骶髂关节炎509例临床资料分析

A clinical analysis of 509 cases of sacroiliitis

目的探讨骶髂关节炎的临床特点及鉴别诊断。方法回顾性分析2007-2012年解放军总医院门诊和住院有腰背痛和骶髂关节炎患者509例的临床资料。结果509例患者中，男性406例，女性103例，其中强直性脊柱炎／脊柱关节炎436例，致密性骨炎36例，骶髂关节退行性病变10例，骶髂关节感染10例，弥漫性特发性骨肥厚4例，掌趾脓疱病性关节炎4例，代谢性骨病4例，骶髂关节痛风1例，肿瘤性疾病4例。强直性脊柱炎／脊柱关节炎患者HLA—B27阳性率86．9％。强直性脊柱炎／脊柱关节炎患者红细胞沉降率、C反应蛋白轻中度升高，骶髂关节感染和肿瘤性疾病患者红细胞沉降率、C反应蛋白升高较明显。强直性脊柱炎／脊柱关节炎影像学特点主要表现为骶髂关节骨破坏，磁共振成像显示为骶髂关节骨髓水肿，但范围不超出解剖结构。结论非强直性脊柱炎引起的骶髂关节炎并不少见，应提高警惕，防止遗漏，尤其是HLA－B27。阴性者，以免误诊、误治。

Objective To study the clinical features of sacroiliitis and differential diagnosis. Methods Totally 509 patients with chief complaints of back pain and diagnosed as sacroiliitis from January 2007 to January in Chinese PLA General Hospital were enrolled. The clinical manifestations, laboratory examinations, imaging and pathological data of the 509 patients were retrospectively analyzed. Results There were totally 406 male patients and 103 female patients. Among all 509 patients, 436 were diagnosed as ankylosing spondylitis （ AS ）/ spondyloarthropathy （ SpA ） , including 385 men. Thirty-six cases were diagnosed as sclerosing osteitis. Ten cases were diagnosed as sacroiliac joint degeneration. Ten cases were diagnosed as pyogenie sacroiliitis or sacroiliac joint tuberculosis. Four cases were diagnosed as diffuse idiopathic bone hypertrophy. Four cases were diagnosed as palmoplantar pustulosis arthritis. Four cases were diagnosed as metabolic bone disease. One case was diagnosed as sacroiliac joint gout. Four cases were diagnosed as neoplastic disease. HLA-B27 positive rate was 86.9% in AS/SpA. Erythrocyte sedimentation rate and C-reactive protein were increased mildly-to-moderately in AS/SpA patients. Erythrocyte sedimentation rate and C-reactive protein increased obviously in sacroiliac joint infection and tumor diseases. Imaging characteristics were sacroiliac joint bone destruction. Magnetic resonance imaging showed sacroiliac joint bone marrow edema, but range was not beyond anatomical structure in AS/SpA. Conclusions Based on disease distribution of sacroiliitis, AS/SpA is predominant while uon-ankylosing spondylitis is not uncommon. Differential diagnoses of sacroiliitis should be considered to avoid malpractice, especially in patients with negative HLA-B27.