强直性脊柱炎男性患者的骨质疏松情况及影响因素

目的:了解强直性脊柱炎患者骨质疏松的发生情况,并探讨其相关影响因素。方法:以34例强直性脊柱炎男性患者为观察组,使用双能X线骨密度仪测量其腰椎、股骨颈、Ward's三角区、大转子骨密度(BMD)。并记录其病程、年龄,测量脊柱活动度,检测红细胞沉降率(ESR)、C反应蛋白(CRP)水平。30例年龄、性别、体重指数匹配的健康志愿者作为正常对照组。结果:与健康对照组比较,AS组在各腰椎、股骨颈、Ward's三角区、大转子各不同部位骨密度检测结果均明显下降,差异有统计学意义(P<0.05)。34例AS男性患者中,符合骨质疏松诊断标准者5例(14.71%)。年龄、病程、脊柱功能状态、炎症指标(ESR、CRP)等与AS患者的骨质疏松发生相关。结论:强直性脊柱炎患者早期即可出现骨质疏松,并普遍存在。可能和炎症、疾病的活动程度、关节制动等因素相关。     

强直性脊柱炎合并骨密度异常患者危险因素分析

目的 探讨首诊强直性脊柱炎(AS)合并骨密度(BMD)异常患者的临床特点及危险因素.方法 回顾性分析2014年1月至2020年6月首次于该院风湿免疫科确诊为AS患者83例,其中男69例,女14例;中位年龄29(26,37)岁.统计分析患者BMD值、年龄、病程、身高、体重、炎症标记物、骨代谢指标等.结果 83例患者中骨量减少63例(75.9％),骨质疏松(OP)24例(28.9％),脆性骨折2例(2.4％);BMD值与红细胞沉降率、碱性磷酸酶、β-胶原特殊序列呈负相关,与总25羟维生素D[25(OH)D]呈正相关;长病程组患者体重指数(BMI)、BMD值与短病程组比较,差异均有统计学意义(P<0.05).结论 AS患者早期即可出现OP,疾病高活动度、β-胶原特殊序列、低BMI及低总25(OH)D是发生OP的危险因素.     

短期小剂量激素治疗对男性强直性脊柱炎患者骨代谢及骨密度的影响

目的：探讨短期应用小剂量糖皮质激素（GCs）对男性强直性脊柱炎（AS）患者骨代谢及骨密度的影响。方法：46例男性AS患者分为常规治疗组（22例,予免疫抑制剂＋非甾体抗炎药）和GCs组（24例,在常规治疗基础上加用小剂量激素）,检测2组治疗6个月前后血清骨保护素（OPG）、巨噬细胞-集落刺激因子（M-CSF）、血沉（ESR）、血清C反应蛋白（CRP）及BASDAI评分、骨密度（BMD）变化。结果：与治疗前比较,2组治疗后OPG水平显著升高（P〈0.05）;ESR、CRP、BASDAI评分显著降低（P〈0.05）;M-CSF水平亦降低,其中GCs组变化差异有统计学意义（P〈0.05）。治疗后2组间比较,OPG和M-CSF水平及BMD差异无统计学意义（P〉0.05）;ESR、CRP、BASDAI评分差异有统计学意义（P〈0.05）。结论：短期联合应用小剂量激素影响AS患者骨代谢指标及炎性指标,对BMD影响不大,其在AS治疗中是安全有益的。     

