相关骶髂关节炎 治疗 

分 类 号：R574.62[医药卫生—消化系统]