强直性脊柱炎严重髋关节病变的相关因素

The Main Factors in Severe Lesion of Hip in Patients with Ankylosing Spondylitis

目的 :了解强直性脊柱炎 (AS)严重髋关节病变的临床特点及相关因素。方法 :对 6 5例严重髋关节病变已行髋关节置换术的AS患者 (A组 )和 130例无髋关节病变的AS患者 (B组 )进行对比分析。结果 :A组发病年龄及病程均短于B组 (P <0 0 5 ) ;以外周关节病起病A组明显高于B组 (P <0 0 1) ;A组全身症状和外周关节炎比B组重 (P <0 0 1) ;ESR ,CRP ,IgG ,IgM及r-球蛋白水平A组均高于B组 (P <0 0 5 ) ;X线检查骶髂关节及脊柱病变两组无明显差异 ;早期用柳氮磺胺吡啶 (SASP)治疗的人数A组少于B组 (P <0 0 5 ) ,早期用激素治疗的人数A组多于B组 (P <0 0 5 )。结论 :发病年龄早、病情进展快 ,以外周关节起病伴全身症状重以及外周关节炎者易发生髋关节严重破坏 ,炎症或免疫反应、早期应用激素可能与髋关节破坏有关。早期用SASP治疗 ,尽量避免用激素 。

Objective To evaluate clinical features and main factors that related to severe lesion of hip in patients with ankylosing spondylitis Methods 65 patients with ankylosing spondylitis complicated with severe lesion of hip and had hip arthroplasty (group A) were compared with 130 patients with ankylosing spondylitis and without hip joint lesion (group B) Results Both age of onset and course of disease in group A were significantly shorter than that in group B (p<0.05); The incidence of peripheral arthralgia in group A (43.75%) was higher than that in group B (p<0.01); Systemic symptom and peripheral arthritis in group A were more severe than that in group B (p<0.01); ESR, CRP, IgG, IgM and r-globulin in group A were higher than that in group B (p<0.05); The lesion of sacroiliac joint and spine in X-ray image were the same in both groups; The number of early treatment with SASP in group A was lower than that in group B (p<0.05); The number of early treatment with hormone in group A was higher than that in group B (p<0.05). Conclusion Severe lesion of hip in the early age, rapid progression, severe systemic symptom with peripheral joint lesion, and peripheral arthritis were found in patients with ankylosing spondylitis complicated with severe lesion of hip, which could be caused by the infection or immunity reaction and early treatment with hormone.Early use of SASP and avoidance of early hormone therapy could prevent or delay the impairment of hip.