强直性脊柱炎误诊文献分析OACSTPCD
Literature analysis of misdiagnosis of ankylosing spondylitis
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.
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,in-flammatory indicators,human leukocyte antigen B27(HLA-B27),imaging data and diagnosis of diseases were summarized and ana-lyzed.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 ca-ses(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 ca-ses(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 infec-tion 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.
伍伟;李瑛;黄河颂;张勇;何东初
430070 武汉,中部战区总医院中西医结合科
临床医学
强直性脊柱炎误诊感染氟骨症血液系统疾病
ankylosing spondylitismisdiagnoseinfectionbone fluorosisdisease of blood system
《武警医学》 2024 (004)
290-293 / 4
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