僵直性脊推炎併不等程度之心房心室傳導阻窒：一病例報告

Ankylosing Spondylitis Complicated with Various Degree Atrioventricular Block: Report of a Case

心房心室傳導阻窒為一種僵直性脊椎炎之併發症，過去台灣並無類似之病例報告，我們在此報告一個僵直性脊椎炎病人併不等程度傳導阻窒之病例。此病人為74歲男性之僵直性脊椎炎病人，他因不明原因之頭暈至本院就診，住院期間我們紀錄到病人有不等程度之心房心室傳導阻窒，其理學檢查發現嚴重之脊椎活動受限，病人為HLA-B27陽性而類風濕性因子及抗核抗體皆為陰性，心臟電生理檢查顯示在希氏束上有Wenckebach之傳導阻窒，具X光有典型的僵直性脊椎炎變化，病人在無明顯之血行動力學變化下處以保守治療後出院。僵直性脊椎炎併傳導阻窒之發生率介於5％到40％之間，在統計上有這麼大差異的原因，可能與病人之年齡、罹病及追蹤時間的長短及心電圖記錄之次數有關。此等傳導阻窒常為間歇性發作或在不等程度間變化。病理上主要為竇房結、房室結及心室中膈有纖維化之變化。在治療上曾有人使用類固醇來治療此等疾患但在療效上尚未得到進一步之証實。在過去此等傳導阻窒被視為一種良性的心律不整，然而在近年的研究顯示在使用人工心臟節律器的病人中，僵直性脊椎病人 佔有相當的比例，因此僵直性脊椎炎之此等併發症實不容我們的忽視，並應加以進一步的研究。

A 74-year-old male with ankylosing spondylitis has suffered from intermittent dizziness for 5 years prior to this hospitalization. After admission, various degree atrioventricular block was fund. Physical examination revealed limited spinal motion and bradycardia. Laboratory results revealed positive HLA B27 and elevated erythrocyte sedimentation rate. X-ray disclosed sclerotic change and obliteration of bilateral sacroiliac joint and 'bamboo spine'. He was treated conservatively without major sequelae. Previous descriptions of this cardiac complication in ankylosing spondylitis are reviewed.