强直性脊柱炎延误诊断的初步调查和原因分析

Reasons for delayed diagnosis of ankylosing spondylitis in Chinese

目的 调查强直性脊柱炎（AS）延误诊断的情况和分析原因。方法 收集我院门诊或病房就诊的符合1984年修订纽约AS诊断标准的的308例AS患者，通过面对面和电话联系相结合方法．选择13个问题来搜集AS延误诊治的情况；并从误诊时的症状和检查等方面分析延误诊治的原因。结果 238／308例作出了全部问题的回应，其中，男女比例是6：1；①发病年龄：发病年龄〈15岁占18．1％，15-39岁占79．0％．≥40岁占2.9％，平均发病年龄是22．1岁。②男女患者平均确诊年龄分别是（28±8）岁和（31±10）岁；男女患者平均延迟诊断时间差异无统计学意义（P=0．135）。③有As家族患病史的有57例（占23.9％），有家族史的平均延迟诊断时间分别是73．2个月，无家族史的患者平均延迟诊断时间是71．9个月，两组比较差异无统计学意义（P=0．899）。④人类白细胞抗原（HLA）-B27（＋）占84．9％．HLA—B27（＋）组和（-）组平均延迟诊断时间分别是70．1个月和88．1个月，两组比较差异均无统计学意义（P〉0．05）。但在延迟诊断〉10年确诊的AS患者中，24例HLA—B27（＋）和10例HLA—B27（-），两组比较差异有统计学意义（P=0．012）。⑤在238例患者中，误诊率为66、4％，平均延迟诊断时间是（72±68）个月。其中，单次误诊占45．0％，多次误诊的占21．4％，其中有7例延迟诊断≥10年却无出现误诊：最常误诊的疾病包括：与风湿热相关的关节炎（23.4％）、腰肌劳损（22．9％）和椎间盘突出（20．3％）等。结论 AS延误诊治可能与是否HLA—B27阳性和缺乏骶髂关节的X线资料密切相关。

Objective To investigate the reasons for delayed diagnosis of ankylosing spondylitis （AS） in a Chinese population. Methods Three hundred and eight patients fulfilled the 1984 Modified New York criteria of AS were enrolled. They were interviewed in person or by telephone by rheumatologists for 13 questions. Results Of the 308 AS patients, 238 （75%） completed 13 questions. Among these 238 patients, male to female ratio was 6 to 1. The average age at AS onset was 22.1 years. Those aged under 15 years at disease onset was 18.1%, and between 15 and 39 years was 79.0% while over 39 years was 2.9%. Of these 238 patients, 27 （23.9%） had family history of AS. 84.9% of the patients were HLA-B27 positive. The average duration of delayed diagnosis in HLA-B27 （＋） and HLA-B27 （-） were 70.1 and 88.1 months respectively, which was not significant statistically. Among those delayed over 10 years, 24 AS patients were HLA-B27（＋） and 10 were HLA-B27（- ）, which was statistically significant （P=0.012）. 66.4% of 238 patients were misdiagnosed, of which 23.4% were diagnosed as arthritis associated with rheumatic fever, 22.9% as fatigue and 20.3% as intervertebrate disc. 45.0% were misdiagnosed by one physician while 21.4% were misdiagnosed for several times, and the average length of delay diagnosis was 72±68 months. Seven cases, although the diagnosisi was being delayed for more than 10 years the initial diagnosis was correct. Conclusion Delayed diagnosis of AS is common in China. The major reasons for delayed diagnosis are HLA-B27 negative and lack of X-ray changes of sacroiliac joint at the initial visit.