强直性脊柱炎和放射学阴性的脊柱关节病患者临床及实验室特征比较

Comparison of clinical and laboratory features between patients with ankylosing spondylitis and nonradiolographic axial spondyloarthritis

目的分析和比较As和放射学阴性的脊柱关节病（nr-axSpA）患者的临床及实验室特征。方法收集141例As和73例nr—axSpA患者，详细记录患者的临床及实验室指标，并计算BASDAI、强直洼脊柱炎疾病活动评分（ASDAScrp）积分，采用加拿大脊柱骨关节研究协会评分系统（SPARCC）积分作为骶髂关节骨髓水肿的评估指标，采用t检验、秩和检验和矿检验的统计学方法。结果①一般特征的比较：As患者的平均年龄[（32±11）岁]明显高于nr=axSpA患者[（25±5）岁]（t=4．962，P〈0．01）；AS患者中男性占82．0％明显高于nr-axsDA患者中的49.3％0（2=24．079，P〈0．01）；AS患者的病程明显长于nr-axSpA患者（Z=6．396，P〈0．01），AS患者的HLA—B27阳性率为89．4％与nr—axSpA患者（84．9％）差异无统计学意义（r=0．884，P〉0．05）。②2组间炎症程度的比较：As患者中有21例有外周关节肿胀（21．6％），nr—axSpA患者仅有1例有关节肿胀（2．2％）（x2=8．861，P=0．003）；AS患者中有40例有关节压痛（41．2％），nr-axSpA患者仅有6例有关节压痛（13．3％），差异有统计学意义（r=11．458，P〈0．01）；AS患者的ESR中位数27（12，57）和CRP中位数21．36（7．64，39．3）均明显高于nr-axSpA患者的7（2．25，14）和2．65（0．84，6．20），差异有统计学意义（Z=6．405，P〈0．01；Z=7．507，P〈0．01）；AS患者BASDAI和ASDAScrp中位数均明显高于nr-axsDA患者（P均〈0．01）；AS患者总体评价（PGA）亦高于nr．axSpA患者（t=4．636，P〈0．01）；AS患者的SPARCC评分与nr—axSpA患者差异无统计学意义（Z=0．051，P〉0．05）；70．5％（55／78）的AS患者具有骶髂关节活动性炎症改变，nr—axSpA患者中的比例为68．4％（26／38）（x2=0．053，P=0．818）。③2组间功能指标的比较：AS患者枕墙距〉0cm的比例、指地距的中位数分别高于nr—axSpA患者（x2=19．844，P〈0．01；z=5．724，P〈0．01）：AS患者的胸扩张度、腰椎活动中位数分别低于Dr—axSpA患者（Z=3．083，P=0．002；z=5．103，P〈0．01）；AS患者的BASFI中位数高于nr-axSpA患者（Z=5．840，P〈O．01）；AS关节功能构成比明显差于nr-axSpA患者（x2=11．369，P=0．01）。结论与nr-axSpA患者相比，AS患者以男性为主，其临床及实验室的炎症程度更重，功能更差。

Objective To analyze and compare the clinical and laboratory features between patients with aukylosing spondylitis （AS） and nonradiographic axial spondyloarthfitis （nr-axSpA）. Methods One hundred and forty-one patients with AS and 73 cases with nr-axSpA were recruited. Clinical and laboratory indexes of individuals were recorded in detail, Bath Ankylosing Spondylitis Disease Activity Index （BASDAI） and Ankylosing Spondylitis Disease Activity Score （ASDAS） crp were calculated. Spondyloarthritis research consortium of Canada （SPARCC） score standard was used to evaluate the degree of bone marrow edema in sacr-oiliac joint under magnetic resonance imaging scanning. T test, rank test and X2 test were used statistical analysis. Results The average age of patients with AS was obviously higher than that of patients with nr-axSpA （t=4.962, P〈0.11）. Patients with AS were more often male, and those with nr-axSpA were more often female （82.0% of the AS patients were men and 49.3% of the nr-axSpA patients were men （x2=24.079, P〈0.01）. Disease duration of AS was significantly longer than that of the nr-axSpA （Z=6.396, P〈0.01）. The incidence of human leukocyte antigen （HLA）-B27 positive in AS was 89.4%, which was similar to that in patients with nr-axSpA （84.9%） （x2=0.884, P〉0.05）. 21.6% （21 cases） of patients with AS had peripheral swollen joints, which was higher than that in nr-axSpA （2.2%,）（2=8.861, P=0.003）. Forty cases in AS had tender joints （41.2%）, only 6 patients in nr-axSpA had tender joints （13.3%,A,2=11.458, P〈0.01）. Serum erythrocyte sedimentation rate （ESR） and C reactive protein （CRP） levels in patients with AS were clearly higher than those in nr-axSpA （P〈0.01） patients. In AS, the patient global assessment （PGA）, BASDAI and ASDAScrp value was significantly higher than that in nr-axSpA （P〈0.01）. There were no differences in SPARCC score or incidence of bone marrow edema in sacroiliac joint in magnetic resonance imaging scanning between AS and nr-axSpA （P〉0.05）. Percentage of patients with occipit-to-wall distance higher than 0 cm in AS was higher than that in nr-axSpA, and the mean distance of fingers to ground in AS was also higher than that in nr-axSpA （X2=19.844, P〈0.01; Z=5.724, P〈0.01）. Chest expansion degree and Schboer＇s test in AS was much lower than that in nr-axSpA, respectively （Z=3.083, P=0.002; Z=5.103, P〈0.01）. BASFI in AS was higher than that in nr-axSpA （Z=5.840, P〈0.01）. The ratio of joint function in AS was obviously worse than that in nr-axSpA （X2=11.369, P=0.01）. Conclusion Compared to patients with nr-axSpA, AS patients are male predominant, and have severer inflammation in clinical and laboratory findings and are worse in functional status.