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目的探讨强直性脊柱炎(AS)患者的临床特点,提高AS的诊断水平。方法整理分析35例AS患者的临床表现、实验室指标、影像学改变。结果首发症状是中轴关节受累的AS患者占58%(20/35),有中轴关节病变症状的患者占80%(28/35),有周围关节炎表现的患者占61%(21/35),人体白细胞抗原(HLA-B27)阳性率94%(33/35),类风湿因子(RF)阴性率为88%(28/32),抗氧(O)阴性率为72%(12/16),抗核抗体(ANA)阴性率为90%(28/31),抗环瓜氨酸多肽抗体(anti-CCP)阴性率为93%(14/15),1年以上患者骶髂关节CT影像学检查有14(75%)例患者达到Ⅱ级及其以上,5例患者(25%)为0～Ⅰ级,1年以上患者经CT影像学检查有15例患者达到Ⅱ级及其以上,1例患者(4%)为0～Ⅰ级。结论在AS诊断中HLA-B27占有举足轻重的地位;血沉(ESR)、C-反应蛋白(CRP)升高可以有利于诊断;病程的长短可以对骶髂关节炎性病变的分级造成影响。在临床诊断中,必须加强对AS的认识,并与患者的临床症状、影像学检查和实验室指标相结合,由此来提高AS的早期诊断率,以能及时早期的进行治疗,改善AS患者的预后。
Objective To investigate the clinical features of patients with ankylosing spondylitis (AS) and to improve the diagnostic value of AS. Methods The clinical manifestations, laboratory parameters and imaging changes of 35 AS patients were analyzed. Results The first symptom was 58% (20/35) in patients with central axis involvement of AS, 80% (28/35) in patients with central axis joint disease, and 61% (61% 35). The positive rate of HLA-B27 was 94% (33/35), the negative rate of rheumatoid factor (RF) was 88% (28/32) and the rate of anti-O / 16), anti-nuclear antibody (ANA) negative rate was 90% (28/31), anti-CCP antibody negative rate was 93% (14/15), more than 1 year patients with sacroiliac 14 (75%) of the patients had grade Ⅱ and above in the joint CT imaging examination, 0 to 1 grade in 5 patients (25%), grade Ⅱ in 15 patients after 1 year of diagnosis by CT imaging, In the above, 1 patient (4%) was grade 0 ~ Ⅰ. Conclusion HLA-B27 plays a decisive role in the diagnosis of AS. ESR and CRP may be helpful for the diagnosis. The duration of the disease may affect the grade of sacroiliitis. In the clinical diagnosis, we must strengthen the understanding of AS, and clinical symptoms, imaging and laboratory parameters combined to improve the early diagnosis of AS in order to be able to promptly early treatment to improve AS patients The prognosis.