38例强直性脊柱炎早期诊断影响因素探讨

Approach to early diagnosis of ankylosing spondylitis on 38 cases

目的总结强直性脊柱炎早期的重要临床表现以及实验室检查方法,进一步提高对强直性脊柱炎的认识。方法收集笔者所在医院2007年7月～2009年6月间38例确诊为强脊炎早期患者的病例资料进行回顾性分析。结果 38例强直性脊柱炎患者中有夜间休息痛和晨僵者24例(63.2%),有活动后疼痛缓解者30例(78.9%),骶髂关节检查阳性者22例(57.9%);HLA-B_(27)阳性者36例(94.7%),血沉和C反应蛋白异常增高者分别为15例(39.5%)和14例(36.8%)。结论晨僵和休息后疼痛加重以及活动后疼痛缓解是强直性脊柱炎早期重要的临床症状,HLA-B_(27)阳性对早期诊断具有重要价值。骶髂关节检查具有较高阳性率,血沉和C反应蛋白有辅助诊断意义。

Objective To further understand the early clinical features and diagnosis of ankylosing spondylitis （AS）. Methods The clinical data of 38 cases with early AS in our hospital from July 2007 to June 2009 were retrospectively analyzed. Results The male - to - female ratio was 3.2： 1. Mean age at disease onset was 26 years and disease duration was 3 years. Of the clinical features in these 38 patients, there were night pain and morning stiffness （ n = 24,63.2% ）, improvement of backache with exercise（ n = 30,78.9% ） and positive of physical examination of sacroiliac （SI） joint（ n = 22,57.9% ）. ESR and CRP were abnormally high in 39.5% （ 15/38 ） and 36.8% （14/38） , respectively. HLA - B27 was present in 94. 7% （36/38）of patients . Conclusion The night pain, morning stiffness and improvement with exercise are important clinical symptoms for early AS. Physical examination of SI joint,tests of HLA -B27, CRP and ESR have a high clinical value in diagnosis of AS.