目的 探讨强直性脊柱炎(ankylosing spondylitis,AS)患者临床特征和生活质量的性别差异.方法 纳入2013年8月-2015年9月在本院门诊就诊的AS患者522例,其中女性80例,男性442例.比较男性与女性组发病年龄、病程、家族史、HLA-B27阳性率、临床症状、炎性标记物、Bath AS疾病活动指数(bath ankylosing spondylitis disease activity index,BASDAI)、AS病情活动度评分(AS disease activity score,ASDAS)、Bath AS功能指数(bath ankylosing spondylitis functional index,BASFI)、Bath AS测量指数(bath ankylosing spondylitis metrology index,BASMI)及SF-36生活质量量表各维度的差异.结果 女性发病年龄较男性晚(24.3±9.2 vs 20.5±7.5,P<0.001),外周关节受累比例明显高于男性(55.6%vs 40.5%,P<0.05),生活质量方面在精神健康维度得分低于男性(54.2±15.4 vs 58.2±16.9,P<0.05),背痛程度、患者总体评价、附着点炎比例、BASDAI、BASFI及ASDAS等方面男女两组无显著差异.在小于40岁年龄层中,女性BASMI评分低于男性(0.4±0.9 vs 1.0±1.5,P<0.05),ASDAS评分低于男性(2.5±1.3 vs 2.7±1.2,P<0.05),精神健康维度得分较男性低(54.8±14.8 vs 58.5±17.0,P<0.05).在大于或等于40岁年龄层,女性躯体功能(45.6±4.9 vs 75.0±23.9,P<0.05)及躯体疼痛维度得分(42.9±24.1 vs 59.4±22.0,P<0.05)低于男性.HLA-B27阳性女性患者躯体疼痛和精神健康维度得分较男性低(48.6±25.1 vs 55.3±23.2,P<0.05;53.0±14.5 vs 58.1±17.1,P<0.05),高疾病活动度(BASDAI>4)的女性患者躯体疼痛得分较男性低(29.7±16.3 vs 38.9±18.9,P<0.05).随访发现,高疾病活动度的女性患者正规治疗后ASDAS改善程度大于男性(1.3±1.7 vs 0.9±1.0,P=0.044).结论 女性AS患者发病年龄较晚,更易出现外周关节受累,生活质量特别是躯体疼痛和精神健康维度较差,而男性在脊柱活动度方面较女性差,但在疾病活动度及功能等方面未表现出性别差异.高疾病活动度的女性患者疗效优于男性,提示对病情活动度高的女性患者应给予积极治疗.女性患者疾病严重程度与男性相当,在临床诊治中应得到与男性患者相同的重视.%Objective To investigate the gender-attributable differences in clinical characteristics and life quality of ankylosing spondylitis (AS) patients. Methods A total of 522 AS patients (80 females and 442 males) were collected from the Department of Rheumatology, Chinese PLA General Hospital from August 2013 to September 2015. A comparison was conducted in terms of age at onset, disease course, family history, HLA-B27, clinical manifestations, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The disease activity was assessed by the bath ankylosing spondylitis disease activity index (BASDAI) and AS disease activity score (ASDAS), physical function by the bath ankylosing spondylitis functional index (BASFI), spinal mobility by the bath ankylosing spondylitis metrology index (BASMI) and quality of life (QoL) by the Short Form-36 between male and female patients. Results Compared with male patients, female patients were older at disease onset (24.3±9.2vs 20.5±7.5,P < 0.001), and had higher rates of peripheral articular involvement (55.6%vs 40.5%, P < 0.05), and a lower mental health score(54.2±15.4 vs 58.2±16.9, P < 0.05). But no significant gender-attributable difference was observed in other clinical parameters like low back pain, patients'global assessment scores, enthesitis, BASDAI, BASFI and ASDAS. In age < 40 years old group, female patients had lower BASMI scores (0.4±0.9 vs 1.0±1.5, P < 0.05), lower ASDAS scores (2.5±1.3 vs 2.7±1.2, P < 0.05) and lower mental health scores (54.8±14.8 vs 58.5±17.0, P < 0.05) than male. In the age ≥ 40 years old group, female had lower physical functioning (45.6±4.9 vs 75.0±23.9, P < 0.05) and bodily pain scores (42.9±24.1 vs 59.4±22.0, P < 0.05) in SF-36 than man. Female patients with positive HLA-B27 had lower mental health and bodily pain scores (48.6±25.1 vs 55.3±23.2,P <0.05; 53.0±14.5vs 58.1±17.1,P < 0.05), and female patients in highly active disease stage had lower bodily pain score than male patients (29.7±16.3 vs 38.9±18.9, P < 0.05). There was a significant improvement in ASDAS scores in female patients compared with male (1.3±1.7 vs 0.9±1.0, P=0.044). Conclusion AS more likely occurs in older age, had higher rates of peripheral articular involvement, and results in poor QoL in female patients than in male, especially in mental health domain. Moreover, significant impairment of spinal mobility are found in male AS patients.No gender-attributable differences in disease activity or physical function are found between male and female patient, which indicating that female disease should be paid the same attention on as male patients in clinical diagnosis and treatment.
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