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强直性脊柱炎并发葡萄膜炎临床分析

Clinical analysis of ankylosing spondylitis complicated with uveitis

  • 摘要: 目的: 探讨强直性脊柱炎(AS)并发葡萄膜炎的临床特点、诊断和治疗,提高对该病的认识。方法: 回顾性分析近3年江苏省苏北人民医院风湿免疫科门诊及住院部301例AS患者的临床资料,将AS并发葡萄膜炎的患者及未并发葡萄膜炎的患者分别定义为葡萄膜炎组及非葡萄膜炎组,进行统计学分析。结果: 301例AS患者中,男性218例,女性83例,男女比约2.6∶1;曾经或就诊时有葡萄膜炎的患者为36例(11.96%)。葡萄膜炎组及非葡萄膜炎组患者的性别(P=0.119)、发病年龄(P=0.563)、HLA-B27阳性率(P=1.000)以及疾病活动度方面差异均无统计学意义。而葡萄膜炎组平均病程(7.84±7.45)年长于非葡萄膜炎组(4.14±4.43)年,P=0.006;葡萄膜炎组患者中CD25升高的患者比例(55.56%)高于非葡萄膜炎组(36.60%,P=0.029);Bath AS功能指数(BASFI)评分在葡萄膜炎组(2.29±2.36)高于非葡萄膜炎组(0.96±1.53,P=0.003);葡萄膜炎组中77.78%患者有外周关节受累,高于非葡萄膜炎组(47.55%, P=0.001)。治疗方面,葡萄膜炎组生物制剂使用率为41.67%,高于非葡萄膜炎组(24.53%,P=0.029)。结论: AS患者的葡萄膜炎发病与病程相关,随着病程的延长葡萄膜炎发病率升高。葡萄膜炎组中有较多患者CD25升高,提示CD25可能与葡萄膜炎相关。伴发葡萄膜炎的AS患者更易有躯体功能受损和外周关节受累。AS病程中若出现葡萄膜炎,需积极进行局部及全身治疗; 若疗效不佳,可建议患者使用生物制剂。

     

    Abstract: Objective: To study the clinical characteristics, diagnosis and treatment of ankylosing spondylitis(AS) complicated with uveitis, and improve the understanding of this disease. Methods: A retrospective analysis of clinical data was made among 301 patients with AS, who visited outpatient and inpatient Department of Rheumatism and Immunology in the Clinical Medical College of Yangzhou University in the past three years. Patients of AS complicated with uveitis and not with uveitis were defined as the uveitis group and the non-uveitis group, and the data were analyzed statistically. Results: There were 301 patients, including 218 males and 83 females, and the ratio of male to female was about 2.6∶1. Thirty-six cases had uveitis at the moment or had ever had it before (11.96%). Gender (P=0.119), age (P=0.563), HLA-B27 positive rate (P=1.000) and disease activity showed no significant difference between the two groups. And the average duration of the uveitis group (7.84±7.45 years) was longer than that of the non-uveitis group (4.14±4.43 years, P=0.006). The proportion of patients with CD25 elevated was higher in the uveitis group (55.56%) than that of the non-uveitis group (36.60%, P=0.029). The Bath Ankylosing spondylitis functional index (BASFI) score of the uveitis group (2.29±2.36) was significantly higher than that of the non-uveitis group (0.96±1.53, P=0.003). In treatment, the biological agent utilization rate of the uveitis group (41.67%) was significantly higher than that of the non-uveitis group (24.53%, P=0.029). Conclusions: The incidence of uveitis in AS patients was correlated with the duration. There were more patients with elevated CD25 level in the uveitis group, suggesting that CD25 might be associated with uveitis. The AS patients with uveitis are more likely to have impaired physical function and peripheral joint involvement. If uveitis emerges in the course of AS, active local and systemic treatment is needed. If the effect is not good, the use of biological agents may be recommended.

     

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