中文摘要：

目的：调查强直性脊柱炎（AS）延迟诊断的情况,并分析其原因以及对疾病预后的影响。方法：收集2012年8月至2014年10月西京医院风湿免疫科收治的AS患者376例,均符合1984年修订的纽约分类标准,采用当面询问并填写调查问卷的形式收集患者的临床资料。从人口参数和临床特征等方面调查AS患者延迟诊断的原因,并分析不同延迟诊断时间对疾病预后的影响。结果：376例AS患者的平均延迟诊断时间为（72.52±70.80）月。幼年发病AS（JOAS）患者的延迟诊断时间（90.48±77.17月）明显长于成年发病患者（AOAS）（63.45±58.85月）,差异有统计学意义（P=0.033）。具有关节外表现的AS患者的延迟诊断时间（93.04±67.25月）显著长于无关节外表现患者（62.09±66.16月）,差异有统计学意义（P=0.036）。误诊组延迟诊断时间（92.09±74.95月）明显长于非误诊组（46.09±55.41月）,差异有统计学意义（P=0.001）。与早期诊断组相比,晚期诊断组患者的AS疾病活动度评分（ASDAS）≥2的患者比例、Bath AS活动指数（BASDI）、Bath AS功能指数（BASFI）、Bath AS测量指数（BASMI）以及骶髂关节放射学分级均显著增高（P〈0.05）。结论：临床医生应重视幼年发病和具有关节外表现的AS患者,减少误诊,这将有助于缩短AS患者延迟诊断的时间并改善其预后。

英文摘要：

Objective： To investigate the situation of delayed diagnosis in patients with ankylosing spondylitis（AS）, and to analyze the possible reasons and its effect on the prognosis of AS patients. Methods： Three hundred and senventy-six patients with AS admitted in the Department of Clinical Immunology of Xijing Hospital were recruited. The patients were diagnosed by rheumatologist according to the Modified New York criteria. A detailed investigator administered questionnaire was used to gather data. Face-to-face interview was conducted to take medical history and some clinical knowledge. Results： Among these 376 patients, the mean and median delayed diagnosis time were 72.52 months and 58.5 months. Patients with JOAS had longer delayed diagnosis time compared to those with AOAS （90.48± 77.17 months vs. 63.45±58.85 months, P=0.033）. Patients with extra-articular involvement had significantly longer delayed diagnosis time compared to those without extra-articular involvement（93.04± 67.25 months vs. 62.09± 66.16 months, P=0.036）. The mean delayed diagnosis time in the misdiagnosed group was 92.09± 74.95 months; compared to 46.09＋ 55.41 months in the non-misdiagnosis group, this difference was statistically significant （P=0.001）. The proportion of patients with ASDAS 〉 2, BASDAI, BASFI, BASMI and Sacroiliac joint radiological grading was significantly higher in patients with late diagnosis （diagnosis delay more than 58.5 months） compared to the patients with early diagnosis （diagnosis delay less than 58.5 months）. Conclusions： The major reasons for delayed diagnosis of AS included juvenile age, extra-articular manifestations and misdiagnosis. Delayed diagnosis resulted in significantly worse disease activity and severity of AS.