强直性脊柱炎患者骨质疏松的研究进展

强直性脊柱炎(ankylosing spondylitis,AS)是一种慢性进展性炎症性骨关节病,主要累及脊柱、骶髂关节及髋关节,早期表现为滑膜炎及韧带附着点的病变,随后可引起椎体周围软组织骨化及椎体间骨桥形成,导致脊柱强直,晚期出现僵硬的胸腰椎后凸畸形。骨质疏松(osteoporosis,OP)作为AS的一个常见并发症[1],可导致脊柱骨折、后凸畸形及神经功能损害等并发症[2],严重影响患者生活质量。尽管很多慢性炎性骨关     

强直性脊柱炎患者治疗依从性的研究进展

强直性脊柱炎(ankylosing spondylitis,AS)是一种慢性进行性疾病,主要侵犯骶髂关节、脊柱骨突、脊柱旁软组织及外周关节,并可伴发关节外表现.最终可发生脊柱强直、关节畸形,导致残疾[1].目前强直性脊柱炎尚无根治方法,如能积极配合治疗,就可以控制症状,降低致残率,提高生活质量.因此,加强患者对疾病的认知,提高治疗依从性,已成为治疗该病的重要环节.     

强直性脊柱炎的研究进展

从现代医学关于强直性脊柱炎的病因病机、诊断及治疗等方面进行综述,以期为强直性脊柱炎的临床诊断与治疗提供参考依据。     

强直性脊柱炎的骨化研究进展

病理性骨化是强直性脊柱炎最主要的特点之一。目前有很多关于强直性脊柱炎骨化的研究,包括炎症与骨化的关系、骨化信号通路及Wnt信号通路等。从不同的方面来研究强直性脊柱炎的骨化过程,彻底弄清其骨化的机制,对治疗强直性脊柱炎有着重要的意义。     

强直性脊柱炎致病机制研究进展

强直性脊柱炎(AS)是一种慢性进行性脊柱关节病.骶髂关节炎症和关节骨化强直是AS典型病理变化的两个阶段,两者之间有一定相关性,但炎症的发生不是异位骨化的充分必要条件.AS异位骨化涉及BMP、Wnt、Notch和Hedgehog等多条信号通路,各信号通路之间相互联系、相互制约,形成一错综复杂的调节网络.该文就AS病理特征...     

强直性脊柱炎的关节外科研究进展

强直性脊柱炎（ankylosingspondylitis,AS）是一种慢性系统性自身免疫性疾病,患病率在各国报道不一。白种人群的调查为0．1％～0．2％,我国患病率初步调查为0．26％。本病以男性多见,男女之比为（2～3）：1,女性发病较缓慢且病情较轻。发病年龄通常在13～31岁,高峰为20～30岁,40岁以后及8岁以前发病者少见。作为最为常见且表现最为典型的血清阴性脊柱关节病（spondyloarthritis,SpA）,AS主要累及臀带、肩带以及中轴关节,并伴外周关节受累表现。AS致残性很强,约1／3患者丧失劳动能力。     

强直性脊柱炎患者生活质量的影响因素分析

目的 探讨影响强直性脊柱炎（AS）患者生活质量的相关因素。方法 选取2017—2019年在本院治疗的AS患者为研究对象。采集患者空腹静脉血,检测人类白细胞抗原B27（HLA-B27）、C反应蛋白（CRP）、红细胞沉降率（ESR）。采用AS疾病活动评分-CRP指标（ASDAS-CRP）评估患者疾病活动情况,改良Stoke AS脊柱评分系统（mSASSS）评估脊柱病变情况,AS生活质量问卷（ASQoL）评估患者生活质量。结果 共纳入患者206例,中位年龄37.4岁,男性患者占75.2%（155/206）,HLA-B27阳性患者占59.2%（122/206）。Kendall''相关分析结果显示,与ASQoL评分相关的因素有年龄、体质量指数（BMI）、学历、工作状况、病程、婚姻状况和HLA-B27,其中年龄与ASQoL的相关系数最大（r=0.815）,其次为病程（r=0.786）。多重线性回归分析显示,影响ASQoL评分的因素为年龄、HLA-B27、工作状况、学历和婚姻状况,其中影响最大的因素为年龄（β=0.654）,其次为HLA-B27（β=0.335）。结论 年龄、HLA-B27、工作状况、学历和婚姻状况是AS患者ASQoL评分的影响因素。在AS的长期治疗中需要积极干预,以提高患者生活质量。     