强直性脊柱炎患者合并骨质疏松的临床特征研究

目的 探讨强直性脊柱炎(AS)患者合并骨质疏松(OP)的临床特征.方法 选择2010-2011年河北医科大学第三医院免疫风湿科门诊及病房收治的AS患者105例,根据是否合并OP分为AS组64例和AS-OP组41例.比较两组患者的一般资料、生化指标,并分析其相关性.结果 AS-OP组患者的年龄及发病年龄均较AS组低,累及外周关节数及骶髂关节CT分级均较AS组高,红细胞沉降率(ESR)、C-反应蛋白(CRP)、钙(Ca)水平均较AS组高,差异有统计学意义(P＜0.05).AS患者骨密度降低最大T值与ESR(r=0.208,P=0.033)、CRP(r=0.209,P=0.033)、累及关节数(r=0.341,P=0.000)、骶髂关节CT分级(r=0.205,P=0.041)呈正相关;与年龄、发病年龄、病程、Ca、磷(P)、碱性磷酸酶(ALP)生化指标无直线相关性(r=-0.003,0.175,-0.077,-0.166;P=0.973,0.073,0.433,0.090).结论 合并OP的AS患者发病更早、病情更重,且骨量下降会随着ESR、CRP、累及关节数、骶髂关节CT分级的升高而增多,随着年龄和发病年龄的升高而减少.     

强直性脊柱炎患者康复锻炼现状及影响因素分析

目的:调查强直性脊柱炎患者功能锻炼现状,分析其影响因素。方法:通过自行设计调查问卷对148例强直性脊柱炎患者的康复锻炼现状进行调查。结果:148例患者中仅38%的患者在疾病确诊后进行康复锻炼,不了解康复锻炼的重要作用、缺少专业护理人员进行健康指导、患者本身因素是强直性脊柱炎患者康复锻炼的主要影响因素。结论:仅少数强直性脊柱炎患者进行康复锻炼,其影响因素较多,护理人员应针对影响因素积极地对患者进行健康指导,从而促进强直性脊柱炎患者的功能恢复。     

强直性脊柱炎寒、热不同证型的骨密度与疾病活动度特点

目的:探讨强直性脊柱炎(AS)寒、热不同辨证分型的骨密度、疾病活动度特点。方法:依据纳入标准选择45例肾虚督寒证、45例肾虚湿热证的AS患者为研究对象,检测ESR、CRP、BASDAI、BASFI、枕墙距、颌柄距、指地距、胸廓活动度、Schober征。应用双能X法检测腰椎、股骨骨密度(BMD),超声法检测双侧足跟BMD,分析寒热证型之间以上指标的差异,及寒热证型患者骨密度与其他指标的相关性。结果:寒热两组的ESR、CRP、BASDAI、腰椎BMD、股骨颈BMD、左跟骨BMD存在显著差异(P<0.05);肾虚督寒证组左跟骨BMD与年龄、指地距呈负相关(P<0.01);肾虚湿热证组股骨颈BMD与ESR、CRP、指地距呈负相关(P<0.05),左跟骨T值与枕墙距、指地距、颌柄距呈负相关(P<0.01)。结论:肾虚督寒证AS患者的骨密度、疾病活动度较肾虚湿热证患者减低,提示肾虚督寒证患者治疗上要注重扶正药物的应用,肾虚湿热证患者治疗上要注重祛邪。     

骨密度和骨代谢指标在强直性脊柱炎合并骨质疏松患者中的水平变化

目的 分析强直性脊柱炎(AS)并发骨质疏松(OP)患者的骨密度及骨代谢指标水平的变化及其临床意义.方法 选取2017年1月至2018年12月该院收治的65例AS合并OP患者为AS+OP组,70例单纯AS患者为AS组,并于同期选取40例健康志愿者为对照组.检测受试者骨密度(腰椎、股骨颈、股骨粗隆、Ward's三角区),以及血清Ⅰ型胶原羧基端前肽(CICP)、Ⅰ型胶原羧基端交联肽(CTX-Ⅰ)、骨碱性磷酸酶(BALP)、甲状旁腺激素(PTH)、骨钙素(BGP)、尿脱氧胶原吡啶交联(D-Pyr)水平,并进行比较及相关性分析.结果 AS+OP组AS病程比AS组长,累及外周关节数、骶髂关节CT分级高于AS组,差异均有统计学意义(P<0.05).与对照组比较,AS+OP组、AS组各检测部位骨密度及血清PTH、BGP水平均明显降低(P<0.05),且AS+OP组均明显低于AS组(P<0.05);血清CICP、CTX-Ⅰ、D-Pyr水平明显升高(P<0.05),且AS+OP组明显高于AS组(P<0.05).Pearson相关分析结果显示,腰椎、股骨颈、股骨粗隆、Ward's三角区骨密度与CICP、CTX-Ⅰ、D-Pyr水平呈负相关(P<0.05),与PTH、BGP水平呈正相关(P<0.05),与BALP无明显相关性(P>0.05).结论 AS合并OP患者存在不同程度的骨密度降低及骨代谢异常,联合检测可辅助临床早期评估患者病情.     

