以醫院為基礎的僵直性脊椎炎病患之世代研究

A Hospital-based Cohort Study of Patients with Ankylosing Spondylitis

許立潔(Li-Jie Shiu)

指導教授 ： 李鴻森 ； 翁瑞宏

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2009年)

https://doi.org/10.6834/CSMU.2009.00023

摘要

僵直性脊椎炎 (ankylosing spondylitis；AS)，為血清陰性脊椎關節病變 (seronegative spondyloarthropathy；SpA) 中典型的自體免疫疾病。由於僵直性脊椎炎本質多元 (heterogeneous)、病程時間長且缺乏合適與有效的測量工具，對於僵直性脊椎炎的發生與進展的相關因子並未清楚地瞭解。因此，本研究之目的是 (1) 分析台灣僵直性脊椎炎臨床流行病學之現況，(2) 探討台灣僵直性脊椎炎病患的疾病自然史，(3) 評估巴斯僵直性脊椎炎疾病活動量表 (Bath Ankylosing Spondylitis Disease Activity Index；BASDAI) 與C-反應蛋白 (C-reactive protein；CRP) 之關係，以訂立出判斷僵直性脊椎炎疾病活動期的最佳切點分數。於2002年至2008年間，共計有1085名僵直性脊椎炎病患被納入我們一項以醫院為基礎的世代研究。問卷被執行以獲取所有病患的人口學資料及臨床特徵，巴斯僵直性脊椎炎疾病活動量表 (BASDAI)、巴斯僵直性脊椎炎功能量表 (Bath Ankylosing Spondylitis Functional Index；BASFI)、巴斯僵直性脊椎炎整體評分 (Bath Ankylosing Spondylitis Global Score；BAS-G)、理學檢查、生化指標以及HLA-B27基因也被測量。我們的結果顯示病患的男女性別比為2.5 : 1，平均年齡為35.5 ± 10.4 (算術平均數 ± 標準差) 歲，平均發病年齡為27.7 ± 9.6歲，平均病程為7.8年；而性別、發病年齡早晚以及有無周邊關節炎症狀與其臨床症狀的表現具有相關性。進一步地，457名僵直性脊椎炎病患被持續地追蹤其疾病進展，男性病患相較於女性病患其長期的BASDAI與BAS-G量表分數具有顯著減少；而發炎性腸道疾病、指尖離地距離及C-反應蛋白 (CRP) 與病患長期的BASDAI量表分數之增加具有顯著相關；枕骨至牆壁距離、指尖離地距離與CRP值則和病患長期的BAS-G量表分數之增加具有顯著相關。此外，對於整體病患疾病活動程度判斷之最佳CRP切點濃度為0.5 mg/dl。我們的研究建議著，性別、發病年齡及周邊關節炎症狀是相關於僵直性脊椎炎患者的臨床症狀表現；而性別、發炎性腸道疾病、腰椎活動度與體內發炎程度可能為僵直性脊椎炎患者長期疾病活動程度的預測指標，其性別、頸椎與腰椎活動度以及體內發炎程度則為患者長期身心舒適狀態之預測指標。並且，CRP切點濃度為0.5 mg/dl將有效地鑑別出台灣僵直性脊椎炎患者是否處於疾病活動期。

關鍵字

僵直性脊椎炎 ； 臨床流行病學 ； 疾病自然史 ； 疾病活動程度

並列摘要

Ankylosing spondylitis (AS) is a typical autoimmune disease in seronegative spondyloarthropathy (SpA). Relevant factors that influence the disease occurrence and progression of AS are poorly understood because of the heterogeneous nature of AS, long disease duration, and lack of appropriate and valid measuring instruments. Therefore, the aims of our study were to (1) analyze current status of clinical epidemiology of AS in Taiwan; (2) explore natural history of Taiwanese AS patients; and (3) establish the best cutoff for discriminating between disease active stage and inactive stage in AS, by evaluating the relationship of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and C-reactive protein (CRP). A total of 1085 AS patients were enrolled in our hospital-based cohort study. Questionnaires were administered to all patients on demographic data and clinical features. The BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS-G), anthropometric indicators, biochemical variables and HLA-B27 status were also measured. Our results showed that the sex ratio of the study subjects was 2.5:1 in favor of men, mean age was 35.5 ± 10.4 (standard deviation) years, mean age at disease onset was 27.7 ± 9.6 years, and mean disease duration was 7.8 years. Moreover, male gender, early age at disease onset and presence of peripheral arthritis were correlated with the manifestation of clinical symptoms in AS. Further, 457 AS patients were followed their disease progression continuously. Male patients with AS had a significant decrease in long-term BASDAI and BAS-G scores than did women patients with AS. Inflammatory bowel disease, fingertip-to-floor distance and CRP) were significantly associated with increased long-term BASDAI scores of AS patients. Occiput-to-wall distance, fingertip-to-floor distance and CRP concentration were significantly associated with increased BAS-G scores from patients. In addition, the best CRP cutoff for identifying the disease active stage in all patients was 0.5 mg/dl. Our study suggested that gender, age of onset, and peripheral arthritis were correlated with the presence of clinical symptoms in AS patients. Gender, inflammatory bowel disease, mobility of lumbar spine, and inflammation in body might be predictive indicators for long-term disease activity in AS patients. Gender, mobility of cervical and lumbar spine as well as inflammation in body might be predictive indicators for long-term patients’ wellbeing status. Moreover, it would be effective to differentiate between Taiwanese active AS patients according to their CRP cutoff of 0.5 mg/dl.

並列關鍵字

ankylosing spondylitis ； clinical epidemiology ； natural history of disease ； disease activity

參考文獻

Arikan S. Akalin N. Comparison of the erythrocyte sedimentation rate measured by the Micro Test 1 sedimentation analyzer and the conventional Westergren method. Annals of Saudi Medicine. 27(5):362-5, 2007.

Averns HL. Oxtoby J. Taylor HG. Jones PW. Dziedzic K. Dawes PT. Smoking and outcome in ankylosing spondylitis. Scandinavian Journal of Rheumatology. 25(3):138-42, 1996.

Bakland G. Nossent HC. Gran JT. Incidence and prevalence of ankylosing spondylitis in Northern Norway. Arthritis and Rheumatism. 53(6):850-5, 2005.

Blumberg B. Ragan C. The natural history of rheumatoid spondylitis. Medicine. 35(1):1-31, 1956.

Boonen A. van der Heijde D. Landewe R. Guillemin F. Spoorenberg A. Schouten H. Rutten-van Molken M. Dougados M. Mielants H. de Vlam K. van der Tempel H. van der Linden S. Costs of ankylosing spondylitis in three European countries: the patient's perspective. Annals of the Rheumatic Diseases. 62(8):741-7, 2003.