伴前葡萄膜炎的脊柱关节病86例临床分析

Clinical analysis of 86 patients with spondyloarthropathy associated with anterior uveitis

目的 探讨脊柱关节病（SpA）合并前葡萄膜炎的临床特点及危险因素.方法 收集2005年3月至2008年12月在我科就诊的伴发前葡萄膜炎的86例SpA患者的临床和实验室资料,进行总结分析,对其进行随访,并与同期不伴前葡萄膜炎的93例SpA患者进行对比分析.正态分布资料用t检验,非正态资料用秩和检验;计量资料用x2检验;两变量间用线性相关分析,与眼炎发病风险相关的多种因素用Logistic回归分析.结果 眼炎组患者平均病程显著长于非眼炎组[分别为（11±8）年和（5±6）年,P＜0.01],阳性家族史比例显著升高（27.9%与9.7%,P＜0.01）,患者出现夜间腰痛、晨僵、弯腰受限、脊柱畸形及骶髂关节X线严重病变的比例均高于非眼炎组（P均＜0.05）,人类白细胞抗原（HLA）-B27阳性率也显著高于非眼炎组（92.2%与81.5%,P＜0.05）.眼炎发作多有季节性和诱因;以前葡萄膜炎为首发症状患者的眼炎平均发作次数和出现眼睛永久性病变的比例显著升高（P均＜0.01）.眼炎的发作次数与病程呈正相关（r=0.294,P=0.006）.Logistic多因素回归分析显示,与眼炎发病风险相关的因素为病程[P=0.013,OR=1.099,95%可信区间（CI）1.030～1.183]和骶髂关节严重病变（P=0.012,OR=3.071,95%CI 1.286～7.314）.结论 伴前葡萄膜炎的脊柱关节病有其自身特点,应重视前葡萄膜炎发病的危险因素,预防眼炎复发.

Objective To investigate the clinical features and risk factors of spondyloarthropathy with anterior uveitis. Methods The clinical and laboratory data of 86 patients with spondyoarthropathy associated with anterior uveitis in our hospital were collected, analyzed and summarized from March 2005 to December 2008, and the patients were followed up as closely as possible. The data of the 86 patients were compared with 93 patients who had spondyloarthropathy without anterior uveitis at the same period. All data were analyzed by using SPSS11.5 software package. Results Compared with non-ophthalmia group, ophthalmia group had significantly longer course[（11 ±8）vs（5±6）, P〈0.01], and higher proportion of positive family history（27.9%vs 9.7%, P〈0.01）, the proportion of low back pain at night, morning stiffness, spinal deformity, limitation of waist-bending and severe sacroiliac joint lesions were all significantly higher（P〈0.05）, HLA-B27 positive rate was significantly higher as well（92.2% vs 81.5%, P〈0.05）. The attack of uveitis usually had seasonality and precipitating cause. The patients with anterior uveitis as first symptom had significant higher frequency of ophthalmitis（P〈0.01）, the ratio of eye permanent lesions was also significantly higher（P〈0.01）. The frequencies of attack were positively correlated with the course of disease（r=0.294, P=0.006）, Logistic multiple regression analysis showed that the incidence risk of ophthalmia were related to the course of disease（P=0.013, OR=1.099, 95%CI 1.030～1.183）and severe sacroiliac joint lesions（P=0.012, OR=3.071, 95%CI 1.286 ～7.314）. Conclusion The spondyloarthropathy associated with anterior uveitis had its own characteristics, We should pay attention to the risk factors of anterior uveitis,and prevent the recurrence of ophthalmia.