容易误诊为慢性非特异性腰背痛的青少年强直性脊柱炎

Juvenile Ankylosing Spondylitis Easily Misdiagnosed as Nonspecific Chronic Low Back Pain

目的探讨青少年强直性脊柱炎(ankylosing spondilitis,AS)的临床特点及其与慢性非特异性腰背痛的鉴别诊断。方法对2001～2009年门诊确诊为青少年AS103例的临床资料进行回顾性分析。结果 103例均有腰背疼痛,其中以骶髂关节疼痛为主93例,晨起时腰背僵硬感99例,活动后症状减轻95例,休息后加重97例。伴有全身乏力21例,并发虹膜炎17例,并发外周大关节滑膜炎25例。所有患者均误诊为慢性非特异性腰背痛。入院后查人白细胞抗原B27(HLA-B27)阳性101例,C反应蛋白(CRP)51例增高,红细胞沉降率(ESR)76例增快,结合X线、CT、MRI检查确诊为AS,给予相应治疗,症状缓解。结论青少年慢性非特异性腰背痛应考虑AS的可能,需行骶髂关节X线、CT、MRI及相关实验室检查,及早确诊。

Objective To explore the clinical characteristics of juvenile ankylosing spondylitis and its differential diagnosis with nonspecific chronic low back pain.Methods Clinical data of 103 juvenile outpatients with ankylosing spondylitis（AS） from 2001～2009 were retrospective analyzed.Results All patients had a symptom of low back pain,among whom 93 patients had sacroiliac joint pain;99 patients had flow back stiffness in the early morning;symptom decreased in 95 patients after activity,but became worse in 97 patients after the break.21 patients had accompanied weakness;17 patients had iritis and 25 patients had peripheral large joint synovitis.All the patients were misdiagnosed as chronic nonspecific low back pain,among whom 101 patients were of human leukocyte antigen B27（HLA-B27） positive.The level of C-reactive protein（CRP） increased in 51 patients,and ESR accelerated in 76 patients.All patients were diagnosed as AS by X ray,CT,MRI and laboratory examination.Symptoms were relieved after appropriate treatment.Conclusion Juvenile with chronic nonspecific low back pain should be considered to be related to AS,and sacroiliac joint X ray,CT,MRI and related laboratory examinations are needed in early diagnoses.