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目的强直性脊柱炎(AS)伴有髋关节受累是其预后不良因素之一,及时发现早期干预可以改善预后。本文旨在探讨AS伴髋关节病变的临床和影像学特点,提高对AS髋关节病变的认识,以及不同干预方法对预后的影响。方法对220例有髋关节病变的AS患者(A组)和182例无髋关节病变的AS患者(B组)进行系统性分析,对其临床症状和体征、实验室指标、影像学表现及治疗效果进行比较。结果 A组患者较B组患者起病年龄早[(21.97±8.79)岁vs.(26.60±9.97)岁,P<0.001],临床确诊时间长[(5.75±4.27)年vs.(3.84±3.60)年,P<0.001],幼年发病患者多(44.5%vs.20.88%,P<0.001),以髋关节首发症状为多(41.36%vs.28.02%,P<0.05);A组患者C反应蛋白[(30.36±25.52)mg/L vs.(22.58±18.83)mg/L,P<0.01]、骶髂关节CT分级(Ⅲ级:91例vs.56例,P<0.01;Ⅳ级:42例vs.24例,P<0.01)水平均高于B组。2组患者中应用肿瘤坏死因子(TNF)-α拮抗剂联合髋关节注射玻璃酸钠的患者经1年随访预后较好。结论 AS伴髋关节受累的患者多以髋关节表现为首发症状,发病早,从发病到确诊时间长,较强的炎性反应可能是AS髋关节受累的主要影响因素,早期应用TNF-α拮抗剂联合髋关节注射玻璃酸钠可明显缓解症状,改善髋关节功能,可能是AS髋关节病变的保护因素。
Objective Ankylosing spondylitis (AS) associated with hip involvement is one of the poor prognosis factors, and timely detection of early intervention can improve the prognosis. This article aims to explore the clinical and imaging features of AS with hip joint disease, improve the understanding of the AS hip joint disease, and the impact of different interventions on prognosis. Methods 220 patients with AS (group A) with hip joint disease and 182 patients without AS (group B) with hip disease were systematically analyzed, and their clinical symptoms and signs, laboratory parameters, imaging findings and treatment The effect is compared. Results The onset age of patients in group A was earlier (21.97 ± 8.79) vs. (26.60 ± 9.97) years, P <0.001, and the duration of definite diagnosis was longer in group A than that in group B [(5.75 ± 4.27) vs. (3.84 ± 3.60 ) (P <0.001), the incidence of juvenile onset was higher (44.5% vs.20.88%, P <0.001), and the first symptom of hip joint was more (41.36% vs.28.02%, P <0.05) (30.36 ± 25.52) mg / L vs. (22.58 ± 18.83) mg / L, P <0.01]. The grade of sacroiliac joint CT was grade Ⅲ (91 cases vs. 56 cases, P <0.01) Cases vs.24 cases, P <0.01) higher than the B group. Patients with TNF-α antagonist plus hip sodium hyaluronate in both groups had a better follow-up at 1-year follow-up. Conclusions Most patients with AS involvement have hip joint performance as the first symptom. The incidence of AS is high and the duration from onset to diagnosis is longer. A strong inflammatory reaction may be the main influencing factor of AS hip joint involvement. Early application of TNF-α antagonist Agent combined with hip injection of sodium hyaluronate can significantly relieve symptoms and improve hip joint function, which may be the protective factor of AS hip joint disease.