骨密度和骨代谢指标在强直性脊柱炎合并骨质疏松患者中的水平变化

目的 分析强直性脊柱炎(AS)并发骨质疏松(OP)患者的骨密度及骨代谢指标水平的变化及其临床意义.方法 选取2017年1月至2018年12月该院收治的65例AS合并OP患者为AS+OP组,70例单纯AS患者为AS组,并于同期选取40例健康志愿者为对照组.检测受试者骨密度(腰椎、股骨颈、股骨粗隆、Ward's三角区),以及血清Ⅰ型胶原羧基端前肽(CICP)、Ⅰ型胶原羧基端交联肽(CTX-Ⅰ)、骨碱性磷酸酶(BALP)、甲状旁腺激素(PTH)、骨钙素(BGP)、尿脱氧胶原吡啶交联(D-Pyr)水平,并进行比较及相关性分析.结果 AS+OP组AS病程比AS组长,累及外周关节数、骶髂关节CT分级高于AS组,差异均有统计学意义(P<0.05).与对照组比较,AS+OP组、AS组各检测部位骨密度及血清PTH、BGP水平均明显降低(P<0.05),且AS+OP组均明显低于AS组(P<0.05);血清CICP、CTX-Ⅰ、D-Pyr水平明显升高(P<0.05),且AS+OP组明显高于AS组(P<0.05).Pearson相关分析结果显示,腰椎、股骨颈、股骨粗隆、Ward's三角区骨密度与CICP、CTX-Ⅰ、D-Pyr水平呈负相关(P<0.05),与PTH、BGP水平呈正相关(P<0.05),与BALP无明显相关性(P>0.05).结论 AS合并OP患者存在不同程度的骨密度降低及骨代谢异常,联合检测可辅助临床早期评估患者病情.     

强直性脊柱炎误诊原因分析

<正> 强直性脊柱炎(AS)是一种较多见的风湿性疾病,好发于青年男性,早期疗效好,晚期可致残。因对AS认识不足及其早期症状常不典型易误诊。我们近一年确诊AS 46例,其中27例曾误诊,为提高对本病的早期认识,结合误诊病例进行误诊原因分析。     

强直性脊柱炎

强直性脊柱炎(ankylosing spondylitis,简称AS),是一种原因不明的全身性慢性疾病。病变主要累及骶髂关节、脊柱,引起强直和纤维化,并可有不同程度的眼、肺、心血管、肾等多器官的病变。现已确认AS与类风湿性关节炎性质不同,它不是类风湿性关节炎的一个亚型,而是一个独立的疾病。它是血清阴性关节炎中的一种。AS病人一般类风湿因子呈阴性。一、病因和发病机制本病在不同种族,不同地区的发病率由于调查的时期及所用标准不同有很大差异。最近确定我国AS的发病率为0.3％。过去认为患AS的男性多于女性,现在认为在分布上很可能相近,只不过女性患病常较缓慢和呈良性经过。     

Factors relating to bone mineral density in young and middle-aged patients with ankylosing spondylitis

