僵直性脊推炎－－臨床分析

ANKYLOSING SPONDYLITIS-- A CLINICAL ANALYSIS

本科門診部在六個月期間，共收集了47位僵直性脊椎炎患者做臨床表徵的分析與研究。其中包含了46位男性與1位女性。平均發病年齡為19.1歲，而分析時的年齡為24.3歲，平均疾病期為5.2年。至於再發年齡則以16〜20歲較多23.4 ％的患者有家族病史。所有患者均主訴背痛。93.6％的患者有腰椎晨間僵硬，其中79.5％的患者會在運動後達到緩解。70.2％的患者有腰椎活動限制，而31.9％的患者則有陽性的Schober指數（小於2.5公分）。51.1％的患者有周圍關節炎。最常見的早期表徵為下背痛，共有61.8％的患者。在關節之外的表徵方面，12.8％的患者有結膜炎，17.0％的患者有血尿或蛋白尿，但卻沒有發現患者主動脈瓣閉鎖不全。2位患者接受腎臟組織切片，經由免疫螢光分析檢查證實為IgA與IgM腎病變。所有患者均接受骨盆X光攝影，發現34.0％的患者為II級荐腸骨關節炎，53.2％的患者為III級荐腸骨關節炎，僅僅12.8％的患者為IV級荐腸骨關節炎。19位患者接受核醫骨掃描，其中73.7％的患者有荐腸骨關節放射的活性增加現象。在實驗數據方面，53.3％的患者其紅血球沈降速率是增加的；81.5％的患者其HLA-B27呈陽性反應。若與西方的研究報告比較，可以發現我們的患者有較低的發病年齡，較少的周圍關節炎與關節之外表徵；但卻有較高的下背痛與腰椎活動限制。至於HLA-B27基因的陽性率，我們的患者要比高加索人來得少，但卻比日本人與非洲黑人來得多。這似乎暗示遺傳因子在疾病的表現仍是非常重要的。

A studly was carried out involving 47 patients with ankylosing spondylitis (AS). Among them, 46 were males and 1 was female. The mean age at disease onset was 19.1 years and at time of study was 24.3 years.The disease duration was 5.2 years, and the peak age at onset was from 16 to 20 years. 23.4% of patients had a positive family history. All of them had low back pain. 93.6% had morning stiffness, which could be relieved by exercise in 79.5% of patients. 70.2% had limitation of motion on lumbar spine, 31.9% had positive Schober index (< 2.5cm), and 51.1% had peripheral arthritis. 61.8% of patients had low back pain as their initial manifest ation. Examination of extraarticular manifestations, showed 12.8% had conjunctivitis or uveitis and 17.0% had hematuria or proteinuria, but no patient had any aortic insufficiency. Two patients received renal biopsy, IgA and IgM nephropathy were comfirmed by immunofluorescent study. X-ray examinations were performed on all patients and Grade II sacroi1iitis was found in 34.0%, Grade III in 53.2% and Grade IV in 12.8%. Bone scans were done on 19 patients and 73.7% of them showed increased radionuclide activity on the sacroiliac joint. The laboratory findings demonstrated ESR increased in only 53.3% and HLA-B27 was positive in 81.5%. Compared to the western reports, the age at onset in our patients, was younger. They experienced less peripheral arthritis and extra-articular manifestations, but had a higher in cidence of low back pain and motion limitation of lumbar spine. The presence of HLA-B 27 gene in our patients was less than in Caucasians, but higher than in Japanese or black Africans. It is suggested that the genetic factor may be important in the expression of the disease.