强直性脊柱炎患者寰枢椎前半脱位的患病率和危险因素

Prevalence and risk factors of atlantoaxial anterior subluxation in patients with ankylosing spondylitis

目的探讨强直性脊柱炎(ankylosing spondylitis,AS)患者寰枢椎前半脱位(anterior atlantoaxial subluxation,AAS)的患病率和危险因素。方法回顾性分析2010年1月~2020年12月在本院就诊的261例AS患者病历资料,根据是否发生AAS将患者分为AAS组和非AAS组,观察两组患者年龄、性别、个人史、脊柱关节病家族史、症状发作年龄、AS诊断年龄、周围型关节炎和葡萄膜炎、抗肿瘤坏死因子(anti-tumor necrosis factor,TNF)拮抗剂应用、实验室检查和放射学检查结果等资料,分析影响AAS发生的风险因素。结果AAS发生率为13.03%。AAS组和非AAS组患者疾病病程、症状病程、HLA-B27阳性、类风湿因子(rheumatoid factor,RF)阳性、抗蛋氨酸蛋白抗体(anti-methionine protein antibody,ACPA)阳性、RF或ACPA阳性、C反应蛋白(C reactive protein,CRP)阳性、血沉(erythrocyte sedimentation rate,ESR)阳性、周围型关节炎、葡萄膜炎、抗TNF拮抗剂、寰前间隙(anterior interspace,AADI)等资料差异存在统计学意义(P<0.05)。多因素Logistic回归分析显示,疾病病程>7.4年、CRP阳性、周围关节炎和抗TNF拮抗剂是影响AAS的风险因素(P<0.05)。结论AS患者尤其是疾病病程>7.4年、CRP阳性、周围关节炎、应用抗TNF拮抗剂等患者应注意定期检查AAS。

Objective To investigate the prevalence and risk factors of anterior atlantoaxial subluxation(AAS)in patients with ankylosing spondylitis(AS).Methods The medical records of 261 patients with AS treated in our hospital from January 2010 to December 2020 were retrospectively analyzed.According to the occurrence of AAS,the patients were divided into AAS group and non AAS group.The age,sex,personal history,family history of spinal arthropathy,age of symptom onset,age of diagnosis of AS,peripheral arthritis and uveitis,application of anti-tumor necrosis factor(TNF)antagonists,laboratory examination and radiological examination results were observed,and the risk factors affecting the occurrence of AAS were analyzed.Results The incidence of AAS was 13.03%.There were significant differences in disease course,symptom course,HLA-B27 positive,RF positive,ACPA positive,RF or ACPA positive,CRP positive,ESR positive,peripheral arthritis,uveitis,anti TNF antagonist and aadi between AAS group and non AAS group(P<0.05).Multivariate logistic analysis showed that the disease course>7.4 years,CRP positive,peripheral arthritis,uveitis and anti TNF antagonists were the risk factors affecting AAS(P<0.05).Conclusion Patients with AS,especially those with disease course>7.4 years,CRP positive,peripheral arthritis and application of anti TNF antagonists,should pay attention to regular examination of AAS.