Background:Ankylosing spondylitis (AS) is a common chronic progressive rheumatic disease. The aim of this study was to explore factors influencing abnormal bone mineral density (BMD) in young and middle-aged patients with AS.Methods:From July 2014 to August 2018, hospitalized patients with AS and health examinees in the health examination center of our clinics, ranging in age from 20 to 50 years, were monitored. The BMD of the lumbar spine and femoral neck of AS patients and those of a healthy control group were measured using dual-energy X-ray absorption. The BMDs of AS patients were compared with respect to age, course of disease, iritis, smoking habits, sex, height, weight, body mass index (BMI), medication use, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet volume, platelet count, uric acid (UA), alkaline phosphatase (AKP), and calcium ion levels. Single-nucleotide polymorphisms (SNPs) related to BMD were screened using genome-wide association analysis.Results:There was no statistical difference in the proportion of abnormal bone masses between the different body parts. The BMD of all bones in AS patients was lower than that in healthy controls (P < 0.05). Additionally, BMD was correlated with serum calcium and CRP in AS patients (P < 0.05), but not with age, platelet volume, platelet count, ESR, UA, AKP, height, weight, and BMI. The incidence of abnormal bone mass in AS patients was correlated with sex (P < 0.05), but not with medication use, iritis, or smoking. BMD of the lumbar spine in AS patients did not correlate linearly with the course of the disease, but BMD of the femoral neck correlated linearly with the course of the disease (P < 0.05). BMD was correlated with multiple SNPs in patients with AS. Lumbar BMD was correlated with rs7025373 and rs7848078. Femoral head BMD was correlated with 3:102157365, 3:102157417, rs1252202, rs1681355, rs3891857, rs7842614, and rs9870734, suggesting that genetic factors play a role in BMD in patients with AS.Conclusions:The proportion of abnormal bone mass in AS patients was higher than that in healthy individuals of the same age. The factors related to BMD in patients with AS are gender, CRP, and blood calcium. The BMD of the femoral neck of AS patients decreases with the course of the disease, but BMD of the lumbar spine is not related to the course of the disease. BMD in AS patients is associated with multiple SNPs.     

Height and weight are correlated with lumbar spinal bone mineral contents and densities in Chinese adolescents with early ankylosing spondylitis

Adolescenceisapivotaltimeforskeletalgrowth ,mineralizationandpeakbonemassachievement[1,2 ] .Whereas,ankylosingspondylitis (AS)withthegreatprev alenceduringthisperiodhasdetrimentalinfluencesonbonesandjointsevenintheearlystages[3 ] .However,bonelossandalterationinChineseadolescentswithearlyASisstillpoorlyunderstood .Therefore ,inpresentwork ,thefactorseffectinglumbar2 -4bonemineralcontent (L2 -4BMC) ,lumbar2 -4arealbonemineraldensity (L2 -4BMD)andlumbar2 -4volumetricbonemineralapparentdensi…     

强直性脊柱炎患者细胞毒性T淋巴细胞变化

目的 探讨细胞毒性T淋巴细胞(T-lymphocytes,Tc)在强直性脊柱炎(ankylosing spondylitis,AS)患者中的表达变化.方法 筛选42例AS患者作为研究对象(病例组),20例同时期健康查体者作为对照(对照组).检测2组血小板计数、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-neactveprotein,CRP)水平并记录强直性脊柱炎病情活动指数调查表(bath ankylosing spondylitis disease activity index,BASDAI)评分.应用流式细胞仪检测外周血中淋巴细胞表型(CD3+CD8+)、胞浆内细胞因子γ干扰素、白细胞介素4的表达.采用t检验分析两组间外周血中Tc、Tc1、Tc2、Tc1/Tc2比值的差异;相关分析采用Pearson检验.结果 病例组与对照组外周血中Tc分别为(21.22±4.27)％ vs (14.23±4.15)％ (t=6.177,P＜0.01),Tc1分别为(0.35±0.08)％vs(1.45±0.27)％(t=24.640,P＜0.01),Tc2分别为(0.53±0.12)％vs(0.41±0.12)％(t=3.608,P＜0.01),Tc1/Tc2比值分别为0.72±0.29vs3.93±1.63(t=6.431,P＜0.01).相关分析显示AS患者外周血中Tc、Tc1、Tc2、Tc1/Tc2比值与血小板计数、ESR、CRP、BASDAI均无相关性.结论 AS患者外周血中Tc1细胞减少,Tc2细胞增多,的确存在Tc1/Tc2细胞的失衡,而且是Tc2细胞占优势.     

