幼年起病强直性脊柱炎患者的临床特点分析

Clinical characteristics of juvenile-onset ankylosing spondylitis

目的分析幼年起病的强直性脊柱炎(AS)患者临床特点。方法对2014年1月至2019年12月北京积水潭医院诊治的350例AS患者临床资料进行回顾性分析。350例病程(10.8±8.6)年,人类白细胞抗原B27(HLA-B27)阳性率90.9%(318/350),其中起病年龄≤16岁即幼年起病AS(JoAS)者75例(JoAS组),起病年龄>16岁即成年起病AS(AoAS)者275例(AoAS组)。结果①与AoAS组相比,JoAS组男性占比较高[98.7%(74/75)比79.6%(219/275)]、病程较长[11(8,15)比8(4,15)年],差异均有统计学意义(χ^2=15.65,P<0.01;Z=-3.09,P<0.01)。②与AoAS组相比,JoAS组以外周关节肿痛[45.3%(34/75)比18.9%(52/275)]、髋痛[26.7%(20/75)比15.3%(42/275)]、足跟痛[9.3%(7/75)比2.9%(8/275)]为首发临床表现的比例较高,两组比较差异有统计学意义(χ^2=22.20,P<0.01;χ^2=5.25,P=0.03;χ^2=5.93,P=0.02)。③校正病程后与AoAS组相比,JoAS组放射学髋关节损害率[77.3%(58/75)比43.3%(119/275),OR=4.71]、骨量低于同龄人率[34.7%(26/75)比23.3%(64/275),OR=2.23]、营养不良率[25.3%(19/75)比13.8%(38/275),OR=2.16]、急性葡萄膜炎的发生率[17.3%(13/75)比6.5%(18/275),OR=2.72]均更高,差异均有统计学意义(Wald=25.60,P<0.01;Wald=7.20,P<0.01;Wald=5.84,P=0.02;Wald=6.24,P=0.01)。结论与AoAS患者临床特点不同,JoAS患者更多以外周关节肿痛或髋痛为首发临床表现,病程中放射学髋关节损害、骨量低于同龄人、营养不良及葡萄膜炎的发生风险更高。

Objective To explore the clinical characteristics of juvenile-onset ankylosing spondylitis.Methods Clinical data of 350 cases of ankylosing spondylitis diagnosed in Beijing Jishuitan Hospital from January 2014 to December 2019 were collected.There were 75 cases with the symptom onset in age≤16 years(juvenile-onset ankylosing spondylitis,JoAS),and 275 cases with the symptom onset in age>16 years(adult-onset ankylosing spondylitis,AoAS).The clinical characteristics of two groups were analyzed.Results Compared with AoAS,JoAS had a higher proportion of males[98.7%(74/75)vs.79.6%(219/275);χ^2=15.65,P<0.01]and longer course of disease[11(8,15)vs.8(4,15)years;Z=-3.09,P<0.01].Compared with AoAS,JoAS was more prone to have peripheral joint swelling and pain[45.3%(34/75)vs.18.9%(52/275),χ^2=22.20,P<0.01],hip pain[26.7%(20/75)vs.15.3%(42/275),χ^2=5.25,P=0.03]or heel pain[9.3%(7/75)vs.2.9%(8/275),χ^2=5.93,P=0.02]as the first clinical manifestation.Compared with AoAS,JoAS had a higher incidence of radiological hip involvement[77.3%(58/75)vs.43.3%(119/275),OR=4.71,Wald=25.60,P<0.01],lower bone mineral density than peers[34.7%(26/75)vs.23.3%(64/275),OR=2.23,Wald=7.20,P<0.01],higher incidence of malnutrition[25.3%(19/75)vs.13.8%(38/275),OR=2.16,Wald=5.84,P=0.02]and higher incidence of acute uveitis[17.3%(13/75)vs.6.5%(18/275),OR=2.72,Wald=6.24,P=0.01]after adjusting the course of disease.Conclusion Compared with adult-onset ankylosing spondylitis,juvenile-onset ankylosing spondylitis is more prone to have peripheral joint swelling or hip pain as the first clinical manifestation;the radiological hip involvement,lower bone mineral density than peers,malnutrition and uveitis are more likely to occur.