强直性脊柱炎异位骨化机制研究进展

强直性脊柱炎是一种发病机制不明的慢性炎性脊柱关节病,主要侵犯骶髂关节、脊柱关节等,严重者可发生脊柱、关节的畸形和强直。临床表现为炎性腰背痛,夜间及休息后加重,活动后减轻。该病发病率男性高于女性,且男性主要表现为中轴关节改变,而女性大多首发于外周关节。目前生物制剂肿瘤坏死因子抑制剂通过控制炎症,从而改善病情发展,被认为是最前沿的药物,但其在阻断新骨形成方面尚未经循证医学证实有效。本文着眼于新骨形成角度,从基因及细胞因子层面探讨强直性脊柱炎的病因。目前相关研究发现LRP5、ANTXR2、PTGER4、ANKH等基因的异常表达激活骨形成信号通路,在多种细胞因子及相关蛋白(如Noggin蛋白、DKK、转化生长因子-β、骨形态发生蛋白、碳酸酐酶1等)直接或间接作用下将骨形成信号传至靶细胞表面,进而传入细胞核,改变靶细胞正常生理代谢过程,导致过度骨形成,造成异位骨化。近年的临床影像学病例分析也提示了骨赘形成的分布特点,进而推断机械应力是促进其形成的外部因素。本文对强直性脊柱炎异位骨化方面进行了文献综述,以期待能进一步加深对本病的认识,为临床治疗研究提供新的思路。     

强直性脊柱炎骨代谢的研究进展

强直性脊柱炎（ankylosing spondylitis,AS）是一种自身免疫功能异常引起的以慢性炎症性关节炎为主要表现的疾病,可发展为脊柱关节炎,慢性炎症和病理性骨形成是它的两个主要病理特点。进行性的脊柱关节僵硬引起的脊柱活动障碍是患者最常见的主诉,因此对脊柱关节的异常骨增生的病理机制得到广泛的关注。但随着对AS研究的深入,发现在脊柱局部过度骨化的同时伴有系统性的骨丢失,表明AS发病过程不仅仅是单一的成骨或破骨异常,而是处于兼有两者的骨代谢失衡环境中。目前研究发现AS疾病中Wnt、BMP信号通路和炎症反应在AS疾病中既促进成骨,又能影响破骨细胞形成;而破骨细胞在发挥骨吸收作用的同时,它的产物又参与了新生骨形成。但大多数研究均是着重于描述单独的成骨或破骨机制,未能明确地阐明它们是如何在引起脊柱周围骨质增生的同时导致全身骨量丢失的具体作用机制。AS病理过程中炎症因子是否在不同的部位发挥不同的作用,如何在控制新生骨形成的同时减少骨质疏松发生的风险,这些问题仍需要得到进一步的探索研究。     

强直性脊柱炎骨化临床研究进展

强直性脊柱炎（ankylosing spondylitis, AS)是脊柱关节病中最常见的疾病,早期以炎症为主,晚期可出现骨质疏松和骨化两种看似矛盾的表现,骨化的研究有助于AS的治疗。骨化是导致患者出现相关症状、功能障碍、甚至残疾的主要原因。骨化主要发生于脊柱,因为病变组织不易获取,且病程漫长,个体间差异大,目前研究进展缓慢。AS患者骨化平均每年改良的 Stoke强直性脊柱炎脊柱评分（modified Stoke’s AS spine score,mSASSS)进展1分,仅不到30%的患者出现较快进展。基线时炎症与骨化进展有关,主要是红细胞沉降率（erythrocyte sedimentation rate,ESR)、C-反应蛋白（C-reactive protein,CRP)、强直性脊柱炎疾病活动指数（ankylosing spondylitis disease activity score, ASDAS)等客观炎症指标,而与基于患者自我报告结果 (patient-reported outcome,PRO)的 Bath 强直性脊柱炎疾病活动指数（bath ankylosing spondylitis disease activity index, BASDAI) 关系不明确。此外,基线时已存在的骨化程度、磁共振成像（magnetic resonance imaging,MRI)骨髓脂肪沉积、吸烟等也是骨化预测因素。非甾体抗炎药和肿瘤坏死因子拮抗剂对延缓AS病理性成骨的作用尚不明确。     

