摘要
目的 通过分析感染性骶髂关节炎患者的临床资料,以提高临床医生的诊治水平,避免误诊误治.方法 回顾性分析2005年6月-2014年9月在解放军总医院就诊以臀区或腰骶部疼痛为主诉的21例感染性骶髂关节炎患者的临床、实验室检查、病理检查及影像学资料.结果 21例患者中男性9例,女性12例,平均年龄28.2岁,均有明显的臀区或腰骶部疼痛,其中非布氏杆菌非结核性感染性骶髂关节炎（ISI） 10例,布氏杆菌性骶髂关节炎（BSI）3例,结核性骶髂关节炎（TSI）8例.ISI患者的ESR、C反应蛋白升高较明显.21例患者中12例行CT引导下骶髂关节穿刺活检,其中ISI6例,BSI 2例,TSI 4例;ISI病理结果以急性或慢性炎性细胞及中性粒细胞浸润为主,BSI以淋巴细胞及浆细胞浸润为主,TSI以肉芽肿形成伴坏死为主.21例患者影像学显示骶髂关节单侧受累18例,双侧受累3例;12例行骶髂关节CT,表现为关节面模糊、骨侵蚀、软骨硬化、骨赘形成、关节融合;17例行骶髂关节MRI,轻度异常6例,明显异常11例;2例行PET-CT,均提示病变部位骶骨及髂骨放射性浓聚、代谢活跃.20例患者接受抗生素和抗结核治疗后症状明显好转.结论 感染性骶髂关节炎常出现臀区或腰骶部疼痛,极易与脊柱关节炎混淆,需综合分析患者临床、影像学检查及实验室指标才能做出正确判断,避免误诊误治.
Objective To study the clinical and imaging characteristics of patients with infectious sacroiliac arthritis.Method Twenty-one patients diagnosed with infectious sacroiliac arthritis were analyzed retrospectively between 2000 and 2014.The chief complaint was pain in hip and lumbosacral area.Their clinical features,laboratory tests and pathological examination results as well as CT/MRI/PET-CT images were evaluated.Results There were nine males and thirteen females eighteen （85.7%） patients had unilateral sacroiliac joint involvement.Among these patients,three were diagnosed with brucellosis sacroiliac arthritis（BSI）,eight patients with tuberculosis sacroiliac arthritis （TSI）,and ten patients with non-brucellosis and non-tuberculosis infectious sacroiliac arthritis （ISI）.For those patients with non-brucellosis and non-tuberculosis infectious sacroiliac arthritis,white blood cell count,erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP）were dramatically increased.Twelve patients were diagnosed pathologically including 6 ISI,2 BSI and 4 TSI.Twelve patients and seventeen patients were scanned by CT and MRI respectively.Two patients undertook PET-CT examination.Antibiotic therapy showed significant therapeutic effects in all patients.Conclusion Infectious sacroiliac arthritis patients with hip or lumbosacral pain as the chief complaint can be easily misdiagnosed as spondyloarthritis.Comprehensive analysis of clinical features,imaging and laboratory findings is essential for accurate diagnosis.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2015年第5期420-425,共6页
Chinese Journal of Internal Medicine
关键词
骶髂关节
感染
布鲁杆菌病
结核
Sacroiliac joint
Infection
Brucellosis
Tuberculosis
作者简介
通信作者：黄烽，Email：fhuang@301hospital．com．cn
