目的 分析误诊为强直性脊柱炎(AS)的病例文献及鉴别诊断方法。方法 以“AS”“误诊”为关键词,采用万方数据库、中国知网数据库、中华医学期刊全文数据库,检索其他疾病误诊为AS文献报道,对患者基本资料、症状、炎性指标、人类白细胞抗原B27(HLA-B27)、影像学资料、诊断疾病进行总结及分析。结果 共检索到其他疾病误诊为AS文献报道63篇,共计纳入误诊为AS病例193例,年龄11~78岁,平均(36.14±16.72)岁。临床表现主要以腰背痛84例次(43.52%)、晨僵71例次(36.79%)、腰骶部疼痛48例次(24.87%)、发热38例次(19.69%)、膝关节痛37例次(19.17%)为主。血沉升高74例(38.34%),CRP升高65例(33.68%)。HLA-B27 阳性43例(22.28%),阴性123例(63.73%)。关节面正常20例(10.36%),异常158例(81.87%)。脊柱呈竹节样改变46例(23.83%)。误诊疾病以骶髂关节感染57例(29.53%),布鲁氏菌病22例(11.40%),细菌感染20例(10.36%),结核15例(7.77%),氟骨症42例(21.76%),血液系统疾病15例(7.77%)为主。结论 AS临床症状与多种疾病相似,须注意鉴别,防止误诊。
Abstract
Objective To analyze the literature and differential diagnosis of cases misdiagnosed as ankylosing spondylitis (AS). Methods With “AS” and “misdiagnosis” as keywords, Wanfang database, CNKI database and Chinese Medical Journal full-text database were used to search the literature reports of other diseases misdiagnosed as AS, and the basic information, symptoms, inflammatory indicators, human leukocyte antigen B27 (HLA-B27), imaging data and diagnosis of diseases were summarized and analyzed. Results A total of 63 literature reports on other diseases misdiagnosed AS were retrieved, including 193 cases misdiagnosed as AS, aged 11 to 78 years, with an average age of (36.14±16.72) years. The main clinical manifestations were low back pain in 84 cases (43.52%), morning stiffness in 71 cases (36.79%), lumbosacral pain in 48 cases (24.87%), fever in 38 cases (19.69%), and knee joint pain in 37 cases (19.17%). Erythrocyte sedimentation rate increased in 74 cases (38.34%), CRP increased in 65 cases (33.68%). There were 43 HLA-B27 positive cases (22.28%) and 123 negative cases (63.73%). There were 20 normal cases (10.36%) and 158 abnormal cases (81.87%). There were 46 cases (23.83%) with bamboo like changes in the spine. The main misdiagnosed diseases were were sacroiliac joint infection in 57 cases (29.53%), brucellosis in 22 cases (11.40%), bacterial infection in 20 cases (10.36%),tuberculosis in 15 cases (7.77%), skeletal fluorosis in 42 cases (21.76%), and hematological diseases in 15 cases (7.77%). Conclusions The clinical symptoms of AS are similar to those of many diseases, so attention should be paid to differentiation to prevent misdiagnosis.
关键词
强直性脊柱炎 /
误诊 /
感染 /
氟骨症 /
血液系统疾病
Key words
ankylosing spondylitis /
misdiagnose /
infection /
bone fluorosis /
disease of blood system
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 丁艳霞,贺玉杰,卢甲盟,等.不同类型感染性骶髂关节炎临床表现与影像学特点分析[J].中华内科杂志,2021,60(4):368-372.
[2] 王炎焱, 赵 征, 张江林,等. 感染性骶髂关节炎110例临床及影像学特点分析[J]. 中华内科杂志,2020,59 (2): 134-139.
[3] 李攀龙.MRI下骶髂关节炎的临床鉴别诊断[J].西部医学,2018,30(11):1704-1708.
[4] 王春晓,毛瑞君,赵希高,等.以胸锁关节受累为首要表现的布鲁氏菌病1例[J].武警医学,2023,34(2):160-162.
[5] 王 艳,杨豫新,刘文亚,等.布鲁氏菌性骶髂关节炎MRI诊断[J].临床放射学杂志,2019,38(6):1090-1093.
[6] 吴喜迪,李 潇,毕志国,等.布鲁氏菌致全髋关节置换术后假体周围感染1例并相关文献回顾[J].中华骨与关节外科杂志,2022,15(3):209-212.
[7] 袁 武,熊萍香.骶髂关节结核的影像学表现[J].江西医药,2011,46(5):470-472.
[8] 贺玉杰,丁艳霞,乔 博,等.结核性骶髂关节炎临床表现及影像学特点[J].郑州大学学报(医学版),2022,57(3):432-435.
[9] 郑洁婷,王丹敏,侯志铎,等.以骶髂关节炎症为首发表现的结核病1例[J].汕头大学医学院学报,2022,35(1):42-43.
[10] 张刘波,周 峻,宋继鹏,等.氟骨症的中医治疗研究进展[J].海南医学院学报,2020,26(1):77-80.
[11] 地方性氟骨症诊断标准(发布稿)WS/T 192-2021[S].2021.
[12] 王 岚,赵扬辉,苏 静,等.氟骨症与强直性脊柱炎临床特点对照分析[J].武警医学,2012,23(8):662-663.
[13] 谢长好,陈琳洁,王 涛,等.白血病关节炎8例临床分析[J].中华临床免疫和变态反应杂志,2007,1(2):197-201.
[14] 李宏超,宋 慧,满斯亮,等.以关节炎表现为首发症状的成人血液系统肿瘤10例临床分析[J].临床内科杂志,2019,36(8):561-562.
[15] 赵 征,王炎焱,金京玉,等.34例骶髂关节异常误诊为脊柱关节炎的磁共振成像分析[J].中华内科杂志,2014,53(9):724-729.
[16] 王健雄,徐胜前.中轴型脊柱关节炎的诊疗进展[J].临床内科杂志,2021,38(5):289-292
[17] Maksymowych W P, Lambert R G, Stergaard M,et al.MRI lesions in the sacroiliac joints of patients with spondyloarthritis: an update of definitions and validation by the ASAS MRI working group[J].Ann Rheum Dis,2019,78(11):1550-1558.
[18] Maksymowych W P,Baraliakos X,Weber U,et al.Preliminary definition of a positive mri for active lesions in the sacroiliac joints typical of axial spondyloarthritis[J]. Ann Rheum Dis 2020,79 (Suppl 1):53-54.
PDF(942 KB)
