脊柱关节炎误诊112例临床和实验室特征  

Clinical and laboratory characteristics of 112 rare cases misdi agnosed as spondyloarthritis

作　　者：赵楚楚[1] 叶华[1] 陈适[1] 栗占国[1] 

机构地区：[1]北京大学人民医院风湿免疫科,100044

出　　处：《中华风湿病学杂志》2016年第8期537-540,共4页Chinese Journal of Rheumatology

摘　　要：目的回顾分析被误诊为SpA的病例，探讨误诊原因，以期减少临床误诊。方法收集2004年1月至2014年4月于我院就诊前曾误诊为SpA，并检索1998年1月至2014年10月中文文献报道的误诊病例，依照2009年中轴SpA标准及2011年外周spA标准进行分析。结果共112例符合本研究入选条件。被误诊为SpA的疾病主要有感染性疾病27例（24．1％），遗传和代谢性疾病47例（42．0％），肿瘤25例（22．3％），骨关节疾病13例（11．6％）。被误诊患者的临床表现多不典型，其中102例患者（91．1％）不具备炎性腰背痛特点，有23例（20．5％）患者伴随发热，HLA—B27阳性者仅占20．4％（21／103）。29例行骶髂关节X线检查患者中，11例提示有关节面模糊、关节间隙变窄或骨质破坏。4例最终依靠骶髂关节磁共振检查确诊。仅19．8％（18／91）以腰背痛为主要表现的患者符合2009年国际脊柱关节炎协会中轴型SpA分类标准，33．3％（2／6）以外周关节炎为主要表现的患者符合外周型SpA分类标准。结论对于非典型炎性下腰痛的患者，尤其伴有发热等表现，应考虑到肿瘤、感染以及遗传和代谢性骨病等疾病。HLA-B27阳性有助于诊断SDA，但并非特异指标。对X线表现不确切者，应及早行骶髂关节CT或磁共振检查。多数误诊病例不符合分类标准。Objective To reduce the misdiagnosis rate of spondyloarthritis （SPA） by reviewing the rare cases misdiagnosed as SpA. Methods Cases misdiagnosed as SpA were collected from our hospital from January 2004 to April 2014. Reported cases among Chinese journals from January 1998 to October, 2014 were also collected. According to the Assessment of Spondylo Arthritis international Society （ASAS） axial SpA criteria （2009） and peripheral SpA criteria （2011）, the diagnostic accordance rate was studied. Results There were 112 cases within the objective scope, out of which, 27 cases （24.1%） were infectious diseases, 47 cases （42.0%） were heredity and metabolic diseasesl 25 cases （22.3%） were hematonosis or tumor, 13 cases （11.6%） were osteoarthropathies. Also, only 10 cases （8.9%） out of 112 had the symptoms of inflammatory back pain （IBP）, 23 cases （20.5%） exhibited fever. Human leukocyte antigen （HLA）-B27 was positive in 20.4% （21/103） of the cases. Eleven cases out of those 29 cases performed X-ray in the sacroiliac joint and showed blurred articular surface, narrowing of joint space or bone destruction. Four cases were diagnosed based on magnetic resonance imaging （MRI）. 18/91 （19.8%） cases met the criteria of ASAS axial SpA criteria （2009）, 2/6（33.3%） cases were in accordance to the ASAS peripheral SpA criteria （2011）. Conclusion For patients with atypical back pain, if accompanied with fever, other diseases such as tumor, infection, heredity and metabolic diseases should be considered. The diagnosis should not only based on HLA-B27 for SpA diagnosis. Due to the ambiguity of X-ray in sacroiliac joint, CT or MRI may be recommended to assist the diagnosis. Careful clinical history taken is also with great significance.

关 键 词：脊柱关节炎 误诊 

分 类 号：R593.23[医药卫生—内科学]