CAJ | 학술논문

目的分析总结误诊为脊柱关节炎(SpA)的低磷软骨病(HO)的临床特点,寻找误诊原因,改善HO患者的预后.方法收集曾误诊为SpA的26例HO患者病历资料,对其临床特征、实验室检查及影像学表现进行分析,并回顾相关文献,总结其临床特点.结果 (1)一般资料:26例患者男12例,女14例,中位年龄38(20 ～ 60)岁,平均病程3.2(9个月～10年)年,其中肿瘤致HO15例,长期口服阿德福韦酯致HO 4例,范可尼综合征致HO 3例,甲状旁腺功能亢进症致HO 2例,干燥综合征并发肾小管酸中毒致HO 2例.26例患者均有腰背痛,晨僵约30 min,其中15例有夜间腰背痛.(2)实验室检查:PLT、炎性指标[ESR、C反应蛋白(CRP)]多正常,血钙正常或稍低,所有患者均有低磷血症,ALP均升高.阿德福韦酯、范可尼综合征、干燥综合征并发肾小管酸中毒致HO患者有低钾、高氯血症、碱性尿,甲状旁腺功能亢进症患者甲状旁腺激素(PTH)升高,干燥综合征患者抗核抗体(ANA)(滴度≥1∶320)、抗SSA/SSB抗体阳性.(3)影像学检查:HO患者可在X线、CT、PET-CT、MRI上表现为骶髂关节病变,但病变均以骶骨、髂骨为主,而非关节本身.同时有骨代谢异常的表现,骨扫描异常不仅存在于关节部位,在肋骨、长骨及其他软组织部位均可见异常显像.结论 HO在临床上并不少见.如临床出现腰背痛、骶髂关节受累时应考虑SpA以外的疾病,如各种原因导致的HO.全面分析反映骨代谢的实验室指标有助于及时诊断HO.
목적 분석총결오진위척주관절염(SpA)적저린연골병(HO)적림상특점,심조오진원인,개선HO환자적예후.방법 수집증오진위SpA적26례HO환자병력자료,대기림상특정、실험실검사급영상학표현진행분석,병회고상관문헌,총결기림상특점.결과 (1)일반자료:26례환자남12례,녀14례,중위년령38(20 ～ 60)세,평균병정3.2(9개월～10년)년,기중종류치HO15례,장기구복아덕복위지치HO 4례,범가니종합정치HO 3례,갑상방선공능항진증치HO 2례,간조종합정병발신소관산중독치HO 2례.26례환자균유요배통,신강약30 min,기중15례유야간요배통.(2)실험실검사:PLT、염성지표[ESR、C반응단백(CRP)]다정상,혈개정상혹초저,소유환자균유저린혈증,ALP균승고.아덕복위지、범가니종합정、간조종합정병발신소관산중독치HO환자유저갑、고록혈증、감성뇨,갑상방선공능항진증환자갑상방선격소(PTH)승고,간조종합정환자항핵항체(ANA)(적도≥1∶320)、항SSA/SSB항체양성.(3)영상학검사:HO환자가재X선、CT、PET-CT、MRI상표현위저가관절병변,단병변균이저골、가골위주,이비관절본신.동시유골대사이상적표현,골소묘이상불부존재우관절부위,재륵골、장골급기타연조직부위균가견이상현상.결론 HO재림상상병불소견.여림상출현요배통、저가관절수루시응고필SpA이외적질병,여각충원인도치적HO.전면분석반영골대사적실험실지표유조우급시진단HO.
Objective To study and summarize the clinical features of hypophosphatemia osteomalacia (HO) misdiagnosed as spondyloarthritis (SpA),aiming to analyze the reasons of misdiagnosis and improve the prognosis of such patients.Methods A total of 26 cases of HO misdiagnosed as SpA were selected.Clinical features,laboratory tests,and image presentations were analyzed.Related literatures were reviewed.Results (1) Clinical characters:26 patients were included (12 males and 14 females) with a median age of 38 years (range 20-60).The mean disease duration was 3.2 years (range 0.75 to 10 years).Of all the patients,15 were diagnosed as tumor-induced HO,4 were long-term oral adefovir dipivoxil-related HO,3 were associated with Fanconi syndrome,2 were related to hyperparathyroidism,while 2 were Sjogren's syndrome complicated with renal tubular acidosis.All of the 26 patients presented with low back pain including 15 with night pain.The time of morning stiffness was about 30 minutes.Non-steroidal antiinflammatory drugs were given to each patient whereas with poor efficacy,neither did other agents work well,such as glucocorticoids,disease modifying anti-rheumatic drugs and biologics.(2) Laboratory findings:the platelet count and inflammatory markers such as erythrocyte sedimentation rate,C-reactive protein (CRP) were usually normal.The level of serum calcium was normal or slightly lower,nevertheless,all patients had hypophosphatemia and increased level of alkaline phosphatase (ALP).Patients with adefovir dipivoxil related HO,Fanconi syndrome or Sjogren's syndrome complicated with renal tubular acidosis were characterized by hypokalemia,hyperchloremia and alkaline urine.Patients with hyperparathyroidism had elevated parathyroid hormone (PTH).Positive antinuclear antibodies (ANA) (titer ≥ 1:320),anti-SSA / SSB antibodies were found in patients with Sjogren's syndrome.(3) Radiographic features:sacroiliac joint lesions were found in X-ray,CT,positron emission tomography (PET-CT) or MRI,however the lesions in sacrum or ilium were predominant rather than in joints.Abnormal bone imaging in ribs,long bones and soft tissues in addition to joints could be detected by bone scintigraphy.Conclusion HO is not uncommon in daily practice.Besides SpA,other diseases should be considered in the setting of low-back pain and diseased sacroiliac joints.Comprehensive screening of bone metabolic parameters contributes to the timely diagnosis of HO.