比较BASDAI和mini-BASDAI对强直性脊柱炎病情的判断价值

目的 评价Bath 强直性脊柱炎病情活动指标(bath ankylosing spondylitis disease activity index,BASDAI) 和改良的BASDAI 即mini-BASDAI 在评价无外周关节受累的强直性脊柱炎(ankylosing spondylitis,AS) 的病情活动度时的价值.方法 根据是否有外周关节受累,将患者分为P+ 组(有外周关节受累) 和P- 组(无外周关节受累).采用BASDAI 对患者的疾病活动度进行评价,然后再省略BASDAI 中的第3、4 个问题计算出mini-BASDAI.结果 本研究共纳入264 例AS 患者.有P+ 组的患者其各项炎症指标(BASDAI、miniBASDAI、Bath 强直性脊柱炎功能指数(bath ankylosing spondylitis functionalindex,BASFI)、Bath 强直性脊柱炎计量指数(bath ankylosing spondylitis metrology index,BASMI)、血沉、C- 反应蛋白) 均显著高于P- 组患者.两组mini-BASDAI 值均高于BASDAI,但两者与其他疾病活动度评价指标之间的相关性并无差异,如医生总体评价与BSADAI 的相关系数为0.703,与mini-BASDAI 的相关系数为0.696,其余指标间的相关性也基本相同.结论 在评价无外周关节受累的AS 患者病情活动度时,mini-BASDAI 并不优于BASDAI ;BASDAI 仍然是最有效的评价工具.     

强直性脊柱炎与HLA-B2704,05亚型分布关系

目的：用流式芯片以及PER技术检测HLA-B2704,05亚型,提供临床诊断强直性脊柱炎的新方法．方法：对124例强直性脊柱炎患者及50例正常人采用流式细胞方法检测HLA-B27,采用流式芯片方法检测HLA-B27亚型．结果：124例强直性脊柱炎患者HLA-B27阳性数116例,阳性率94％,其中HLA-B2704亚型68例,占总阳性数的58．6％,HLA-B2705亚型48例,占总阳性数的41．4％．50例正常人的亚型检测结果均为HLA-B2704阳性．结论：强直性脊柱炎患者的发病机制与各亚型的特异序列无关,仅与HLA．B27各亚型共有序例有关,流式芯片技术可以快速准确地对HLA-B27相关亚型作出分析,为深入探讨强直性脊柱炎发病机制奠定工作基础,并提供强直性脊柱炎临床诊断的新方法．     

Value of the peripheral blood B-cells subsets in patients with ankylosing spondylitis

