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Clinical Characteristics of Ankylosing Spondylitis Complicated with Takayasu's Arteritis
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摘要:
目的 探讨强直性脊柱炎(ankylosing spondylitis, AS)合并大动脉炎(Takayasu's arteritis, TA)患者的临床特点。 方法 回顾性分析2000年6月至2011年7月北京协和医院确诊的AS合并TA患者的资料。使用改良的纽约标准作为AS的诊断标准, 美国风湿病学会大动脉炎分类标准作为TA的诊断标准。所有患者均行抗核抗体、类风湿因子、抗中性粒细胞胞浆抗体、抗心磷脂抗体检查, 排除结缔组织疾病或其他疾病。同时行红细胞沉降率(erythrocyte sedimentation rate, ESR)、C反应蛋白、HLA-B27、心脏超声心动图、主动脉及其分支的血管造影或CT血管造影和/或血管超声、骶髂关节X线和CT检查。 结果 7例患者诊断为AS合并TA, 其中男性4例, 女性3例。就诊时年龄18~50岁, 平均年龄(29.6±10.6)岁。5例患者HLA-B27阳性, 2例阴性。所有患者ESR和C反应蛋白均升高, ESR平均84 mm/h。所有患者均先诊断AS, 多年后又发现TA。诊断TA前, 患者AS病史最短3年, 最长29年, 平均(13.9±11.6)年。发现TA的原因主要由于出现TA受累血管的症状或炎症所引起的发热。 结论 AS合并TA并非随机现象, 炎症因素可能在发病机制中起重要作用。 Abstract:Objective To summarize the clinical features of ankylosing spondylitis (AS) complicated with Takayasu's arteritis (TA). Methods We retrospectively analyzed the clinical data of AS complicated with TA patients who had been treated in Peking Union Medical College Hospital from June 2000 to July 2011. AS was diagnosed in accordance with the Modified New York criteria, and TA with American College of Rheumatology classification criteria. All patients had been tested for antinuclear antibody, rheumatoid factor, antineutrophil cytoplasmic antibody, and anticardiolipin antibodies to exclude connective tissue disease and other diseases. Other examinations included tests for erythrocyte sedimentation rate (ESR), C reactive protein, HLA-B27, echocardiography, CT angiography or digital subtraction angiography of aorta and its major branch, color Doppler ultrasound of aorta and its major branch, and X ray and CT of the sacroiliac joint. Results Seven patients[4 males and 3 females, with an average age of (29.6±10.6) years (range:18 to 50 years)] during this period were diagnosed as AS complicated with TA. HLA-B27 was positive in 5 patients and negative in 2 patients. The levels of inflammatory markers such as ESR and C reactive protein were high in all patients. The average ESR was 84 mm/h. All patients were first diagnosed as AS, then found to be with TA years later. Before the diagnosis of TA, AS had lasted for (13.9±11.6) years (range:3 to 29 years). The main reason leading to the diagnosis of TA was the symptoms of the involved arteries and the fever caused by inflammation. Conclusions AS complicated with TA is not a random phenomenon, in which the inflammatory process may play a crucial role. -
Key words:
- ankylosing spondylitis /
- Takayasu's arteritis /
- inflammation
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表 1 AS合并TA患者的一般资料及AS相关临床资料
患者 性别 年龄
(岁)AS病史
(年)AS
家族史外周关节
受累史跟腱附着点
炎病史虹膜睫状
体炎病史HLA-B27 ESR
(mm/h)CRP
(mg/L)骶髂关节
放射学分级1 男 18 9 无 右膝 + 左眼 + 81 108 双侧Ⅱ级 2 女 29 3 无 双膝 + - + 112 13 双侧Ⅱ级 3 男 35 20 有 双髋、踝和膝 + 右眼 - 90 85 左侧Ⅲ级, 右侧Ⅳ级 4 男 27 14 无 双髋、踝和膝 + - + 46 30 双侧Ⅳ级 5 男 21 6 有 右肘、右髋、双膝 + - + 123 131 双侧Ⅱ级 6 女 50 37 有 双髋、踝和膝 - - + 86 49 双侧Ⅲ级 7 女 27 8 有 左踝、右膝、双髋 - 右眼 - 50 17 双侧Ⅲ级 AS：强直性脊柱炎；TA：大动脉炎；ESR：红细胞沉降率；CRP：C反应蛋白；正常ESR女性＜20 mm/h，男性＜15 mm/h；正常CRP＜3 mg/L 
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表 2 AS合并TA患者的TA相关临床资料
患者 双上肢血压差
＞10 mmHg无脉 就诊时发热 发现TA原因 锁骨下或腹部
血管杂音受累动脉 1 + - + 发热、关节炎 + 主动脉弓、腹主动脉、双肾动脉、腹腔干 2 - - + 发热 - 颈总动脉、头臂干和锁骨下动脉 3 + - - 头晕、脉搏减弱 + 头臂干、右锁骨下、双颈总和颈内动脉 4 + + - 无脉 + 颈总、头臂干和左锁骨下动脉、腹主动脉 5 - - - 腹痛 + 腹主动脉 6 + + - 无脉 + 主动脉弓、腹主动脉、左锁骨下动脉、腹腔干 7 + + + 头晕 + 头臂干、锁骨下动脉，双颈总和肾动脉 AS、TA：同表 1
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