摘要
目的 提高对幼年发病型脊柱关节病 (JSpA)的认识。方法 分析 190例JSpA患者的临床、实验室及放射学资料 ,并对幼年发病关节炎的诊断、分类和鉴别进行讨论。结果 190例JS pA中 ,男性 16 3例 ,女性 2 7例 ,男女之比为 6∶1,发病年龄 3～ 16岁 ,平均 (12± 3)岁 ,8岁后发病 175例 ,占 92 1% ;15 7例 (82 6 % )患者首先出现的是外周关节炎 ,2 3例 (12 1% )以腰背痛为第一症状 ,病程中共有 187例 (98 4% )的患者出现了外周关节炎 ,12 3例 (6 4 7% )患者有或有过腰背疼痛史 ,外周关节炎与腰背疼痛出现的时间间隔 ,从同时发生到间隔 2 0年 ,平均 3 2年。 6 7例 (35 3% )有肌腱端炎的表现 ,2 0例 (10 5 % )腊肠指 (趾 ) ,9例虹膜炎。HLA B2 7的阳性率为 87 9% ,76 0 %有X线证实的骶髂关节炎。在 190例患者中 ,10 6例患者确诊幼年强直性脊柱炎 (JAS) ,此组患者平均病程 6 3年 ,明显长于JSpA组 (P <0 0 1)。 结论 JSpA的概念有助于提高对儿童关节炎的认识 ,半数以上JSpA患者约在发病 6 3年后发展为幼年强直性脊柱炎。
Objective To better understand the clinical characters of juvenile onset spondyloarthropa thies (JSpA).Methods The clinical and laboratory data of 190 in patients with JSpA were analyzed and the diagnosis,classification and differentiation of juvenile onset arthritis were discussed.Results Among these 190 patients,163 were male,with a male to female ratio 6∶1.Of them 92 1% had the disease after the age of 8.Peak of age at onset was 12 to 15 years;157(82 6%) patients had peripheral arthritis and only 23(12 1%) patients felt low back pain at onset.During the disease course, peripheral arthritis was found in 187(98 4%) patients and the history of low back pain or buttock pain was recorded in 123(64 7%).The interval between peripheral arthritis and low back pain was from 0 to 20 years,with an average of (3 2±4 5)years.Extra articular features including enthesitis in 67(35 3%)patients,dactylitis in 20(10 5%),iritis in 9(4 7%) were observed.HLA B27 was positive in 87 9%(160/182) patients.Sacroiliitis on X ray was observed in 76 0%(136/179) patients,and 106(55 8%) patients were diagnosed juvenile ankylosing spondylitis (JAS) according to 1984 New York modified criteria.The average disease course in JAS was (6 3±6 2) years,longer than that in JSpA ( P <0.01).Conclusion The concept of JSpA is helpful to early diagnosis and treatment of juvenile onset arthritis.The JSpA are characterized by asymmetric lower limb predominant oligoarthritis,a wide spectrum of extra articular features,presence of HLA B27 and familial history of SpA or psoriasis.It will take an average of 6 3 years for JSpA patients to fulfill the diagnostic criteria of adult AS.
出处
《中华风湿病学杂志》
CAS
CSCD
2001年第2期113-116,共4页
Chinese Journal of Rheumatology
