强直性脊椎炎伴发葡萄膜炎的临床特征及漏诊误诊分析(1)
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【摘要】目的探讨强直性脊椎炎伴发葡萄膜炎的临床特征及漏诊和误诊的可能原因。方法回顾分析1998年6月至2007年12月诊治的强直性脊椎炎伴发葡萄膜炎83例的临床资料。对所有患者详细询问病史,进行双眼裂隙灯显微镜检查,详细记录角膜后沉着物(KP)的性质及分布、前房细胞的数量以及前房闪辉的程度,尤其是否合并纤维素性渗出、前房积脓,骶髂关节X线影像学检查。查阅以往的病史记录,统计分析诊断的一致性及漏诊、误诊的原因。结果患者83例,男77例,女6例,男女比例为12.83:1,患者年龄13~72岁,平均年龄为34.8岁。骶髂关节炎≥ Ⅱ级者44例(53.01%),≥ Ⅲ级者39例(46.99%)。双眼受累者76例,所有病例均有睫状充血、KP、前房闪辉以及前房细胞合并纤维素渗出或前房积脓19例(22.88%),HLA-B27阳性76例(91.57%),反复发作71例(85.54%)。结论强直性脊椎炎伴发葡萄膜炎多发生于男性,具有高复发、高致盲率的表现,有典型的骶髂关节X线影像学改变及HLA-B27高阳率的特征,缺乏对临床特征的认识是漏诊、误诊的重要原因。
【关键词】
强直性脊椎炎 ;葡萄膜炎; 诊断;误诊;漏诊
Clinical features and missed and inaccurate diagnosis of uveitis associated with ankylosing spondylitis
MA Cui-ping,LUO Rong-jiang,CHENG Xue-mei,et al.The first affiliated hospital,Sun Yat-Sen university 510080,China
【Abstract】ObjectiveTo investigate the clinical manifestations and possible reasons of the missed and inaccurate diagnosis of uveitis associated with ankylosing spondylitis.MethodsThe clinical data of 83 patients with uveitis associated with ankylosing spondylitiswho were diagnosed and treated from June 1998 to December 2007 were retrospectively analyzed.The disease history of each patient was carefully recorded.Slit-lamp microscopy was performed on the patients.The character and distribution of keratic precipitates(KP),the cell number and the flare degree in anterior chamber were noted in detail,especially The anterior chamber cellulose、oculus purulentus and cacroiliac joint’s X-ray examination.The data recorded in other hospitals were analyzed and the reasons of missed and inaccurate diagnosis were statistically analyzed.ResultsIn the 83 patients of Uveitis associated with AS,male 77,female 6,male vs female is 12.83:1,The age of the patients ranged from 13 to 72 years,the mean age 34.8 year-old.Sacroiliitis equal to or over grade two 44(53.01%),equal to or over grade three 39(46.99%).Binocular involvement was noted in 76 patients.All of the patients showed ciliary congestion、 KP、Anterior-chamber flare and anterior-chamber cells,anterior chamber cellulose or oculus purulentus 73(87 ......
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