幼年强直性脊柱炎的早期诊断探讨

Exploration of early diagnosis on juvenile ankylosing spondylitis

目的探讨幼年强直性脊柱炎(juvenile ankylosing spondylitis,JAS)的早期临床表现及其早期诊断条件。方法分析30例JAS的早期临床表现、实验室与影像学资料,结合随访观察,对JAS的早期临床表现、早期诊断标准进行探讨。结果早期临床表现:膝、踝、指、趾关节肿痛8例(26.66%),髋部疼痛8例(26.66%),外周关节(膝、踝、指、趾)肿痛+髋部疼痛5例(16.66%),肌腱端炎或足跟痛4例(13.33%),腰骶痛3例(10%),足跟痛+外周关节肿痛1例(3.33%),颈痛1例(3.33%);HLA-B27阳性27例(86.67%),HLA-B27阴性4例(13.33%)。结论本文研究显示,JAS早期临床表现依次为:外周关节炎、髋部疼痛、足跟痛(肌腱端炎)、腰骶部疼痛等。早期诊断应对以外周关节炎或周身肌肉疼痛发病的男孩,详细询问有无脊柱关节病家族史,做HLA-B27检测,动态摄骶髂关节X线片或CT,注重随访观察,以期早期确诊,及时用药,改善预后。

Objective To explore the early clinical manifestations and early diagnosis of JAS. Methods We analyzed the early clinical manifestations, the data of laboratory and imaging in 30 cases of JAS. And observed them in several years, explored the early clinical manifestations and the condition of early diagnosis of JAS. Results The early manifestations：8 cases（26.66% ） had peripheral joints arthritis （ including knee, ankle, finger; toe） , 8 cases（26.66% ） had coax pain, 5 cases （ 16. 66% ） had peripheral joints arthritis and coax pain, 4 cases（ 13.33% ） had thews end inflammatory and thenar pain, 3 cases（ 10% ） had stiffness and pain of back, 1 case（3.33% ） had thenar pain and peripheral joints arthritis, 1 ease（3. 33% ） has neck pain. There are 27 cases（ 86. 67% ） of HLA -B27 positive and 4 cases （13.33%） of HLA -B27 negative. Conclusion As the result, the early clinical manifestations of JAS includes peripheral arthritis, coax pain, thews end inflammatory and thenar pain and stiffness and pain of back. To those child who have peripheral arthritis and muscle pain as the first clinical manifestation, doctor should remember to enquire the family history of spondylitis, test HLA - B27, check sacroiliac joint CT, so that diagnosis it in the first time and therapy, reduce disability ratio.