强直性脊柱炎胸腰椎后凸畸形患者生存质量与矢状面参数的相关性

 目的 探讨强直性脊柱炎（ankylosing spondylitis,AS）胸腰椎后凸畸形患者生存质量与矢状面参数的相关性。方法 2011年6月至2013年8月,门诊AS患者30例、行经椎弓根椎体截骨矫形术的住院AS患者34例纳入研究。以SF-36量表评估患者生存质量;在站立位全脊柱X线侧位片上测量脊柱-骨盆矢状面参数;评估AS疾病活动性指数、AS功能指数和Oswestry下腰痛评分。依据胸腰椎最大后凸角将患者分为轻度后凸组（＜60°,29例）和重度后凸组（≥60°,35例）,比较两组患者的生存质量及矢状面参数,分析生存质量与矢状面参数的相关性。结果 重度后凸组患者在生理职能、一般健康状况、社会功能和情感职能四个维度的得分低于轻度后凸组。两组患者C7倾斜角、胸腰椎最大后凸角、矢状面躯干偏移、骨盆倾斜角、腰椎前凸角和骶骨倾斜角的差异有统计学意义。C7倾斜角和腰椎前凸角减小致生理职能评分减少;胸腰椎最大后凸角增加致情感职能评分降低;矢状面躯干偏移增大致社会功能评分减低。手术治疗患者随访6~36个月,平均16个月。末次随访时除胸椎后凸角和骨盆入射角外其他矢状面参数均较术前改善,一般健康状况、社会功能和情感职能评分均提高。结论 重度胸腰椎后凸畸形AS患者的生理职能、一般健康状况、社会功能和情感职能较轻度后凸患者降低。C7倾斜角、胸腰椎最大后凸角、腰椎前凸角和矢状面躯干偏移改变是AS患者生存质量降低的重要因素。经椎弓根椎体截骨术矫正胸腰椎后凸畸形矢状面参数的同时可提高患者生存质量。     

强直性脊柱炎患者腰椎骨化程度和后凸程度与生活质量的相关性分析

目的 :探讨强直性脊柱炎(ankylosing spondylitis,AS)患者腰椎骨化程度和后凸程度与生活质量的相关性。方法:从2011年4月~2014年10月在我院就诊的AS患者中筛选出具有完整临床资料的患者106例,其中男98例,女8例;年龄36.4±9.5岁(20~64岁);病程12.4±7.5年(1~37年)。临床资料包括患者的年龄、发病年龄、病程、全脊柱最大后凸角(global kyphosis,GK)、Oswestry功能障碍指数(Oswestry disability index,ODI)、Bath AS疾病活动性指数(Bath ankylosing spondylitis disease activity index,BASDAI)、Bath AS功能指数(Bath ankylosing spondylitis functional index,BASFI)、血沉(ESR)和C反应蛋白(CRP)。应用Stoke脊柱病变评分(Stoke ankylosing spondylitis spinal score,SASSS)评估AS患者腰椎韧带骨化情况。根据SASSS分组:A组,SASSS≤36分;B组,SASSS36分。运用独立样本t检验比较两组间各参数的差异;采用Pearson相关性检验分析各临床参数间的相关性,寻找导致SASSS增加的危险因素。结果:A组61例患者,男58例,女3例,SASSS得分18.6±9.4分;B组45例患者,男40例,女5例,SASSS得分59.1±21.4分。两组患者年龄、病程、GK和BASFI有显著性差异(P0.05);而发病年龄、ODI、BASDAI、ESR、CRP无显著性差异(P0.05)。AS患者的SASSS与年龄、病程、GK、ODI及BASFI显著相关(r=0.505、0.650、0.414、0.219、0.319,P0.05);病程、SASSS和GK均与ODI和BASFI显著相关(r=0.228、0.219、0.230,P0.05;r=0.258、0.319、0.314,P0.05)。结论:年龄增加、病程延长和GK增大可能是AS患者腰椎韧带骨化程度增加的危险因素;AS患者腰椎骨化程度增加和后凸畸形加重会显著降低患者生活质量。     

