军事飞行人员脊柱关节炎相关因素研究  

Pathogenic factors of spondyloarthritis in military flying personnel

作　　者：黄志芳 李红霞 王星 李晓梅 贾微微 王亚琨 崔丽 徐先荣 王建昌 HUANG Zhifang;LI Hongxia;WANG Xing;LI Xiaomei;JIA Weiwei;WANG Yakun;CUI Li;XU Xianrong;WANG Jianchang(Department of Rheumatology,Air Force Medical Center,Beijing 100142,China)

机构地区：[1]空军特色医学中心风湿免疫科,北京100142 [2]空军特色医学中心医学鉴定科,北京100142 [3]空军特色医学中心睡眠医学科,北京100142 [4]空军特色医学中心航空航天眩晕诊疗研究中心,北京100142 [5]空军特色医学中心医研部,北京100142

出　　处：《空军医学杂志》2022年第1期9-12,共4页Medical Journal of Air Force

基　　金：全军后勤科研重大项目(AKJ15J003)。

摘　　要：目的探讨军事飞行人员脊柱关节炎(spondyloarthritis,SpA)发病相关因素,为SpA诊治及医学鉴定提供依据。方法选取2010年1月—2020年12月空军特色医学中心确诊患SpA的军事飞行人员28例,分析其临床表型特征,根据人类白细胞抗原(human leucocyte antigen,HLA)-B27结果分为阳性组及阴性组;根据飞行机种分为歼(强)机飞行员组及其他机种飞行人员组,分别收集飞行时间、发病年龄、确诊年龄、病程、血沉(erythrocyte sedimentationrate,ESR)、C反应蛋白(C-reactive protein,CRP)、脊柱及骶髂关节影像学检查等临床资料并进行比较。结果28例SpA患者中歼(强)机飞行员14例,运输(轰炸)机飞行员4例,直升机飞行员4例,空中战、技勤人员6例;平均发病年龄(28.4±6.7)岁,平均确诊年龄(33.5±6.6)岁,平均病程(5.2±4.6)年。SpA患者中HLA-B27阳性率78.6%,B27阳性组发病年龄早于B27阴性组(P<0.01)。26例表现为中轴型SpA,其中歼(强)机组12例,其他机种组14例,歼(强)机组确诊年龄早于其他机种组(P<0.05);2例表现为外周型SpA,均为歼(强)机飞行员,歼(强)机中轴型SpA确诊年龄早于外周型SpA(P<0.05),飞行时间短于外周型SpA(P<0.05)。治疗后特许医学鉴定为飞行合格者20例(71.4%),不同机种组间放飞率比较差异无统计学意义(P>0.05)。结论除HLA-B27外,军事飞行人员中轴脊柱承受的机械应力可能与SpA发病及临床表型特征相关,在诊治及航空医学鉴定时应给予充分考虑。Objective To explore the pathogenic factors of spondyloarthritis(SpA)in military f lying personnel in order to provide data for clinical treatment and aeromedical identification.Methods The clinical phenotypic characteristics of military flying personnel with SpA diagnosed at Air Force Medical Center between January 2010 and December 2020 were analyzed.Such clinical data as the years of flight,age of onset,age at which they were diagnosed,disease course,erythrocyte sedimentationrate(ESR),C-reactive protein(CRP),imaging of spine and sacroiliac joint were collected and compared.Results A total of 28 military flying personnel with SpA were included in this study,including 14 fighter pilots,4 transport(bombing)pilots,4 helicopter pilots and 6 technicians.The mean age of onset was 28.4±6.7 years,the mean age at which they were diagnosed was 33.5±6.6 years,and the mean course of disease was 5.2±4.6 years.The positive rate of HLA-B27 was 78.6%,and the disease started earlier among HLA-B27 positive patients than among HLA-B27 negative patients(P<0.01).Among the 28 cases of SpA,there were 26 cases of axial SpA(axSpA),including 12 fighter pilots and 14 pilots of other types of aircraft.Fighter pilots were diagnosed earlier than those of other types of aircraft(P<0.05).In addition,12 fighter pilots with axSpA were diagnosed earlier than the 2 fighter pilots with peripheral SpA(pSpA)(P<0.05).Fighter pilots with axSpA did not fly as long as those with pSpA(P<0.05).20(71.4%)of the 28 cases with SpA were waived after treatment.There was no statistically significant difference in the waiver rate between pilots of different types of aircraft(P>0.05).Conclusion In addition to HLA-B27,the mechanical stress on the axial spine of military f lying personnel may be related to the phenotypic characteristics of SpA,which should be taken into serious consideration during clinical management and aeromedical identification.

关 键 词：飞行员 脊柱关节炎 HLA-B27 机械应力 医学鉴定 

分 类 号：R856.5[医药卫生—航空、航天与航海医学]