The Clinical Feature Analysis Of Ankylosing Spondylitis Of 144 Cases

Objective: To investigate the general characteristics about the clinical manifestations, the findings of physical examinations and the laboratory tests of ankylosing spondylitis (AS) patients, in order to improve the understandings on AS, and to probe the relevance between the AS grading systems that is commonly used in our clinical practice and the disease activity indices, summarize the clinical features and patterns of AS,so that to provide the clue and the basis for the diagnosis.Methods:1. In this study, clinical data is collected from April 2008 to December 2009 in the China-Japan Union Hospital of Jilin University, Division of Rheumatology among 144 inpatient cases of AS , using SPSS application software for data analysis.2. Clinical data includes age, gender, chief complaint, time of morning stiffness, physical examination (including Sch?ber test, thoracic expansion degree), HLA-B27, anti-CCP antibody, rheumatoid factor classification, erythrocyte sedimentation rate, C-reactive protein ,routine blood tese,routine urine test, immunoglobulin, complement, liver function, chest radiograph, thoracic and lumbar plain films, sacroiliac joint CT, ECG, and patient assessment of disease activity (BASDAI, BASFI, spinal pain VAS, overall back pain VAS).Results:1. In this study, male to female AS prevalence ratio is 6.2:1, female patients Sch?ber test, chest expansion measurement values are higher than men, suggesting mild degree of lumbar involvement in female patients than male patients , this also correspnds with the lower BASFI value in female patients than the male .2. Average age of onset in patients is 23.44±7.57 years, onset among 16 years and below age group accounts for 13.5% of patients, 16 years and above age group accounts for 86.5%; 16 years and above onset group has significantly low platelet count, platelet sedimentation rate, immunoglobulin levels, erythrocyte sedimentation rate and C-reactive protein level than 16 years and below onset group, while serum albumin, pre albumin and albumin /globulin ratio is opposite; 16 years and below age group has no patients with bamboo-like changes in thoracolumbar vertebrae and femoral head necrosis ; 16 years and above age group has 29 patients (25.2%) with bamboo-like changes in thoracolumbar vertebrae.3. HLA-B27 positive rate was 90.97%; serum albumin, albumin /globulin ratio in B27 negative group patients is higher than B27-positive group, globulin level in B27-negative group patients is lower than B27 positive group; erythrocyte sedimentation rate and IgG levels is significantly lower in B27 negative group patients than the B27 positive group. 4. There is statistical difference among different classification groups of Sacroiliitis in age of onset , interval from onset to diagnosis, suggesting that the greater the age of onset, the longer diagnosis time interval, more serious changes in the sacroiliac joint; bamboo-like changes in thoracolumbar vertebrae of GradeⅡSacroiliac joint was 2.3%,GradeⅢwas 10.6%, GradeⅣwas 60.0%, suggesting that bamboo like lumbar vertebrae was significantly associated with Sacroiliitis ; Refers statistical variation to distance from the pillow wall sacroiliac arthritis in different groups there are also significant differences between , exist corelation between the degree of lumbar activity limitation with the degree of sacroiliitis; GradeⅣchange group patients of sacroiliac joint , the platelet count ,globulin level was significantly higher than that of GradeⅢchange group, while albumin and albumin / globulin ratio is opposite, suggesting that disease progression has not stopped because of the severity of sacroiliac joint changes ; GradeⅡchange group patients of sacroiliac joint have total cholesterol and low-density lipoprotein level significantly lower than GradeⅣchange group , which indicates that the total cholesterol and low density lipoprotein level may be involved in pathological changes progression of the sacroiliac joint, the lower the total cholesterol and LDL levels , the slower the progression of sacroiliac joint ; GradeⅢgroup patients of sacroiliac joint have significantly lower IgA levels than GradeⅣgroup.5.In patients with BASDAI score≥4 points, BASFI score was significantly higher than the BASDAI score <4 patients, whereas there was no statistical variation in other areas like in the time of morning stiffness, referring to distance, pillow wall distance, Sch?ber test, thoracic expansion degree, spinal pain VAS, and general back pain VAS .6.In this study, the impact of disease was mainly manifested on platelets and mean platelet volume in routine blood test , this is in line with the conclusion that platelet reflect inflammatory activity index .7. The impact of disease in the liver function , blood lipid is mainly manifested in albumin, globulin, prealbumin, albumin / globulin ratio and total cholesterol levels;8. In this study, ESR, CRP of patients was significantly increased than normal cases rate , reflecting these patients are at active phase of disease.9.Among 144 cases , patients with normal ECG accounted for 84.03% , arrhythmia was main finding of abnormal ECG .10. BASDAI, BASFI, spinal pain VAS and overall back pain VAS four score systems have distinct correlation among each other; BASFI with time of morning stiffness, referring to distance is significantly positively correlated, while with Sch?ber test, chest expansion degree is negatively correlated ; BASDAI, spinal pain VAS, overall back pain VAS are not correlated with distance from the pillow wall, Sch?ber test, chest expansion degree, morning stiffness time. From this we can know that BASFI better reflects spinal activities.Conclusions:1.Male have higher incidence than women, disease activity of female AS patients is equal with male patients; the probability of bamboo-like changes of thoracolumbar vertebrae in female AS patients is similar with male AS patients; 2.Radiological change in Adult onset AS patients compared with juvenile onset group is severe; the greater the age of onset, the longer the time interval between diagnosis, the more severe changes in sacroiliitis;3. Bamboo-like changes of thoracolumbar vertebra and lumbar vertebrae activity limitation degree are correlated with the grade of sacroiliitis;4. In AS patients, abnormal laboratory findings is mainly manifested in platelet count, mean platelet volume, serum albumin, globulin, prealbumin, albumin/globulin ratio, total cholesterol level, ESR, CRP ,etc.5.BASFI score can better reflect the spinal activities. Innovations:The first time comparative study in ankylosing spondylitis involving clinical manifestations, physical examination, laboratory indicators, etc stratifying according to gender, age, HLA-B27, the level of the sacroiliac joints changes and the BASDAI score ,comprehensively assessed the clinical features of each group , summarized the clinical patterns, to provide evidence-based medicine for the diagnosis and treatment of this disease.