强制性脊柱炎治疗及预防

强制性脊柱炎治疗及预防 强制性脊柱炎 临床表现 1.初期症状 对于16,25岁青年，尤其是青年男性。强直性脊柱炎一般起病比较隐匿，早期可无任何临床症状，有些病人在早期可表现出轻度的全身症状，如乏力、消瘦、长期或间断低热、厌食、轻度贫血等。由于病情较轻，病人大多不能早期发现，致使病情延误，失去最佳治疗时机。 2.关节病变表现 AS病人多有关节病变，且绝大多数首先侵犯骶髂关节，以后上行发展至颈椎。少数病人先由颈椎或几个脊柱段同时受侵犯，也可侵犯周围关节，早期病变处关节有炎性疼痛，伴有关节周围肌肉痉挛，有僵硬感，晨起明显。也可表现为夜间疼，经活动或服止痛剂缓解。随着病情发展，关节疼痛减轻，而各脊柱段及关节活动受限和畸形，晚期整个脊柱和下肢变成僵硬的弓形，向前屈曲。 (1)骶髂关节炎 约90%AS病人最先表现为骶髂关节炎。以后上行发展至颈椎，表现为反复发作的腰痛，腰骶部僵硬感，间歇性或两侧交替出现腰痛和两侧臀部疼痛，可放射至大腿，无阳性体征，伸直抬腿试验阴性。但直接按压或伸展骶髂关节可引起疼痛。有些病人无骶髂关节炎症状，仅X线检查发现有异常改变。约3%AS颈椎最早受累，以后下行发展至腰骶部，7%AS几乎脊柱全段同时受累。 (2)腰椎病变 腰椎受累时，多数表现为下背部和腰部活动受限。腰部前屈、背伸、侧弯和转动均可受限。体检可发现腰椎脊突压痛，腰椎旁肌肉痉挛;后期可有腰肌萎缩。 (3)胸椎病变 胸椎受累时，表现为背痛、前胸和侧胸痛，最常见为驼背畸形。如肋椎关节、胸骨柄体关节、胸锁关节及肋软骨间关节受累时，则呈束带状胸痛，胸廓扩张受限，吸气咳嗽或打喷嚏时胸痛加重。严重者胸廓保持在呼气状态，胸廓扩张度较正常人降低50%以上，因此只能靠腹式呼吸辅助。由于胸腹腔容量缩小，造成心肺功能和消化功能障碍。 (4)颈椎病变 少数病人首先表现为颈椎炎，先有颈椎部疼痛，沿颈部向头部臂部放射。颈部肌肉开始时痉挛，以后萎缩，病变进展可发展至颈胸椎后凸畸形。头部活动明显受限，常固定于前屈位，不能上仰、侧弯或转动。严重者仅能看到自己足尖前方的小块地面，不能抬头平视。 (5)周围关节病变 约半数AS病人有短暂的急性周围关节炎，约25%有永久性周围关节损害。一般多发生于大关节，下肢多于上肢。肩关节受累时，关节活动受限，疼痛更为明显，梳头、抬手等活动均受限。侵犯膝关节时则关节呈代偿性弯曲，使行走、坐立等日常生活更为困难。极少侵犯肘、腕和足部关节。 此外，耻骨联合亦可受累，骨盆上缘、坐骨结节、股骨大粗隆及足跟部可有骨炎症状，早期表现为局部软组织肿、痛，晚期有骨性粗大。一般周围关节炎可发生在脊柱炎之前或以后，局部症状与类风湿关节炎不易区别，但遗留畸形者较少。 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 3.关节外表现 AS的关节外病变，大多出现在脊柱炎后，偶有骨骼肌肉症状之前数月或数年发生关节外症状。AS可侵犯全身多个系统，并伴发多种疾病。 (1)心脏病变 以主动脉瓣病变较为常见。临床有不同程度主动脉瓣关闭不全者约1%;约8%发生心脏传导阻滞，可与主动脉瓣关闭不全同时存在或单独发生，严重者因完全性房室传导阻滞而发生阿—斯综合征。当病变累及冠状动脉口时，可发生心绞痛。少数发生主动脉肌瘤、心包炎和心肌炎。 (2)眼部病变 长期随访，25%AS病人有结膜炎、虹膜炎、眼色素层炎或葡萄膜炎，后者偶可并发自发性眼前房出血。虹膜炎易复发，病情越长发生率愈高，但与脊柱炎的严重程度无关，有周围关节病者常见，少数可先于脊柱炎发生。眼部疾病常为自限性，有时需用皮质激素治疗，有的未经恰当治疗可致青光眼或失明。 (3)耳部病变 在发生慢性中耳炎的AS病人中，其关节外表现明显多于无慢性中耳炎的AS病人。 (4)肺部病变 少数AS病人后期可并发上肺叶斑点状不的纤维化病变，表现为咳痰、气喘，甚至咯血，并可能伴有反复发作的肺炎或胸膜炎。 (5)神经系统病变 由于脊柱强直及骨质疏松，易使颈椎脱位和发生脊柱骨折，从而引起脊髓压迫症。如发生椎间盘炎则引起剧烈疼痛。AS后期可侵犯马尾，发生马尾综合征，而导致下肢或臀部神经根性疼痛，骶神经分布区感觉丧失，跟腱反射减弱及膀胱和直肠等运动功能障碍。 (6)淀粉样变 为AS少见的并发症。 (7)肾及前列腺病变 与RA相比，AS极少发生肾功能损害，但有发生IgA肾病的。AS并发慢性前列腺炎较对照组增高，其意义不明。 检查 1(电子计算机断层扫描(CT) 对于临床怀疑而X线不能确诊者，可以行CT检查，它能清晰显示骶髂关节间隙，对于测定关节间隙有无增宽、狭窄、强直或部分强直有独到之处。 2.磁共振(MRI)和单光子发射计算机断层扫描(SPECT) 研究者认为，MRI和SPECT闪烁造影骶髂关节拍片，非常有助于极早期诊断和治疗，从这个角度看明显优于普通X线，但费用昂贵，不提倡作为常规检查。 3.实验室检查 白细胞计数正常或升高，淋巴细胞比例稍增加，少数病人有轻度贫血(正细胞低色素性)，血沉可增快，但与疾病活动的相关性不大，而C反应蛋白则较有意义。血清白蛋白减少，α1和γ球蛋白增加，血清免疫球蛋白IgG、IgA和IgM可增加，血清补体C3和C4常增加。约50%病人碱性磷酸酶升高，血清肌酸磷酸激酶也常升高。血清类风湿因子阴性。虽然90%,95%以上AS病人HLA-B27阳性，但一般不依靠HLA-B27来诊断AS，HLA-B27不作常规检查。 4.X线检查 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 对AS的诊断有极为重要的意义，98%,100%病例早期即有骶髂关节的X线改变，是本病诊断的重要依据。早期X线表现为骶髂关节炎，病变一般在骶髂关节的中下部开始，为两侧性。开始多侵犯髂骨侧，进而侵犯骶骨侧。可见斑点状或块状，髂骨侧明显。继而可侵犯整个关节，边缘呈锯齿状，软骨下有骨硬化，骨质增生，关节间隙变窄。最后关节间隙消失，发生骨性强直。骶髂关节炎X线诊断分为5期:0级为正常骶髂关节，?期为可疑骶髂关节炎，?期为骶髂关节边缘模糊，略有硬化和微小侵袭病变，关节间隙无改变，?期为中度或进展性骶髂关节炎，伴有一项(或以上)变化:近关节区硬化、关节间隙变窄/增宽、骨质破坏或部分强直，?期为关节完全融合或强直伴或不伴硬化。 脊柱病变的X线表现，早期为普遍性骨质疏松，椎小关节及椎体骨小梁模糊(脱钙)，椎体呈“方形椎”，腰椎的正常前弧度消失而变直，可引起一个或多个椎体压缩性骨折。病变发展至胸椎和颈椎椎间小关节，间盘间隙发生钙化，纤维环和前纵韧带钙化、骨化、韧带骨赘形成，使相邻椎体连合，形成椎体间骨桥，呈最有特征的“竹节样脊柱”。原发性AS和继发于炎性肠病、Reiter综合征、牛皮癣关节炎等伴发的脊柱炎，X线表现类似，但后者为非对称性强直。在韧带、肌腱、滑囊附着处可出现骨质糜烂和骨膜炎，最多见于跟骨、坐骨结节、髂骨嵴等。其他周围关节亦可发生类似的X线变化。 诊断 1.临床表现 (1)腰和(或)脊柱、腹股沟、臀部或下肢酸痛不适，或不对称性外周寡关节炎、尤其是下肢寡关节炎，症状持续?6周。 (2)夜间痛或晨僵明显。 (3)活动后缓解。 (4)足跟痛或其他肌腱附着点病。 (5)虹膜睫状体炎现在症或既往史。 (6)AS家族史或HLA-B27阳性。 (7)非甾体抗炎药(NSAIDs)能迅速缓解症状。 2.影像学或病理学 (1)双侧X线骶髂关节炎??期。 (2)双侧CT骶髂关节炎??期。 (3)CT骶髂关节炎不足?级者，可行MRI检查。如表现软骨破坏、关节旁水肿和(或)广泛脂肪沉积，尤其动态增强检查关节或关节旁增强强度>20%,且增强斜率>10%/min者。 (4)骶髂关节病理学检查显示炎症者。 3.诊断 符合临床标准第1项及其他各项中之3项，以及影像学、病理学标准之任何一项者，可诊断AS。 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 鉴别诊断 (一)常见疾病鉴别 1.腰骶关节劳损 慢性腰骶关节劳损为持续性、弥漫性腰痛，以腰骶部最重，脊椎活动不受限，X线无特殊改变。急性腰骶关节劳损，疼痛因活动而加重，休息后可缓解。 2.骨关节炎 常发生于老年人，特征为骨骼及软骨变性、肥厚，滑膜增厚，受损关节以负重的脊柱和膝关节等较常见。累及脊椎者常以慢性腰背痛为主要症状，与AS易混淆。但本病不发生关节强直及肌肉萎缩，无全身症状，X线表现为骨赘生成和椎间隙变窄。 3.Forestier病(老年性关节强直性骨肥厚) 脊椎亦发生连续性骨赘，类似AS的脊椎竹节样变，但骶髂关节正常，椎间小关节不受侵犯。 