【作者】 李伟；

【导师】 米存东；

【作者基本信息】 广西医科大学 ， 风湿免疫（专业学位）， 2013， 硕士

【摘要】 目的：了解我院门诊就诊中轴型脊柱关节病(aSPA)患者的临床流行病学特点,评价门诊治疗效果,为aSPA的诊治及科研提供更多临床依据。方法：纳入2012年5月至2013年1月到我院门诊就诊,符合1984年纽约修订的AS诊断分类标准(详见附录1)和／或2009年ASAS中轴型脊柱关节病诊断分类标准(详见附录2)的患者。其中符合AS诊断分类标准为AS组；符合2009年ASAS诊断分类标准,放射学阴性的患者为nrSPA组。排除类风湿关节炎、痛风、感染性关节炎、骨关节炎。使用自制问卷进行一对一调查,建立Excel数据库,使用SPSS13.0进行统计学分析,计数资料以百分比表示,计量资料以x±s表示；组间临床特征对比采用成组t检验,x2检验；从纳入的aSPA患者中筛选出院外未经治疗、无严重并发症及系统疾病、BASDAI≥4的患者,收集其治疗前及治疗12周后相关功能及实验室指标,采用配对t检验进行统计分析,评价治疗效果。结果：1.男性255例,女性50例,男女比例为5.1：1,平均年龄25.95±8.49岁；农民142例(47.5%)、学生57例(18.7%)、商业服务人员44例(14.4%)、国企人员27(8.9%)、工人15例(4.9%)、技术人员14例(3.6%)、办事人员5例(1.6%)、军人1例(0.3%)。2.医保患者195例(63.9%)、无医保患者110例(36.1%)。月收入<1000元的患者159例(52.1%),1000-3000元的患者117例(38.42%),3000-5000元的患者25例(8.2%),>5000元的患者4例(1.3%)；3.305例患者平均发病年龄：19.07±6.00岁,男性18.4±6.00岁,女性22.46±6.01岁,男女发病高峰均在17-24岁,平均病程7.03±7.13年；确诊时间≥60个月159例(52.1%)；首发症状腰背痛117例(38.36%),腰背僵硬96例(31.48%)、骶髂关节疼痛72例(23.61%)、膝关节疼痛58例(19.02%),髋关节疼痛57例(18.69%)；胸廓活动度减低210例(68.85%),病程中胸锁肋关节疼痛71例(23.28%)；合并感染47例(15.41%),尿路感染5例,上呼吸道感染20例,乙肝20例,肺结核2例。262例患者行HLA-B27检查,阳性患者245例(93.51%)。4.AS组242例(79.34%),男性198例,女性44例,男女比例4.5：1；nrSPA组63例(20.66%),男性57例,女性6例,男女比例9.5：1,AS组与nrSPA组临床特点、炎性指标、功能指标进行对比分析无统计学意义(P>0.05)。5.药物使用：双氯芬酸钠278例(91.14%)、SASP282例(92.45%)、沙利度胺253例(82.95%)、生物制剂83例(27.21%)、甲氨蝶呤60例(19.67%)、帕夫林10例(3.27%)。6.93例初诊患者中筛选出64例初治、无系统损害及严重并发症、BASDAI≥4的患者。对其治疗前及治疗3个月后进行疾病活动度评分,功能评分、测量学评分。治疗前：BASDAI评分为5.45±1.43分,BASFI评分为5.94±2.15,BASMI评分为2.88±2.22；治疗后：BASDAI评分为2.38±1.41分,BASFI评分为2.55±1.93,BASMI评分为2.57±2.17。治疗后3项评分明显减低(配对T检验,P<0.01),病情显著缓解。治疗3个月后与治疗前实验室指标相较,白细胞、血小板、CRP、ESR、IgG、IgA、IgM均明显下降,差异有统计学意义(P<0.01)。结论：1.我院门诊aSPA患者以青年男性为主,男女比例5.1：1,平均发病年龄19.07±6.00岁；2.首发症状依次为腰背痛、腰背僵硬、骶髂关节疼痛、膝关节疼痛、髋关节疼痛,胸锁肋关节在病程中受累常见；3.aSPA男性患者临床症状较女性出现早；4. HLA-B27阳性率93.51%；5.门诊初治患者疗效满意。更多还原

