本文選題：強(qiáng)直性脊柱炎 + 隊(duì)列研究　； 參考：《中國人民解放軍醫(yī)學(xué)院》2016年碩士論文

【摘要】：第一部分 強(qiáng)直性脊柱炎數(shù)據(jù)庫的基線期分析目的：本研究旨在建立基于中國強(qiáng)直性脊柱炎(ankylosing spondylitis, AS)患者的前瞻性隊(duì)列研究,用以研究中國AS人群的疾病進(jìn)展、轉(zhuǎn)歸及社會(huì)經(jīng)濟(jì)學(xué)特征，從而指導(dǎo)臨床實(shí)踐。方法：在我院風(fēng)濕科門診連續(xù)收錄確診的AS患者,收集他們的人口學(xué)特征(性別、年齡、發(fā)病時(shí)間、發(fā)病特征、家族史等)、患者自我病情評(píng)估、附著點(diǎn)炎、關(guān)節(jié)腫痛、治療方案等疾病特點(diǎn),建立基線期資料,之后進(jìn)行每年至少1次的門診隨訪。結(jié)果：從2014年5月至2014年12月共收錄449例患者的基線期資料(平均年齡29.4±8.5歲,男性84.0%,HLA(人類白細(xì)胞抗原)-B27陽性率81.2%)。不同病程AS患者的差異：根據(jù)病程時(shí)間分為3組(5年內(nèi)、大于5年且小于等于10年及10年以上)。3組患者在性別分布、HLA-B27陽性率、家族史及是否合并外周關(guān)節(jié)炎、附著點(diǎn)炎、炎性腸病、銀屑病等方面無明顯差異。長病程患者更易出現(xiàn)頸部受累(P=0.003)、前胸壁疼痛(P=0.024)以及前葡萄膜炎(P0.001)。結(jié)論：我國AS患者的關(guān)節(jié)外表現(xiàn)患病率明顯低于西方人群。長病程患者更易出現(xiàn)胸椎、前胸壁受累和葡萄糖炎。本研究將有助于了解中國AS患者的臨床特征、治療及轉(zhuǎn)歸等情況。第二部分基于C反應(yīng)蛋白計(jì)算強(qiáng)直性脊柱炎疾病活動(dòng)度評(píng)分的研究目的：基于C反應(yīng)蛋白(CRP)計(jì)算的強(qiáng)直性脊柱炎疾病活動(dòng)度評(píng)分(ASDAS)是強(qiáng)直性脊柱炎(AS)疾病活動(dòng)度的首選公式，，旨在尋找CRP取值為何水平時(shí),計(jì)算ASDAS-CRP(基于CRP計(jì)算的AS疾病活動(dòng)度評(píng)分)為最佳值,為臨床準(zhǔn)確判斷AS病情活動(dòng)度提供理論依據(jù)。方法：2014年5月至2014年12月就診于解放軍總醫(yī)院的AS患者中,完善化驗(yàn)記錄的患者共386例,其中CRP≥3.5 mg/L者266例,CRP3.5 mg/L者120例。通過分析不同CRP水平時(shí)ASDAS-CRP與ASDAS-ESR(基于血沉計(jì)算的AS疾病活動(dòng)度評(píng)分)的一致性,明確CRP的最佳取值。結(jié)果：當(dāng)CRP ≥ 3.5 mg/L時(shí)，ASDAS-CRP與ASDAS-ESR相關(guān)性好(r=0.899，P=0.000)。如果CRP3.5mg/L時(shí)，CRP水平為1.5mg/L時(shí)ASDAS-CRP與ASDAS-ESR間的一致性最好(組內(nèi)相關(guān)系數(shù)為0.902;Kappa系數(shù)為0.70)，并且以變異輪換法梯度矩陣將ASDAS-CRP與臨床病情活動(dòng)度相結(jié)合,同樣證實(shí)CRP水平為1.5mg/L時(shí)最符合臨床實(shí)際。結(jié)論：CRP水平為1.5mg/L時(shí)可作為當(dāng)CRP3.5時(shí)計(jì)算ASDAS-CRP的CRP最佳取值。
[Abstract]:Part I: baseline Analysis of ankylosing Spondylitis Database objective: to establish a prospective cohort study of patients with ankylosing spondylitis (ankylosing spondylitis, as) in China to study the progression of as in China. The outcome is based on the characteristics of social economics to guide clinical practice. Methods: to collect the demographic characteristics (sex, age, onset time, onset characteristics, family history, etc.), self-assessment, attachment point inflammation, joint swelling and pain of as patients in rheumatological outpatient clinic of our hospital, and to collect their demographic characteristics (sex, age, onset time, onset characteristics, family history, etc.). The treatment program and other disease characteristics, the establishment of baseline data, followed by at least one annual outpatient follow-up. Results: from May 2014 to December 2014, the baseline data of 449 patients were collected (mean age was 29.4 鹵8.5 years old, the positive rate of HLA (human leukocyte antigen) -B27 in males was 81.2%). According to the course of disease, the patients were divided into 3 groups (within 5 years, more than 5 years and less than 10 years and more than 10 years). 3 patients had positive rate of HLA-B27 in sex distribution, family history and whether or not they were associated with peripheral arthritis and attachment point inflammation. There was no significant difference in inflammatory bowel disease and psoriasis. Patients with long course of disease were more likely to suffer from neck involvement (P0. 003), anterior chest wall pain (P0. 024) and anterior uveitis (P0. 001). Conclusion: the prevalence of extraarticular manifestations in as patients in China is significantly lower than that in the western population. Patients with long course of disease are more likely to have thoracic vertebrae, anterior chest wall involvement and glucositis. This study will be helpful to understand the clinical features, treatment and outcome of as patients in China. The second part of the study on calculating the disease activity scale of ankylosing spondylitis based on C-reactive protein objective: the disease activity score of ankylosing spondylitis (ASDAS) calculated based on C-reactive protein (CRP) is the first choice formula for disease activity of ankylosing spondylitis (as). In order to find out the level of CRP, ASDAS-CRP (as disease activity score based on CRP) is the best value, which provides a theoretical basis for clinical diagnosis of as disease activity. Methods: from May 2014 to December 2014, 386 patients with as were diagnosed in PLA General Hospital, including 266 patients with CRP 鈮

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