4.结核性脊椎炎 临床症状如脊椎疼痛、压痛、僵硬、肌肉萎缩、驼背畸形、发热、血沉快等与AS相似，但X线检查可资鉴别。结核性脊柱炎时，脊椎边缘模糊不清，椎间隙变窄，前楔形变，无韧带钙化，有时有脊椎旁结核脓疡阴影存在，骶髂关节为单侧受累。 5.类风湿关节炎 现已确认AS不是RA的一种特殊类型，两者有许多不同点可资鉴别。RA女性多见，通常先侵犯手足小关节，且呈双侧对称性，骶髂关节一般不受累，如侵犯脊柱，多只侵犯颈椎，且无椎旁韧带钙化，有类风湿皮下结节，血清RF常阳性，HLA-B27抗原常阴性。 6.肠病性关节病 溃疡性结肠炎、Crohn病或肠原性脂肪代谢障碍(Whipple)都可发生脊柱炎，且肠病性关节病受累关节和X线改变与AS相似而不易区别，因此需要寻找肠道症状和体征，以资鉴别。溃疡性结肠炎有结肠黏膜溃疡、水肿及血性腹泻。Crohn病有腹痛、营养障碍及瘘管形成。Whipple病有脂肪泻，急剧消瘦等。这些都有助于原发性疾病的诊断。肠病性关节病HLA-B27阳性率低，Crohn病病人肠灌注液IgG增高，而AS病人肠灌液中IgG基本正常。 7.Reiter综合征和银屑病关节炎 两病均可发生脊柱炎和骶髂关节炎，但脊柱炎一般发生较晚，较轻，椎旁组织钙化少，韧带骨赘以非边缘型为主(纤维环外纤维组织钙化)，在相邻两椎体间形成部分性骨桥与AS的竹节样脊柱不同。骶髂关节炎一般为单侧性或双侧非对称损害，牛皮癣关节炎则有皮肤银屑病损害等可资鉴别。 8.肿瘤 肿瘤亦可引起进行性疼痛，需作全面检查，明确诊断，以免误诊。 9.急性风湿热 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 部分病人初期临床表现颇似急性风湿热，或出现大关节肿痛，或伴有长期低热、体重减轻，以高热和外周关节急性炎症为首发症状的也不少见，此类病人多见于青少年，也容易被长期误诊。 10.结核病 个别病人初期类似结核病，表现为低热、盗汗、虚弱、乏力、体重减轻、贫血，有时伴有单侧髋关节炎症，易被误诊为结核病。有关的结核检查可鉴别。 (二)与血清阴性脊柱关节病鉴别 1.Reiter综合征和银屑病关节炎 可发生脊柱炎和骶髂关节炎，但脊柱炎一般发生较晚，较轻，椎旁组织钙化少，韧带骨赘以非边缘型为主(纤维环外纤维组织钙化)，在相邻两椎体间形成部分性骨桥与强直性脊柱炎的竹节样脊柱不同。骶髂关节炎一般为单侧性或双侧非对称性，棘突关节病变少见，无普遍性骨质疏松。另外，Reiter综合征有结膜炎、尿道炎、黏膜皮肤损害，银屑病关节炎则有皮肤银屑病损害等可供鉴别。 2.肠病性关节炎 溃疡性结肠炎、Crohn病、肠原性脂肪代谢障碍(Whippe)都可发生脊柱炎，且肠病性关节病受累关节和X线改变与强直性脊柱炎相似而不易区别，因此需要寻找肠道症状和体征，以资鉴别。溃疡性结肠炎有结肠黏膜溃疡、水肿及血性腹泻，Crohn病有腹痛、营养障碍及痿管形成，Whipple病有脂肪泻，急剧消瘦等。肠病性关节病HLA-B27阳性率低，Crohn病病人肠灌注液IgG增高，而强直性脊柱炎病人肠灌液中IgG基本正常。 3.反应性关节炎 常继发于身体其他部位感染后出现，一般可以发现感染灶，抗生素有效。 治疗 1.控制AS治疗的目的 在于控制炎症，减轻或缓解症状，维持正常姿势和最佳功能位置，防止畸形。要达到上述目的，关键在于早期诊断早期治疗，采取综合措施进行治疗，包括教育病人和家属、体疗、理疗、药物和外科治疗等。 (1)该病治疗从教育病人和家属着手，使其了解疾病的性质、大致病程、可能采用的措施以及将来的预后，以增强抗病的信心和耐心，取得他们的理解和密切配合。 (2)注意日常生活中要维持正常姿势和活动能力，如行走、坐位和站立时应挺胸收腹，睡觉时不用枕或用薄枕，睡硬木板床，取仰卧位或俯卧位，每天早晚各俯卧半小时。参与力所能及的劳动和体育活动。工作时注意姿势，防止脊柱弯曲畸形等。 (3)保持乐观情绪，消除紧张、焦虑、抑郁和恐惧的心理;戒烟酒;按时作息，参加医疗体育锻炼。 (4)了解药物作用和副作用，学会自行调整药物剂量及处理药物副作用，以利配合治疗，取得更好的效果。 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No. 2.