摘要
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 fulltext database were used to search the literature reports of other diseases misdiagnosed as AS,and the basic information,symptoms,inflammatory indicators,human leukocyte antigen B27(HLA-B27),imaging data and diagnosis of diseases were summarized and analyzed.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 cases(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 cases(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 infection 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.
作者
伍伟
李瑛
黄河颂
张勇
何东初
WU Wei;LI Ying;HUANG Hesong;ZHANG Yong;HE Dongchu(Department of Integrated TCM and Western Medicine,General Hospital of PLA Central Theater,Wuhan 430070,China)
出处
《武警医学》
CAS
2024年第4期290-293,共4页
Medical Journal of the Chinese People's Armed Police Force
关键词
强直性脊柱炎
误诊
感染
氟骨症
血液系统疾病
ankylosing spondylitis
misdiagnose
infection
bone fluorosis
disease of blood system
作者简介
伍伟,硕士,副主任医师;通讯作者:李瑛,E-mail:35830826@qq.com