【Abstract】 Objective:To understand the clinical epidemiological characteristics of patients with aSPA in our hospital outpatients, Evaluate the treatment effect of outpatients. Provide more clinical basis for the treatment and scientific research of SPA. Method:Collect the patients who come to our hospital outpatient clinic in May2012and January2013, conform to the ASAS diagnosis classification standard in2010and/or the diagnostic classification standard of revised AS in New York in1984. Patients who meet AS diagnostic classification standard compose AS group, meanwhile patients who meet the ASAS diagnosis classification standard in2010compose nrSPA group, it’s necessary to exclude rheumatoid arthritis, gout, infectional arthritis and ostarthritis. Then one to one survey with self-made questionnaire, builds up the data base and process the data with SPSS13.0. Difference of count data use percentage, Difference of measurement data use x±s.Clinical features between two groups compare with group t test and χ2test. Screening the patients from aSPA without treatment, serious complications, system disease, BASDAI≥4. Collected the relevant function and laboratory indexes which before and after12weeks treatment, use Paired t test for statistical analysis in order to evaluate therapeutic effect.Results:1. In the survey,255cases are men, and50cases are women, sex ratio is5.1:1, average25.95±8.49years of age.farmer142cases(47.5%), student57cases (18.7%), Business service44cases (14.4%), Staff in state-owned enterprises27cases (8.9%), worker15cases (4.9%), technicist14cases(3.6%), clerks5cases(1.6%), soldier1case(0.3%).2. With medical insurance (63.9%), without medical insurance (36.1%). For monthly income, less than1000yuan (52.1%),1000-3000yuan (38.42%),3000-5000yuan (8.2%),>5000yuan (1.3%).3.The age of onset in the whole patients is19.07±6.00years, while male is18.4±6.00years, female is22.46±6.01years old, the peak of onset age is17to24years old in men as while as in women. Diagnosis time:159cases (52.1%) are more than60months.In the initial symptom,117cases (38.36%) appear lumbago and back pain, lower back stiffness in96cases (31.48%), sacroiliac joint pain in72cases (23.61%), knee joint pain in58cases (19.02%), hip joint pain in57cases (18.67%).Thoracic mobility decreases in210cases(68.85%), while71cases (23.28%) feel painful on sternoclavicular joint and sternocostal joint in the whole course. There is47cases (15.41%) combine with infection:including5cases of urinary tract infections,20cases of upper respiratory tract infection,20cases of hepatitis B, and tuberculosis in2cases.(6)262cases of patients do the inspection of HLA B27,245patients are positive (93.51%).(7)242cases (79.34%) meet the diagnosis standards of AS,198cases are men, and44cases are women, sex ratio is4.5:1.63cases (20.66%) meet the diagnosis standards of nrSPA,57cases are men, and6cases are women sex ratio is9.5:1. Compare242AS with63nrSPA, there is no statistical difference (P>0.05) in clinical characteristics, inflammatory indicators, functional parameter.4.278cases (91.14%) use diclofenac sodium,282cases (92.45%) use SASP,253cases (82.95%) use thalidomide,83cases (27.21%) use biological agent,60cases (19.67%) use MTX,10cases (3.27%) use TGP.5. Filter64cases in the93patients for the first time to see the doctor, who without serious complications and system damage. Give these patients the score on disease activity index, functional index and metrology index before and after treatment. Before treatment:BASDAI5.45±1.43分, BASFI5.94±2.15, BASMI2.88±2.22.After treatment:BASDAI2.38±1.41分, BASFI2.55±1.93, BASMI2.57±2.17.Three score significantly reduced after treatment(Paired Samples Test, P<0.01). The condition improved significantly.Laboratory index after3months treatment significantly better compared with before treatment, it dramatic decline in WBC,PLT,CRP,ESR,IgG,IgA and IgM.Conclusion:1.Young men is the main component in our hospital outpatient patients with aSPA, male to female ratio is5.1:1, average onset age is19.07±6.00years.2. Initial symptoms in the order are lumbago and back pain, lower back stiffness, sacroiliac joint pain, hip joint pain. Sternoclavicular joint and stemocostal joint pain is commom in the whole course.3. Clinical symptoms appeared earlier in male more than women in aSPA patients.4. HLA-B27positive rate is93.51%.5.Outpatient patients symptoms improve significantly after treatment.更多还原