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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 improve the understanding of juvenile onset spondyloarthropathy (JSpA). Methods Clinical, laboratory and radiological data of 190 patients with JSpA were analyzed. The diagnosis, classification and identification of juvenile arthritis were also discussed. Results Among 190 JS pA cases, there were 163 males and 27 females, the ratio of male and female was 6: 1. The age of onset was from 3 to 16 years (mean, 12 ± 3) years. There were 175 cases after the age of 8, accounting for 92 1 %; Of the 15 7 (82.6%) patients, peripheral arthritis first appeared, 23 (12.1%) had low back pain as the first symptom, and 187 patients (98.4%) in the course of disease appeared Peripheral arthritis, 12 3 patients (64.7%) had or had history of back pain, and the time interval between peripheral arthritis and low back pain occurred from the same time to the interval of 20 years with an average of 32 years. Sixty-seven cases (35.3%) had tendonitis, 20 cases (105%) with dachshund and nine cases of iritis. The positive rate of HLA B2 7 was 87 9%, and 76 0% of patients had X-ray confirmed sacroiliitis. Of the 190 patients, 106 patients were diagnosed with juvenile ankylosing spondylitis (JAS), with a mean duration of 63 years, significantly longer than that of the JSpA group (P <0.01). Conclusions The concept of JSpA helps to raise awareness of childhood arthritis and more than half of JSpA patients develop ankylosing spondylitis at about 6 3 years after onset.