Bergfeldt L, Edhag O, Vedin L, Vallin H
Am J Med. 1982 Aug;73(2):187-91. doi: 10.1016/0002-9343(82)90177-2.
The cause of severe disturbances of the cardiac conduction system is seldom possible to establish clinically at pacemaker implantation, apart from cases of acute myocardial infarction or digitalis intoxication and in relatively rare cases of inflammatory disorders such as sarcoidosis and systemic sclerosis. Since cardiac manifestations, mainly conduction disturbances, occur in patients with ankylosing spondylitis, the prevalence of this disease was determined using radiologic screening for sacroiliitis in a population of 223 men who had permanently implanted pacemakers. Sacroiliitis was found in 19 men (8.5 percent), 15 of whom fulfilled the diagnostic criteria for ankylosing spondylitis. In six patients, sacroiliitis was asymptomatic and two of the patients were completely free of symptoms other than those originating from their heart manifestations. In seven of the 15 patients with ankylosing spondylitis and in the four patients with sacroiliitis without clinical criteria of ankylosing spondylitis, the diagnosis was previously unknown. Uveitis and aortic regurgitation occurred in five patients each, while peripheral arthritis was twice as common. The prevalence of sacroiliitis and ankylosing spondylitis of 8.5 and 6.7 percent, respectively, differ significantly (p less than 0.01) from the frequencies found in general Caucasian populations of 1 to 2 and 0.1 to 0.5 percent, respectively. HLA B27 was present in more than 80 percent of the patients with sacroiliitis and/or ankylosing spondylitis, compared with 8 to 10 percent in the general population. This strong association is in accordance with previous studies of patients with symptomatic sacroiliitis and/or ankylosing spondylitis. Thus sacroiliitis, diagnosed by x-ray, can be considered a marker for this relatively common rheumatic cause of severe disturbances of the cardiac conduction system.
除急性心肌梗死、洋地黄中毒病例以及相对罕见的结节病和系统性硬化症等炎症性疾病外，在起搏器植入时临床上很少能确定心脏传导系统严重紊乱的病因。由于强直性脊柱炎患者会出现心脏表现，主要是传导紊乱，因此对223名永久植入起搏器的男性进行了骶髂关节炎的放射学筛查，以确定该疾病的患病率。19名男性（8.5%）被发现患有骶髂关节炎，其中15名符合强直性脊柱炎的诊断标准。6名患者的骶髂关节炎无症状，2名患者除心脏表现外完全没有其他症状。15名强直性脊柱炎患者中有7名以及4名无强直性脊柱炎临床标准的骶髂关节炎患者此前诊断不明。5名患者出现葡萄膜炎，5名患者出现主动脉反流，而外周关节炎的发生率是前者的两倍。骶髂关节炎和强直性脊柱炎的患病率分别为8.5%和6.7%，与一般白种人群中分别为1%至2%和0.1%至0.5%的频率有显著差异（p小于0.01）。超过80%的骶髂关节炎和/或强直性脊柱炎患者存在HLA B27，而一般人群中的这一比例为8%至10%。这种强关联与先前对有症状的骶髂关节炎和/或强直性脊柱炎患者的研究一致。因此，经X线诊断的骶髂关节炎可被视为这种相对常见的导致心脏传导系统严重紊乱的风湿性病因的一个标志物。
