“重男轻女”的强直性脊柱炎

发布时间:2019-09-26 21:15

从“强直性脊柱炎之家”谈起
    有这样一个家庭:父亲患强直性脊柱炎已三十余年,出现了驼背,丧失工作能力。前几年两个儿子也相继发病,大儿子24岁,已患此病五年了;小儿子21岁,最近出现关节痛和腰痛,也被诊断为强直性脊柱炎。大女儿26岁,天气变化时有肩痛、踝关节痛或膝关节痛,经有关检查,尚未达到强直性脊柱炎的诊断;小女儿23岁,没有关节痛。 一家子来看病时才知道,母亲在26年前生第一个孩子后便患上·风湿病’,常常腰痛和脚痛,晚上或早上刚起床时,症状更加明显,天气变化时关节痛常常发作更甚。二十多年来,四处求医,均被诊断为“风湿性关节炎·。每次发作时痛得忍不住了,就到医院去点滴青霉素+地塞米松,以便控制症状。经检查,也被诊断为轻型 的强直性脊柱炎。
    从这个三男三女家庭的成员发病情况,可以看到强直性脊柱炎“重男轻女”的特点。父母均患强直性脊柱炎,但母亲的病情很轻,虽然一辈子均有反复腰痛和关节痛,而且长期没有得到确诊和规范治疗,却没有出现残废,照顾这个沉重的家庭二十多年,还是精神抖擞。所生的孩子,两个儿子均发病;两个女儿,一个轻症,一个没病。
强直性脊柱炎的特征
    强直性脊柱炎早期主要表现为颈、背、腰、骶、肩等脊柱的疼痛,或者下肢大关节、足跟的疼痛或肿痛。可以隐匿起病,甚至病人不能确定具体的起病时间。也可以是急性起病,突然出现关节肿痛,活动受限。这类病有一个突出的特点,就是夜间疼痛加重,晨起时症状更加明显,休息不能缓解症状,活动后感到轻松,症状减轻,医学上将此称为“晨僵现象’。
    强直性脊柱炎是一种具有家族倾向的、致残性的风湿病。好 发于青少年男性,男女比例是4-7:1。男性病人中半数最终会出现脊柱的强直、驼背或直背,5%-10%的病人最终会发展为严重的残废,丧失工作能力,甚至丧失生活自理能力。而女性强直性脊柱炎多数为轻型和良性过程,她们一辈子都会间歇地出现腰痛或关节痛,但仅有极少数病人会发展为残废。
    强直性脊柱炎早期很容易误诊,因为许多病人早期并不是表现为脊柱疼痛,不少人是以下肢大关节肿痛为首发表现的,许多医生没有意识到这一特征,导致误诊。而且,许多医生给病人照片(X线,CT或MRl)是哪里痛就照哪里,腰痛照腰,颈痛照颈,结果照片报告腰椎或颈椎骨质增生,就以此为诊断。其实,对诊断强直性脊柱炎有意义的是骶髂关节照片,但以骶髂关节疼痛为突出表现者不多,这是早期强直性脊柱炎很容易误诊的原因。所以,有关节肿痛的青少年,需要找正规医院的风湿科检查,以便早期诊断和治疗,阻止疾病走向关节的畸形和残废。
强直性脊柱炎病人生女孩更好
    由于强直性脊柱炎明显存在“重男轻女”的性别倾向性,所以,病人在生育问题上,不能够存在“重男轻女”的封建思想。实际上,这类病人如果生女孩会更好,因为女孩将来患强直性脊柱炎的概率要比男孩低得多,而且,即使患病也多无大碍。
强直性脊柱炎病人在恋爱结婚问题上,有必要了解一下对方及其父母、兄弟姐妹中,有无年轻时起病的脊柱关节病。如果有的话,可以检查一下强直性脊柱炎的遗传基因(即HLA-B27,90%病人的这个基因为阳性,但并非有这个基因就会得强直性脊柱炎),以免夫妻双方均带有同一个病的易感基因,影响到下一代的健康。
    如果夫妻俩一方患强直性脊柱炎,孩子的患病概率为25%;如果双方均患强直性脊柱炎,孩子的患病概率则为50%;如果患强直性脊柱炎的父亲或母亲,HLA-B27是阴性的,则孩子的患病概率下降。父亲或母亲患强直性脊柱炎时,如果要了解孩子有无获得这个基因,可以抽血检查一下HLA-B27。目前多数大医院有开展这项检查。
    如果强直性脊柱炎患者的孩子查到HLA-B27阳性,也不必太过担心。若是女孩,将来患此病的概率还是很低的,即使有也很轻;若是男孩,则有50%的可能将来会患强直性脊柱炎,那么,在生活中就要注意减少肠道、尿道、上呼吸道感染等的诱发因素,培养孩子睡低枕头的习惯。如果有关节疼痛,要及时找风湿科医生检查,以免延误诊治。


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