强直性脊柱炎合并髋关节受累的临床特点

doi:10.3969/j.issn.1004-583X.2021.06.003

摘要/Abstract

摘要：

目的探讨强直性脊柱炎(AS)伴髋关节受累的临床特征及相关因素。方法回顾分析河北医科大学第三医院住院治疗的AS患者331例,依据患者是否合并髋关节受累分为普通AS组和AS合并髋关节受累组,比较2组的一般资料、实验室指标及既往用药史,分析其危险因素。结果 331例AS患者有224例(73.7%)合并有髋关节受累。AS伴髋关节受累组的年龄及发病年龄均显著低于普通AS组(P<0.01),C反应蛋白(CRP)和血小板(PLT)水平均显著高于普通AS组(P<0.05),男性比例、既往激素使用率以及发生骨质疏松的比例高于普通AS组(P<0.05)。眼炎发病率显著低于普通AS组(P<0.05)。分析显示男性(OR=4.29,P=0.007)、低龄发病(OR=2.98,P=0.003)为AS合并髋关节受累的危险因素。结论 AS合并髋关节受累较常见,且合并髋关节受累者相对病情更重,更容易出现骨质疏松,男性及低龄发病为其危险因素。

关键词: 脊柱炎, 强直性, 骨关节炎, 髋, 骨质疏松, 眼内炎

Abstract:

Objective To evaluate the clinical characteristics and relevant factors of ankylosing spondylitis(AS) with hip involvement. Methods A total of 331 AS patients hospitalized in the Third Hospital of Hebei Medical University were divided into normal AS group and AS with hip involvement group according to if they were concurrent with hip involvement. The normal information, laboratory indicators and past medication history were compared for the risk factors between the two groups. Results Totally 244 (73.7%) cases were hip involvement among 331 AS patients. Compared with normal AS group, AS with hip involvement group had decreased age at onset (P<0.01), increased levels of C-reactive protein(CRP) and platelet(PLT)(P<0.05), increased male ratio, increased past hormone use rate, increased proportion of osteoporosis(P<0.05), and decreased incidence of ophthalmitis (P<0.05). The result showed that the risk factors of AS with hip involvement were male (OR=4.29, P=0.007) and pathogenesis in low age (OR=2.98, P=0.003). Conclusion Hip involvement is more common in AS patients, and with serious illness the patients are more prone to osteoporosis. Male and early-onset are the risk factors of AS with hip involvement.

Key words: spondylitis, ankylosing, osteoarthritis, hip, osteoporosis, endophthalmitis

中图分类号:

R593.23

李惠婷, 孟景红, 顾光, 陈海英, 王俊祥. 强直性脊柱炎合并髋关节受累的临床特点[J]. 临床荟萃, 2021, 36(6): 500-503.

Li Huiting, Meng Jinghong, Gu Guang, Chen Haiying, Wang Junxiang. Clinical characteristics of ankylosing spondylitis with hip involvement[J]. Clinical Focus, 2021, 36(6): 500-503.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.06.003

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I6/500

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参考文献 19

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组别	例数	性别(例)		年龄 (岁)	发病年龄 (岁)	AS家族史 [例(%)]	AS病程 (年)	骨密度[例(%)]			激素 [例(%)]	眼炎 [例(%)]
组别	例数	男	女	年龄 (岁)	发病年龄 (岁)	AS家族史 [例(%)]	AS病程 (年)	1	2	3	激素 [例(%)]	眼炎 [例(%)]
髋关节受累组	244	219	25	27.35±10.30	19.83±7.83	41(16.8)	7.52±7.10	12(7.6)	61(38.9)	84(53.5)	37(15.2)	11(4.5)
普通组	87	64	23	35.59±13.34	27.02±11.09	17(19.5)	8.46±8.62	11(16.9)	31(47.7)	23(35.4)	6(6.9)	10(11.5)
统计值		χ²=13.56		t=-5.322	t=-5.756	χ²=0.148	t=-0.065	χ²=7.818			χ²=3.922	χ²=5.268
P值		0.000		0.000	0.000	0.700	0.948	0.020			0.048	0.022

组别	例数	性别(例)		年龄 (岁)	发病年龄 (岁)	AS家族史 [例(%)]	AS病程 (年)	骨密度[例(%)]			激素 [例(%)]	眼炎 [例(%)]
组别	例数	男	女	年龄 (岁)	发病年龄 (岁)	AS家族史 [例(%)]	AS病程 (年)	1	2	3	激素 [例(%)]	眼炎 [例(%)]
髋关节受累组	244	219	25	27.35±10.30	19.83±7.83	41(16.8)	7.52±7.10	12(7.6)	61(38.9)	84(53.5)	37(15.2)	11(4.5)
普通组	87	64	23	35.59±13.34	27.02±11.09	17(19.5)	8.46±8.62	11(16.9)	31(47.7)	23(35.4)	6(6.9)	10(11.5)
统计值		χ²=13.56		t=-5.322	t=-5.756	χ²=0.148	t=-0.065	χ²=7.818			χ²=3.922	χ²=5.268
P值		0.000		0.000	0.000	0.700	0.948	0.020			0.048	0.022

组别	例数	HLA-B27 阳性 [例(%)]	CRP (mg/L)	ESR (mm/1 h)	PLT (×10⁹/L)
髋关节受累组	244	188(77.1)	35.41±39.57	47.78±30.68	319.26±88.03
普通组	87	61(70.1)	28.26±33.37	45.22±33.83	296.58±75.59
统计值		χ²=1.552	t=-2.321	t=-1.069	t=-2.117
P值		0.213	0.020	0.285	0.034

组别	例数	HLA-B27 阳性 [例(%)]	CRP (mg/L)	ESR (mm/1 h)	PLT (×10⁹/L)
髋关节受累组	244	188(77.1)	35.41±39.57	47.78±30.68	319.26±88.03
普通组	87	61(70.1)	28.26±33.37	45.22±33.83	296.58±75.59
统计值		χ²=1.552	t=-2.321	t=-1.069	t=-2.117
P值		0.213	0.020	0.285	0.034

观察指标	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
观察指标	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
AS发病年龄	1.092	0.364	8.980	0.003	2.980	1.459	6.086
性别	1.455	0.537	7.333	0.007	4.286	1.495	12.291
骨质疏松	0.898	0.345	6.771	0.009	2.455	1.248	4.828
眼炎	-2.043	0.698	8.565	0.003	0.130	0.033	0.509
CRP	0.226	0.419	0.292	0.589	1.254	0.552	2.849
PLT	-0.037	0.367	0.010	0.919	0.963	0.470	1.976
激素	1.044	0.544	3.680	0.055	2.840	0.978	8.253