强直性脊柱炎合并慢性粒细胞白血病1例

doi:10.11958/20253670

天津医药 ›› 2026, Vol. 54 ›› Issue (6): 658-662.doi: 10.11958/20253670

强直性脊柱炎合并慢性粒细胞白血病1例

鞠丹娜¹(), 朱永村², 李毅¹, 夏雯¹, 王晓毅³, 魏蔚⁴^,^△()

¹ 山东大学附属威海市立医院风湿免疫科（邮编 264200）
² 病理科
³ 血液内科
⁴ 天津医科大学总医院风湿免疫科

收稿日期:2025-12-19 修回日期:2026-02-02 出版日期:2026-06-15 发布日期:2026-06-15
通讯作者: ^△E-mail：tjweiwei2003@163.com
作者简介:鞠丹娜（1984），女，副主任医师，主要从事风湿病诊治方面研究。E-mail：237077523@qq.com

Ankylosing spondylitis complicated with chronic myeloid leukemia: a case report

JU Danna¹(), ZHU Yongcun², LI Yi¹, XIA Wen¹, WANG Xiaoyi³, WEI Wei⁴^,^△()

¹ Department of Rheumatology
² Department of Pathology
³ Department of Hematology, Shandong University Affiliated Weihai Municipal Hospital, Weihai 264200, China
⁴ Department of Rheumatology, Tianjin Medical University General Hospital

Received:2025-12-19 Revised:2026-02-02 Published:2026-06-15 Online:2026-06-15
Contact: ^△E-mail：tjweiwei2003@163.com

鞠丹娜, 朱永村, 李毅, 夏雯, 王晓毅, 魏蔚. 强直性脊柱炎合并慢性粒细胞白血病1例[J]. 天津医药, 2026, 54(6): 658-662.

JU Danna, ZHU Yongcun, LI Yi, XIA Wen, WANG Xiaoyi, WEI Wei. Ankylosing spondylitis complicated with chronic myeloid leukemia: a case report[J]. Tianjin Medical Journal, 2026, 54(6): 658-662.

摘要/Abstract

摘要：

强直性脊柱炎（AS）伴发血液系统恶性肿瘤较为少见。该文报告1例AS合并慢性粒细胞白血病（CML）的患者，经尼洛替尼联合非甾体类抗炎药治疗有效，通过回顾该患者的临床资料并进行文献复习，探讨二者共病可能的机制及诱发因素，以提高临床医师对AS合并CML的认识，为类似病例的诊疗提供参考，避免误诊和漏诊。

关键词: 脊柱炎,强直性, 白血病,髓系,慢性,BCR-ABL阳性, 诊断,鉴别

Abstract:

The co-occurrence of ankylosing spondylitis (AS) with hematological malignancies is relatively rare. This article presents a case of AS complicated by chronic myeloid leukemia (CML). The patient responded effectively to the treatment with nilotinib combined with non?steroidal anti?inflammatory drugs. By reviewing clinical data and conducting a literature review, we aim to enhance clinicians’ awareness of AS with concurrent CML, provide reference for the diagnosis and treatment of similar cases, and avoid misdiagnosis and missed diagnosis.

Key words: spondylitis,ankylosing, leukemia,myelogenous,chronic,BCR-ABL positive, diagnosis,differential

中图分类号:

R593.23，R551.3

图/表 5

图1 骨髓病理学表现 A：HE染色示骨髓增生活跃（90%），骨髓腔内脂肪组织减少（×40）；B：HE染色示骨髓腔内以粒系增生为主，其中以中幼及以下阶段细胞为主，粒红比例约10∶1，巨核细胞增多（589个/片），左箭头示中幼粒细胞，右箭头示晚幼粒细胞（×400）。

Fig.1 Bone marrow pathology

图2 骶髂关节CT检查 A：双侧骶髂关节髂骨侧关节面不平整，有虫蚀样破坏，箭头示右侧骶髂关节显著骨质硬化、关节间隙部分融合、狭窄；B：双侧骶髂关节髂骨侧关节面不平整，箭头示左侧骶髂关节骨质硬化。

Fig.2 CT imaging of the sacroiliac joints

图3 颈、胸椎MRI检查 A：颈椎曲度变直，箭头示颈椎前缘斑片状T1WI低信号影为骨髓水肿病灶；B：箭头示颈椎前缘斑片状T2WI高信号影为骨髓水肿病灶；C：箭头示颈椎前缘斑片状STIR序列高信号影为骨髓水肿病灶；D：胸椎曲度变直，椎体“方形变”，实线箭头示T1WI高信号影为椎角脂肪浸润病变，虚线箭头示T1WI低信号影为椎角骨髓水肿病灶；E：实线箭头示T2WI高信号影为椎角脂肪浸润病变，虚线箭头示T2WI高信号影为椎角骨髓水肿病灶；F：实线箭头示STIR序列高信号影为椎角脂肪浸润病变，虚线箭头示STIR序列高信号影为椎角骨髓水肿病灶。

Fig.3 MRI imaging of the cervical and thoracic spine

图4 患者治疗后血细胞计数变化

Fig.4 Changes of blood cell counts after treatment

表1 国内外AS合并CML病例报告

Tab. 1 Cases of AS associated with CML reported at home and abroad

文献来源	国家	性别	年龄/ 岁	AS 确诊时间/年	CML 确诊时间/年	HLA-B27	治疗方案	转归
Tzivras等^[6]	希腊	男	59	31	0	-	NSAIDs、羟基脲	WBC正常，脊柱强直，但疼痛减轻
张瑾^[7]	中国	男	38	2	5	+	NSAIDs、羟基脲	WBC正常，腰痛减轻
杨华强^[8]	中国	男	36	2	5	+	NSAIDs、羟基脲	WBC正常，腰痛减轻
Ben Abdelghani等^[9]	突尼斯	男	46	/	0	+	NSAIDs、物理康复	/
王金刚等^[10]	中国	男	23	2	0	/	NSAIDs、一代TKI	WBC正常，腰痛减轻
邓亚楠等^[11]	中国	男	34	5	2	+	NSAIDs、二代TKI	WBC正常，骶髂关节病灶未进展
Ju等^[12]	中国	男	29	2	3	-	一代TKI	WBC正常，腰痛减轻
李宏超等^[13]	中国	男	28	0	0	+	NSAIDs、二代TKI	WBC正常，腰痛减轻
刘雅等^[14]	中国	男	55	30	2	/	NSAIDs、一代TKI	WBC正常，关节肿痛缓解
本例	中国	男	48	0	0	+	NSAIDs、二代TKI	WBC正常，颈腰疼痛减轻

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强直性脊柱炎合并慢性粒细胞白血病1例

Ankylosing spondylitis complicated with chronic myeloid leukemia: a case report

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