未分化脊柱关节病1024例随访分析

The follow-up analysis of 1024 patients with undifferentiated spondyloarthropathy

目的：了解未分化脊柱关节病（uSpA）的临床特征及发展规律。方法：分析1 024例uSpA患者临床表现及随访转归情况。结果：男女比例为1.7∶1;腰背部疼痛（93.7%）和外周关节痛（96.0%）最多见;女性腰背部疼痛的首发率明显高于男性（P〈0.05）;男性髋关节、臀区或足跟及其他附着点部位疼痛起病的首发率均高于女性（P〈0.05）;家族史阳性率为40.6%,HLA-B 27阳性率为47.4%,两性间比较差异无统计学意义（P〉0.05）;CT对诊断uSpA较X线敏感,二者骶髂关节炎阳性率分别为88.6%（287/324）和45.7%（468/1 024）,男性骶髂关节破坏的阳性率高于女性（P〈0.05）;648例经治疗随诊0.5-8年,其中186例症状消失,234例仍为uSpA,余228例转归为其他疾病：进展为强直性脊柱炎190例,转归为炎性肠病关节炎7例,银屑病性关节炎11例,uSpA合并干燥综合征12例,类风湿关节炎4例,系统性红斑狼疮2例,白塞病和混合性结缔组织病各1例。结论：uSpA是一组常见的临床症状多样的脊柱关节病,有遗传倾向。男性骶髂关节受累较女性严重,女性腰背部疼痛及手关节发生率较高。部分患者可进展为强直性脊柱炎、银屑病性关节炎及炎性肠病关节炎等其他脊柱关节病,个别患者演变或合并干燥综合征、类风湿关节炎、系统性红斑狼疮、混合性结缔组织病、白塞病等,密切随访uSpA患者至关重要。

Objective：To substantiate the clinical features and the developmental rules of undifferentiated spondylarthropathies（undifferentiated spondyloarthropathy,uSpA）.Methods：To analyze the 1 024 uSpA patients′ clinical,behavior and follow-up dates.Results：The male female ratio is 1.7∶1.The chief symptoms were lumbar pain（93.7%） and joints pain（96.0%）.The primary rate of lower back pain in women was significantly higher than in the men（P0.05）.Some men with hip,heel and other attachment sites pain were higher than women（P0.05）.The positive rate of family history was 40.6%.The positive rate of HLA-B27 was 48.4%.There was no significant difference between male and female.The sensitivity of sacroiliac joints for CT in the diagnosis of uSpA was higher than X-ray.The two positive rates for diagnosing sacroiliitis were 88.6%（287/324）,and 45.7%（468/1 024）,respectively.The positive rate of destructed sacrum in men is higher than women（P0.05）.After treatment,648 patients were follow-up for 0.5～8 year.The symptoms disappear in 186 patients,234 patients remain uSpA,228 patients developed to other diseases,190 patients developed ankylosing spondylitis,7 patients developed enteropathic arthropathy,11 patients developed psoriatic arthritis,12 patients developed sjogren syndrome,2 patients developed systemic lupus erythematosus.Others developed 1 behcet′s disease and 1 mixed connective tissue disease.Conclusion：uSpA were a group of a variety of spondyloarthropathy,which had a genetic predispositional potential.The sacroiliac joint involvement of men was more serious than women.Meanwhile lumbar and hand joint pain happen in females more frequently than male.Some patients can progress to ankylosing spondylitis,psoriatic arthritis and enteropathic arthropathy.Specific patients can progress to sjogren′s syndrome,rheumatoid arthritis,systemiclupus erythematosus,mixed connective tissue disease,behcet′s disease and so on.Follow-up on the patients was very important.