体疗 体育疗法对各种慢性疾病均有好处，对AS更为重要。可保持脊柱的生理弯曲，防止畸形。保持胸廓活动度，维持正常的呼吸功能。保持骨密度和强度，防止骨质疏松和肢体废用性肌肉萎缩等。病人可根据个人情况采取适当的运动方式和运动量。如新的疼痛持续2小时以上不能恢复，则表明运动过度，应适当减少运动量或调整运动方式。 3.物理治疗 理疗一般可用热疗，如热水浴、水盆浴或淋浴、矿泉温泉浴等，以增加局部血液循环，使肌肉放松，减轻疼痛，有利于关节活动，保持正常功能，防止畸形 预防 1.应避免强力负重，使病变加重。避免长时间维持一个姿势不动。若要长时间坐着时，至少每小时要起来活动十分钟。勿用腰背束缚器(会减少活动)，使脊椎炎恶化。 2.睡眠时避免垫枕头且不睡软床。睡觉时最好是平躺保持背部直立。 3.清晨起床背脊僵硬时，可以热水浴来改善。热敷对于缓解局部疼痛亦有部分疗效。不抽烟，以免造成肺部伤害。 4.慎防外伤，开车时一定系上安全带，尽量不要骑机动车。 5.在寒冷、潮湿季节中，更应防范症状复发。 6.胃肠道及泌尿道的感染常诱发脊椎炎，故应该注意饮食卫生，多喝开水，多吃青菜水果，避免憋尿及便秘。 7.注意其他家族成员有无强直性脊柱炎的症状，如下背酸痛，晨间僵硬等。若有，应尽早就医。 obstacles, correcting misunderstandings, advocate good cadre style. 2, adhere to the scientific decision-making and democratic decision-making decision-making law. Correctly handle to ensure that government decrees and based on the actual creative work, giving full play to subjective initiative, put an end to implement the conference meeting, to document the implementation of documents etc. Improve the scientific and democratic decision-making mechanism, improve and implement the decision to solicit the views of experts, the public hearing system. Improve the important decision of risk assessment mechanism and legal review mechanism. 3, to promote team unity. Uphold and improve the system of annual party book talk heart to heart, mind and Party members, Party members to exchange each other not less than 2 times. The implementation of sound team democratic life system, consolidate and enhance the party's mass line educational practice will promote the achievement of the topic of democratic life, criticism and self-criticism normalization, a long-term. Adhere to the party on the basis of the principle of unity, enhance internal communication, strengthen internal supervision, self Sleep maintenance team collective image and authority. (three) to