111例川东北地区强直性脊柱炎患者流行病学特征及诊断延误分析

Epidemiological Features and Delayed Diagnosis of 111 Ankylosing Spondylitis Cases in Northeastern Sichuan

目的了解川东北地区强直性脊柱炎(AS)患者的流行病学及临床特征,分析其诊断延误情况。方法采用自编式AS流行病学调查表,收集111份2017年1-12月在川北医学院附属医院风湿免疫科确诊为AS患者的性别、年龄、职业、病程、首发疼痛部位、葡萄膜炎病史等流行病学及临床特征资料,采用流式细胞术对患者外周血进行HLA-B27检测,完善患者双侧骶髂关节、髋关节CT及骶髂关节磁共振扫描。结果111例患者男女比2.58∶1,年龄(35.85±10.53)岁,27.9%为务工人员;发病年龄(27.86±8.64)岁,病程(7.99±6.29)年;HLA-B27总阳性率88.1%,16.2%存在葡萄膜炎病史;52.3%患者此次就诊前无正规治疗史;68.5%患者以外周关节受累为首发症状;CT结果示,25%患者达到骶髂关节晚期骨性强直,17.0%已出现髋关节破坏;磁共振检查示,60.2%患者有骶髂关节面骨髓水肿征象;73.0%患者存在确诊延误,延误组平均年龄、病程均大于未延误组(P<0.05)。结论川东北地区AS患病人群以青壮年为主,大部分患者存在长时间确诊延误,故加强基层医生队伍有关AS临床知识的培训,提高AS早期诊断率,对患者的后期治疗及生活质量改善有重要意义。

Objectives To investigate the epidemiological and clinical features of ankylosing spondylitis （AS） in northeastern Sichuan and analyze the situation of delayed diagnosis. Methods The data of 111 AS cases were collected in Department of Rheumatism of Affiliated Hospital of North Sichuan Medical Oollege from January to December of 2017 with a self-designed questionnaire concerning epidemiological and clinical features such as gender, age, occupation, course of disease, initial pain area and history of uveitis. The HLA B27 expression of the peripheral blood was detected by flow cytometry. Bilateral sacroiliac joints and hip joints were scanned by CT and MaRl. Results Among the 111 patients, the ratio of male to female was 2.58：1, the average age was （35.85±10.53） years, and 27.9% were migrant workers. The age of onset was （27.86 ± 8.64） years and the duration of disease was （7.99 ± 6.29） years. The total positive rate of HLA B27 was 88.1%. 16.2% of those cases had a history of uveitis, 52.3% had no history of regular treatment, and 68.5% had the peripheral joint involvement as the initial symptom. The results of CT scan showed that 25% of the cases reached the advanced osseous ankylosis of the sacroiliac joint and 17% had hip joint destruction. The results of MRI showed 60.2% of those cases had the bone marrow edema of sacroiliac joint face and 73.0% had delayed diagnosis. The average age and disease duration in the delayed diagnosis group were significantly longer than those in the non delayed diagnosis group. Conclusion The majority of the AS patients in northeastern Sichuan are young adults and most of the patients have long-time delay in the diagnosis. Therefore, it is of great significance for AS patients treatment and quality of life by strengthening the training of AS clinical knowledge for the primary medical staff and improving the rate of early diagnosis.