女性强直性脊柱炎临床特征及误诊分析  

Clinical Characteristics of Female Ankylosing Spondylitis and Analysis of Misdiagnosis

作　　者：路占忠 刘进子[1] 安晓蓓 张旭飞 LU Zhan-zhong;LIU Jin-zi;AN Xiao-bei;ZHANG Xu-fei(Department of Rheumatology and Immunology,the Third Hospital of Shijiazhuang City,Shijiazhuang 050011,China)

机构地区：[1]石家庄市第三医院风湿免疫科,石家庄050011

出　　处：《临床误诊误治》2020年第11期15-19,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局科研计划项目(2018261)。

摘　　要：目的分析女性强直性脊柱炎(ankylosing spondylitis,AS)的临床特征及误诊原因、防范措施。方法对曾误诊的10例女性AS的临床资料进行回顾性分析。结果本组10例,年龄(34.20±9.60)岁;病史(24.40±18.01)个月;9例有诱发因素;1例无诱因发病。3例出现肩、膝及踝等关节周围肌腱附着点僵痛症状,2例伴低热、盗汗,1例伴发葡萄膜炎。骶髂关节压痛、叩击痛和骨盆分离试验阳性各8例。超敏C反应蛋白升高10例,红细胞沉降率增快9例,D-二聚体升高8例。人类白细胞抗原B27阳性8例。6例于基层卫生院误诊为腰肌劳损,2例于某中医门诊误诊为产后风湿,1例在县级医院误诊为腰椎间盘突出症,1例于某诊所误诊为软组织损伤。误诊时间3个月~5年(47.00±39.05)个月。10例按误诊疾病予相应处理效果欠佳,后均依据临床表现、相关查体所示,结合骶骼关节影像学检查,根据相关诊断标准,确诊AS。给予相应治疗15 d,病情缓解出院。1例失访;9例随访1~3年,3例自行停药,1例出现病情活动,余均病情控制良好。结论女性AS具有诱因多、遗传史隐匿、多外周关节受累和病变较轻等特点,临床易误诊。病情不典型、临床医生认知水平有限及诊断思维局限是导致其误诊的重要原因。临床应采取仔细病史采集、详细专科查体和及时更新专业知识等多项措施,把控好诊治时机,以提高女性AS诊治正确率。Objective To analyze the clinical features,causes of misdiagnosis and preventive measures of female ankylosing spondylitis(AS).Methods The clinical data of 10 female patients with AS that had been misdiagnosed were analyzed retrospectively.Results There were 10 female patients and the age of this group was(34.20±9.60)years,and the disease lasted(24.40±18.01)months.Nine cases had predisposing factors and 1 case had no predisposing factors.Three cases had symptoms of stiffness at the tendon attachment points around the shoulders,knees and ankles,2 cases had low fever and night sweats,and 1 case had uveitis.There was tenderness around the spine in 8 cases and percussion pain in 8 cases,and pelvic separation test were positive in 8 cases.Hypersensitive C-reactive protein was increased in 10 cases,erythrocyte sedimentation rate was increased in 9 cases,and D-dimer was increased in 8 cases.Eight cases were positive for human leukocyte antigen B27.Six cases were misdiagnosed as lumbar muscle strain in primary health centers,2 cases were misdiagnosed as postpartum rheumatism in a Chinese medicine clinic,1 case was misdiagnosed as lumbar disc herniation in a county hospital,and 1 case was misdiagnosed as soft tissue injury in a clinic.The duration of misdiagnosis was 3 months to 5 years(47.00±39.05)months.According to the misdiagnosed disease,the treatment effect of 10 cases was far from satisfactory.Based on the clinical manifestations and related physical examination combined with the imaging examination of the sacroiliac joint and related diagnostic criteria,AS was confirmed.After 15 days of treatment,the patients were discharged after the disease was relieved.One case was lost to follow-up,9 cases were followed up for 1-3 years,3 cases stopped medication by themselves,1 case developed disease activity,and the others were well controlled.Conclusion Female AS has several characteristics,including multiple predisposing factors,hidden genetic history,multiple peripheral joint involvement and mild lesions,and is easy to

关 键 词：脊柱炎 强直性 女性 误诊 腰肌劳损 风湿 椎间盘移位 

分 类 号：R593.23[医药卫生—内科学]