40例幼年发病型脊柱关节病临床分析

The forty clinical analysis of juvenile onset spondyloarthropathies

目的 提高对幼年发病型脊柱关节病的认识。方法 分析 4 0例 JSp A患者的临床实验室及影像学资料 ,并对其诊断分类进行讨论。结果 4 0例 JSp A中 ,男性 37例 ,女性 3例 ,男女之比 12∶ 1;发病年龄 4～ 16岁 ,平均 (12 +/- 3)岁 ,8岁后发病 37例 (92 .5 % )。首先出现外周关节炎 2 9例 (72 .5 % ) ,以腰背痛为首发症状 8例 (2 0 % ) ,病程中有 18例患者受累关节数大于 4个 (45 % ) ;7例 (17.5 % )出现发热症状 ,12例 (30 % )心电图发现异常改变 ,30例 (75 % )伴有轻度贫血。 HL A- B2 7阳性率 5 0 % ;2 6例 (6 6 .7% )影像学证实为骶髂关节炎 ;6例 (15 .4 % ) CT证实为骶髂关节炎 ,X线检查阴性 ,占 15 .4 %。 4 0例患者中 ,有 2 2例 (5 5 % )确诊为幼年强直性脊柱炎。结论 JSp A的概念提出有助于幼年发病型脊柱关节病的早期诊断 ,CT检查有助于更早检出骶髂关节炎。

Objective\ For a better understanding of the clinical characters of juvenile onset spondyloarthropathies(JSpA).Method\ The clinical & video record data in laboratory of 40 patients with JSpA were analyzed and the diagnosis was further discussed base on the different category of juvenile onset arthritis.Result\ Among the 40 cases,37 are male and 3 are female with a ratio of 12∶1.The disease comes on between 14 16 and the average is 12+/-3 years old.92 5% of them had the disease after the age of 8 29(72 5%)patients had peripheral arthritis and 8(20%)patients felt low back pain at the first onset.During the course of diseases,18(45%)patients had the number of morbidity joints over 4;7(17 5%)patients had a fever,12(30%)patients had abnormal ECG changes;30(75%)patients had low level anemia.50% were proved HLA B27 positive;26(66 7%)patients were observed sacroilits by X ray or CT examination,6(15 4%)patient were observed sacroilits by CT examination,but X ray as negative;22(55%)patients were diagnosed juvenile ankylosing spondylitis(JAS)according to 1984 NEW YORK modified criteria.Conclusion\ The concept of JSpA is helpful to early diagnosis and treatment of juvenile onset arthritis and the CT examination is helpful to early diagnosis of sacroilitis.