氟骨症与强直性脊柱炎临床特点对照分析

Analysis of clinical features of 62 cases of skeletal fluorosis of and a comparison with 54 cases of ankylosing spondylitis

目的探讨氟骨症与强直性脊柱炎(ankylosing spondylitis,AS)的鉴别诊断要点。方法回顾分析我省某氟骨症专科医院提供的62例氟骨症与同期就诊我院54例AS的临床资料。结果氟骨症患者发病平均年龄(42.9±6.66)岁,明显大于AS患者[(18±7.57)岁],差异有统计学意义(P<0.01);外周关节疼痛数目≥3者所占比例明显大于AS组(74.2%vs 3.7%,P<0.01),活动后加重所占比例明显高于AS组(83.9%vs 5.56%,P<0.01),HLA-B27阳性所占比例明显低于AS组(3.2%vs 90.7%,P<0.01),四肢骨病变、外周关节病变及骨间膜钙化比例均明显高于AS组(P<0.01),脊柱竹节样变比例高于AS组(61.3%vs 22.2%,P<0.05),骨质破坏比例明显低于AS组(P<0.01)。结论氟骨症与强直性脊柱炎的鉴别,应从流行病学、临床表现、HLA-B27检测及影像学检查等综合考虑,以减少误诊。

Objective To explore the differential diagnosis between skeletal fluorosis and ankylosing spondylitis. Methods 62 patients of skeletal fluorosis provided by a specialized hospital in Shanxi province and 54 AS patients admitted to Sbanxi Provincial Corps Hospital from August 2009 to March 2010 were retrospectively analyzed. Results The age of onset（42.9 ± 6.66） and number of peripheral joint pain （ ≥3 ）in skeletal fluorosis group were above those in AS group, and the difference was statistically significant （P 〈0.01 ）. The rate of deterioration after exercise（ 83.9% ,52 cases） was higher than that in AS group（ 5.56%, 3 cases） （ P 〈 0.01 ）. The positive rate of HLA -B27 in skeletal fluorosis group （3.2% , 2 cases） was lower than that in AS group（ 90.7% ,49 cases）（P 〈0.01 ）. The rate of limb bone lesions （ 100%, 62 cases） , peripheral joint disease（90.3%, 56cases） and interosseous membrane calcification（27.4% , 17 cases）was higher than in AS group（ P 〈 0.01 ）. The rate of spinal slub amyloidosis （61.3% , 38 cases） was higher than that in AS group （22.2% , 12cases） （ P 〈 0.05 ）. The rate of bone destruction in skeletal fluorosis group （ 0% , 0 cases）was lower than that in AS group（29.6% , 16 cases） （P 〈 0.01 ）. Conclusions Correct diagnosis should be made based on epidemiology ,clinical manifestations,HLA - B27 test and imaging manifestations between skeletal fluorosis and ankylosing spondylitis.