ensure the execution is not strong or disguised to resist government decrees issues. Individual Bureau leadership team members lack of learning political theory system, not from the objective reality, not with the party's interests above all the principles to deal with personal problems. In the specific work safety supervision in the execution is not strong, in the implementation of the decision to deploy the discount, make choices, engage in work, the implementation of the agreement, uncomfortable is not performed, open or disguised to resist, the lack of subject consciousness of the party organization, the lack of resist in society all kinds of bad habits and unwholesome tendencies of courage Gas and courage. Such as the liability insurance of safe production work, individual leaders that have someone arrested, and no funding, not in the global chess perspective to the countryside to carry out daily inspection, found none of my business acceptance of the resumption of production in an armchair, with a pen, indifferent. Corrective measures: (LED Leadership: Luo Mingjun, rectification time: before September 25th, insist for a long time) 1, to strengthen the sense of responsibility, work to solve the lack of decent occupation explain away, conduct problems. To establish the overall concept, eliminate departmentalism. Strict assessment and accountability, to solve the spiritual slack, nianqingpazhong, status quo, To establish and perfect the muddle along and other issues. Bureau staff conduct work regulations, standardize the behavior of personnel. 2, strengthen the responsibility system. One is the in-depth study and implement the "Hunan provincial Party and government leading cadres Interim Provisions on the work safety of a pair of > (Hunan Office issued 2013 No.