Premature ejaculation in patients with ankylosing spondylitis

We aimed to evaluate the premature ejaculation (PE) among ankylosing spondylitis (AS) patients. Fifty male patients with AS who were diagnosed according to the modified New York criteria and fifty normal healthy controls (NHC) were included in this study. The details of patient age, disease duration, morning stiffness, laboratory activity, disease severity and medication use were obtained by reviewing the medical record. The Bath AS Functional Index (BASFI) was used to measure the functional status of the patients with AS. By taking a careful medical and sexual history, patients were classified as lifelong, natural variable, acquired PE or premature ejaculatory dysfunction. In addition to medical and sexual history, self-estimated intravaginal ejaculatory latency times (IELT) of patients were used in the classification of patients. To our knowledge, this is the first study of frequency of PE in men with AS. The prevalence rates of PE in patient and healthy controls were 32 and 30%, respectively (p = 0.331). The prevalence of PE was not significantly different between AS patients and NHC groups as regards the four PE syndromes. Average estimated IELT was 10,009 ± 51.9 sec in the PE group and 145.26 ± 43.01 sec in the non-PE group (p = 0.000). Patients with lifelong PE had a significantly lower mean estimated IELT than the other group (p = 0.000). Patients with premature-like ejaculatory dysfunction had the highest estimated IELT (p = 0.000). There was a significant association between self-estimated IELT and distribution of the patients according to the four PE syndromes (p = 0.01). Both AS patients and NHC groups have the same results. The present study demonstrates that PE in men with AS is as prevalent as it is in the general population. Although this study is restricted in terms of the number of patients, it is the first study ever conducted. For more meaningful results, multi centred studies with more patients are required.     

早期强直性脊柱炎病人的骨质疏松

目的：研究强直性脊柱炎（AS）病人的骨质疏松症（OP）,探讨AS病人的OP与病人的血沉以及强的松治疗之间的关系。方法：28例早期AS病人按照血沉高低分组,用双能X线吸收法（DEXA）测定了腰椎正位和股骨颈的骨密度。结果：AS病人常伴有OP,腰椎正位骨密度比股骨颈骨密度下降更为明显。使用强的松15mg/d会促进骨密度下降,钙剂治疗有助于改善病人的临床指标。结论：AS病人应同时注意对OP的防治。     

Spinal fractures in patients with ankylosing spondylitis

Thirty-one consecutive patients with ankylosing spondylitis and spinal fractures were reviewed. There were 6 women and 25 men with a mean age of 60±11 years; 19 had cervical and 12 had thoracolumbar injuries. Of the patients with cervical fracture, two had an additional cervical fracture and one had an additional thoracic fracture. Three trauma mechanisms were identified: high-energy trauma in 13 patients, low-energy trauma in 13 and insufficiency fracture in 5. One-third of the patients suffered immediate neurological impairment, a further one-third developed neurological impairment before coming for treatment and only one-third remained intact. Two patients with thoracolumbar fractures had deteriorated neurologically due to displacements during surgery at other hospitals. All patients were treated operatively except the two patients with two-level cervical fractures, who were managed in halo vests. In the cervical spine both anterior and posterior approaches were employed. In the thoracolumbar spine the majority of the patients were initially treated using a posterior approach only. Complications were common. Of the 27 patients with neurological compromise, 10 had remained unchanged; 12 had improved one Frankel grade; 4 had improved by two Frankel grades; 1 had improved by four Frankel grades. We conclude that even minor trauma can cause fracture in an ankylosed spine. A high proportion of patients with spinal fractures and ankylosing spondylitis have neurological damage. The risk of late neurological deterioration is substantial. As the condition is very rare and the treatment is demanding and associated with a very high risk of complications, the treatment of these patients should be centralised in special spinal trauma units. A combined approach that stabilises the spine from both sides is probably beneficial.     

The Glidescope for tracheal intubation in patients with ankylosing spondylitis

Editor—After reading the article on use of Glidescope^®for tracheal intubation in patients with ankylosing spondylitis(AS),¹ we had an opportunity of using this in a patient withAS with predicted difficult intubation on preoperative evaluation. A 43-yr-old male patient (weight 40 kg and