男女性强直性脊柱炎胸腰椎后凸畸形患者临床特征及生活质量的比较

Comparison of clinical characteristics and life quality in ankylosing spondylitis(AS)-related thoracolumbar kyphosis between male and female patients

目的：探讨男女性强直性脊柱炎（ankylosing spondylitis，AS）胸腰椎后凸畸形患者临床特征及生活质量的差异。方法：选取2009年5月~2013年2月在我院手术治疗的51例AS患者，其中男31例，女20例，年龄21~62岁，平均40.6岁。所有患者均填写Oswestry功能障碍指数（Oswestry disability index，ODI）、巴氏AS疾病活动指数（Bath ankylosing spondylitis disease activity index，BASDAI）、巴氏AS功能指数（Bath ankylosing spondylitis functional index，BASFI）、巴氏AS计量指数（Bath ankylosing spondylitis metrology index，BASMI）、巴氏AS总体评分（Bath ankylosing spondylitis global score，BAS-G）、巴氏AS放射指数（Bath ankylosing spondylitis radiology index，BASRI）及SF-36量表；同时记录其发病年龄、病程、血沉（erythrocyte sedimentation rate，ESR）、C反应蛋白（C-reactive protein，CRP）、人类白细胞抗原-B27亚型（HLA-B27）；在立位全脊柱侧位X线片上测量全脊柱最大后凸角（global kyphosis，GK）、腰椎前凸角（lumbar lordosis，LL）、胸椎后凸角（thoracic kyphosis，TK）、矢状面平衡（sagittal vertical axis，SVA）、骨盆投射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilting，PT）及骶骨倾斜角（sacral slope，SS）。比较男性组与女性组发病年龄、病程、ESR、CRP、HLA-B27阳性率、TK、GK、LL、SVA、PI、PT、SS、ODI、BASDAI、BASFI、BASMI、BAS-G、BASRI及SF-36量表各维度之间的差异。结果：男女比例为1.6∶1。与男性组比较，女性组发病年龄较晚、病程较短、ESR和CRP水平较高及HLA-B27阳性率较低（P〈0.05）。与男性组比较，女性组表现出较高的ODI、BASDAI、BASRI评分及较低的BASMI评分（P〈0.05），两组BASFI及BAS-G无统计学差异（P＞0.05）。脊柱-骨盆矢状面参数中，与男性组比较，女性组表现出较大的GK、SVA（P〈0.05），两组TK、LL、PI、PT及SS均无统计学差异（P＞0.05）。SF-36量表各维度中，女性组情感职能得分、精神健康得分低于男性组，而生理功能得分、社会功能得分高于男性组（P〈0.05），两组生理职能、身体疼痛、总体健康状况及活力得分无统计学差异（P＞0.05）。结论：在行手术治疗的AS患者中，男女比例为1.6∶1。与男性AS患者相比，女性患者病情较重，且发病年龄较晚，病程较短。此外，男性AS患者生理功能、社会功能受到明显的限制，而女性AS患者情感职能、精神健康受到明显的损害。

Objectives： To investigate the differences in ankylosing spondylitis（AS） -related thoracolumbar kyphosis between male and female patients in terms of clinical characteristics and life quality. Methods： From May 2009 to February 2013, 51 AS patients（31 males and 20 females） with an average age of 40.6 years（21-62 years） were included in the study. All patients were completed Oswestry disability index（ODI）, Bath ankylosing spondylitis disease activity index（BASDAI）, Bath ankylosing spondylitis functional index（BASFI）, Bath ankylosing spondylitis metrology index（BASMI）, Bath ankylosing spondylitis global score（BAS-G）, Bath ankylosing spondylitis radiology index（BASRI） and SF-36. Additionally, age at onset, disease duration, erythrocyte sedimentation rate（ESR）, C-reactive protein（CRP） and HLA-B27 were recorded. Sagittal parameters were measured on standing lateral full-spine radiographs, including thoracic kyphosis（TK）, global kyphosis（GK）, lumbar lordosis（LL）, sagittal vertical axis（SVA）, pelvic incidence（PI）, pelvic tilting（PT） and sacral slope（SS）. A comparison was conducted in terms of age at onset, disease duration, ESR, CRP, HLA-B27, TK, LL, GK, SVA, PI, PT, SS, ODI, BASDAI, BASFI, BASMI, BAS-G, BASRI and SF-36 between male and female patients. Results： The ratio of male/female was 1.6∶1. Compared with male patients, female patients had an older mean age at disease onset, a shorter mean time of disease duration, a higher mean baseline of ESR and CRP and a lower proportion of HLA-B27 positive（P〈0.05）. Additionally, females had higher ODI, BASAI and BASDRI scores than males; however, females exhibited lower BASMI score（P〈0.05）. No significant differences were observed in BASFI and BSA-G between the two groups（P〉0.05）. In sagittal spinopelvic parameters, females had higher GK and SVA（P〈0.05）, whereas there was no difference in TK, LL, PI, PT or SS between the two groups（P〉0.05）. With respect to the domains of SF-36, females showed lower role emotional score and mental health score than males; whereas females had higher physical functioning score and social functioning score（P〈0.05）. No significant differences were noted in role physical, bodily pain, general health and vitality between the two groups（P〉0.05）. Conclusions： In AS patients requiring surgical correction, the male/female ratio of 1.6∶1 is observed. Compared with male AS patients, female patients have a higher burden of disease and a later disease onset of shorter duration. Moreover, notable limitations of physical functioning and social functioning are found in male AS patients. While obvious damages of role emotional and mental health are observed in females AS patients.