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      易誤診的強直性脊柱炎

      發布時間:2019-09-26 21:20

      說起強直性脊柱炎,很多人馬上聯想到那些身體向前極度佝僂、行動極端不便的病人。人們大都知道,病到這個份兒上,就沒辦法治了。但是人們普遍不知道的是,這種病發展到晚期往往是早期誤診的結果,如果能做到早期發現,治療是完全可以控制的。
          在本院病房,記者訪問了幾位因強直性脊柱炎而住院的病人,令人吃驚的是這些小伙子在來此住院之前,全都有多次誤診的經歷。“我剛發病時是右腿疼,去了幾家醫院都說是坐骨神經痛,但怎么也治不好,這么折騰了兩個月,以后兩條腿輪著疼,關節也腫了,這才知道治錯了?!薄拔覄傞_始是后腰疼,拍了片子醫生說我是腰椎間盤突出,可治著治著腳和腿都疼起來,還發起低燒,換了家醫院先說我是痛風、后說我是類風濕,直到進了這家醫院才確診得的是強直性脊柱炎?!?/span>
        為什么這些病人都曾誤診呢?科主任醫師介紹,類風濕關節炎與強直性脊柱炎都是自身免疫性疾病,醫學界曾長期將二者混為一談,認為強直性脊柱炎是類風濕性關節炎的中軸型,近年來才認識到二者在病理上并不相同。類風濕性關節炎是包裹關節的滑膜出現問題;強直性脊柱炎是肌腱附著點發炎,而且這種炎癥多發生在骶髂關節處。從片子上來看,先是錐體之間炎癥、邊緣密度增高、粗糙,再骶髂關節融合鈣化,最后形成骨橋,并逐漸向腰椎、胸椎、頸椎發展,嚴重的,病人變成硬板腰或駝背,影響功能,喪失勞動能力。此病常常侵犯年輕男性。“醫生誤診是由于此病初發時還未出現關節病變,癥狀不典型,只是腰骶部疼、后背疼,還有的表現為屁股疼、腹股溝疼、肋間疼、足跟疼等,一般有肌腱處都可出現疼痛,有的病人還會有低燒、關節腫癥狀,這時醫生不能僅局限在類風濕、腰椎間盤突出、痛風、坐骨神經痛上,而應高度懷疑強直性脊柱炎,及時給予相關檢查?!睆娭毙约怪撞∪硕鄶涤屑易迨?,確診可查HLA-B27基因,90%的病人此基因為陽性,如再有骶髂關節CT片配合,則可確定無疑?;鶎俞t生常常以X線片診斷為依據,但此病早期骨骼的變化X線片是看不出來的,容易延誤治療時機。
        目前現代醫學治療此病尚無理想方案。一般常用的藥物包括激素類、非甾類、免疫抑制劑等,但只能緩解癥狀,不能控制病情發展,更不能改善強直的狀態。尤其是目前常用的一些藥物對生殖系統有不
      良影響,不適用于未婚男青年。
        本研究中心醫務人員深入研究強直性脊柱炎多年,逐漸積累經驗,形成了獨到的認識。他們認為,該病侵犯脊柱,“不通則痛”,屬于中醫“痹癥”范疇,其部位處于中醫的督脈循行處,是本虛標實之候,以腎督不足為本,外邪侵襲與瘀血內阻為標。急性期以關節紅腫熱痛為主,治宜清熱利濕,活血通絡。后期腰背酸痛,活動受限,與腎虛督弱相關,應以補腎通督,養血柔筋,通絡止痛為治則。為此,該院研制了“強直骨寶康”系列藥物不僅改善病人癥狀,控制或延緩病情發展,而且不良反應少,耐受性好。
        30歲的宋艷華去年家里裝修后出現腰背疼、腿疼,2天后開始發高燒、眼睛發紅。一家骨科醫院根據他的X線片診斷為腰椎關節增生,用了幾天激素后好轉。但沒過幾天又高燒39度,用上激素仍1個月不退,又換了一家醫院,先后按鼻竇炎、結核治療無效,最后查了HLA-B27才確診為強直性脊柱炎,但沒有有效治療方法。今年4月,仍高燒39度的宋艷華被用車推著本院,經治療1周后退燒,1個月后可走路,2個月后出院,現已上班。
        其主治醫生最后強調:“強直性脊柱炎分4級,宋艷華是2級,骶髂關節還未完全長死,如到了完全長死的4級,誰也沒有回天之力。我想提醒大家的是,對這種病要有高度警覺,因為很多病人因腰疼首先到骨科就診,而且他們90%會繼發椎間盤退變或膨出,醫生往往以為找到了病根,就不再檢查骶髂關節,以至使治療走彎路,輕病拖重,甚至喪失了治療時機。” (中華強直性脊柱炎研究中心 )


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