强直性脊柱炎伴发炎症性肠病的临床资料分析

目的分析强直性脊柱炎(AS)伴发炎症性肠病(IBD)的临床特征及功能状态,探讨AS合并与未合并IBD者间的差异,提高对其的认识,为临床诊疗提供依据。方法从脊柱关节炎智能管理系统中选2016年4月至2017年6月连续就诊于解放军总医院第一医学中心风湿科门诊就诊的AS患者,通过消化内镜或病理检查确诊(包括溃疡性结肠炎、克罗恩病)IBD。分析其临床资料,包括一般资料、病情评估、实验室检查、疾病严重程度评价。结果共纳入893例AS患者,男739例,女154例,年龄(30.8±8.8)岁。AS合并IBD者64例,未合并IBD者829例。合并IBD者年龄高于未合并IBD者(34.5±7.5)岁比(30.5±8.8)岁,P<0.001],病程长于未合并IBD者(10.8±6.9)年比(8.1±5.9)年,P=0.001]。合并IBD者更易出现颈椎21.9%(14/64)比10.5%(87/829),P=0.006]、胸椎29.7%(19/64)比12.3%(102/829),P<0.001]受累,且易合并葡萄膜炎28.1%(18/64)比16.4%(136/829),P=0.017]和银屑病7.8%(5/64)比2.3%(19/829),P=0.009]。合并IBD者Bath AS疾病活动度(BASDAI)、Bath AS功能指数(BASFI)、国际脊柱关节炎评价协会健康指数(ASAS HI)均高于未合并IBD者BASDAI:3.3±2.1比2.4±1.8,P<0.001;BASFI:2.2(1.0,3.3)比1.1(0.2,2.4),P<0.001;ASAS HI:7.1±4.3比5.3±3.7,P=0.001]。结论合并IBD的AS患者疾病活动度更高,机体功能和总体健康指数更差,发生银屑病和葡萄膜炎的机会增加。

Clinical characteristics of patients with ankylosing spondylitis and inflammatory bowel disease

Objective To analyze the clinical characteristics of patients with ankylosing spondylitis(AS)with inflammation bowel disease(IBD).Methods AS patients fulfilling the 1984 modified New York diagnostic criteria were recruited in Chinese AS Prospective Imaging Cohort(CASPIC)consecutively from April 2016 to June 2017 in Chinese People's Liberation Army General Hospital by using smart management system for spondyloarthritis(SpAMS).The diagnosis of IBD was confirmed by tissue pathology via ileocolonoscopy.Demographic,clinical and biochemical data were collected.Results In total,893 patients with AS were recruited with the mean age 30.8 years.The majority were men(739,82.8%).There were 64(7.2%)patients concomitant with IBD.The mean age(34.5±7.5)years vs.(30.5±8.8)years,P<0.001]was older and the disease duration(10.8±6.9)years vs.(8.1±5.9)years,P=0.001]was longer in patients with IBD than patients without.Compared with patients without IBD,patients with IBD had more frequent involvement of the cervical spine(21.9%(14/64)vs.10.5%(87/829),P=0.006)]and thoracic spine29.7%(19/64)vs.12.3%(102/829),P<0.001].Uveitis28.1%(18/64)vs.16.4%(136/829),P=0.017]and psoriasis7.8%(5/64)vs.2.3%(19/829),P=0.009]were also more common in patients concomitant with IBD.In addition,patients with IBD had significantly higher scores in BASDAI(3.3±2.1 vs.2.4±1.8,P<0.001),BASFI2.2(1.0,3.3)vs.1.1(0.2,2.4),(P<0.001)]and ASAS HI(7.1±4.3 vs.5.3±3.7,P=0.001)than patients without IBD.Conclusions Compared with patients without IBD,AS patients concomitant with IBD have more severe disease activity and organ dysfunction.Furthermore,the uveitis and psoriasis are more frequently accompanied in AS patients with IBD.