Background The role of B-cell remains an enigma in the pathogenesis of ankylosing spondylitis （AS）. This study aimed to investigate the distributions of B-cells and subsets in peripheral blood of AS patients and observe their changes in etanercept-treated AS patents. Methods We detected the proportions of CD19^＋ B-cell, naive B-cell （CD19^＋CD27）, memory B-cell （CD19^＋CD27dim） and plasmablast （CD19^＋CD27high） in peripheral blood of 66 patients with AS （39 at active stage, 27 at stable stage; 35 patients with peripheral joint involvement, 31 patients with axial involvement alone）, 30 patients with rheumatoid arthritis （RA） and 30 healthy volunteers using flow cytometry. And then we observed the changes of the above indexes of 39 active AS patients treated with etanercept in a randomized, double-blind, placebo-controlled trial. Results （1） Percentages of CD19^＋ B-cells in active or peripheral joint involvement AS patients increased more obviously than those in stable or axial involvement alone AS patients （both P=0.001）, and percentage of CD19^＋CD27high B-cells in AS patients with peripheral joint involvement was significantly higher than that in cases with axial involvement alone or healthy volunteers （P=0.005 and 0.006, respectively）; （2） The percentage of CD19~ B-cells in AS patients was positively correlated with Bath Ankylosing Spondylitis Disease Activity Index （BASDAI） scores, Patient＇s Global Assessment （PGA） scores, total back pain scores and nocturnal back pain scores （r=0.270, 0.255, 0.251 and 0.266, P=-0.029, 0.039, 0.042 and 0.031, respectively）; （3） At week 6 and week 12, there were no statistical differences of the percentages of B-cells and subsets between etanercept group and placebo group of AS patients （P 〉0.05）; the percentage of CD19^＋ B-cells in etanercept group was higher than that in healthy volunteers at week 12 （t=3.320, P=0.003）. Conclusions Misbalance is present in B-cells and some subsets in peripheral blood of active AS patients with peripheral joint involved. B-cells might play an important role in the pathogenesis of AS patients. The high percentage of CD19^＋ B-cells in active AS patients cannot be down-regulated after 12-week etanercept treatment.     

雷公藤多苷对强直性脊柱炎患者成纤维细胞中BMP-2表达的影响

目的：探讨雷公藤多苷（LGTDG）对骨形态发生蛋白(BMP)信号转导通路及BMP-2表达的影响,阐明LGTDG抗强直性脊柱炎（AS）骨化的作用机制。方法：体外培养的AS成纤维细胞分为对照组与0.5、 1.0、 1.5和2.0 mg/L 给药组,检测各组细胞内碱性磷酸酶(ALP)活性及最佳药物浓度;CCK-8法检测1.0 mg/L给药组的细胞增殖率;生化检测法定量检测对照组与1.0 mg/L 给药组BMP-2表达水平;Western blotting法检测对照组与1.0 mg/L给药组BMP-2和Cbfal蛋白表达。结果：各给药组细胞中ALP活性均低于对照组,其中以1.0 mg?L-1 给药组细胞的ALP活性为最低(P<0.01)。CCK-8法检测,1.0 mg/L 给药组AS成纤维细胞增殖率明显低于对照组(P<0.01),LDTDG诱导第4天细胞增殖率最高,进入平台期后细胞的增殖率开始下降。生化检测法和Western blotting法检测,1.0 mg/L给药组BMP-2的蛋白表达明显低于对照组(P<0.01)。结论：LGTDG通过对BMP信号转导通路的影响有效地抑制AS成纤维细胞内BMP-2表达,延缓细胞向成骨型分化导致AS骨化发生。     

云克联合治疗强直性脊柱炎疗效评价

目的评价云克联合治疗强直性脊柱炎的疗效。方法选取活动期强直性脊柱炎初诊患者56例,随机分为两组:治疗组(云克 甲氨喋呤和/或柳氮磺吡啶)28例、对照组(非甾类抗炎药 甲氨喋呤和/或柳氮磺吡啶)28例,对比观察两组治疗前后临床症状、实验室指标变化及不良反应。结果治疗后两组各项指标均较治疗前明显改善(P<0.001),治疗组总有效率为95%,对照组总有效率93%,两组比较,无统计学意义(P>0.05),治疗组在疼痛程度、疾病活动度评价及Dougados指数等指标的改善值高于对照组(P<0.05),且不良反应的发生率少于对照组,两者差异有统计学意义(P<0.05)。结论云克联合治疗强直性脊柱炎疗效可靠,副作用少。     

Management of pregnancy with ankylosing spondylitis

To discuss the interaction between pregnancy and ankylosing spondylitis,and the management of pregnancy with ankylosing spondylitis.Methods Twelve cases of pregnancy with ankylosing spondylitis in Pek...