骨水泥强化治疗伴强直性脊柱炎的骨质疏松性椎体骨折

目的 探讨骨水泥强化治疗伴强直性脊柱炎的骨质疏松性椎体骨折的临床疗效。方法 回顾性分析2010年1月～2018年1月因骨质疏松性椎体骨折合并强直性脊柱炎接受椎体后凸成形33例手术患者的资料,其中男15例,女18例。年龄67～85岁,平均(73.3±4.6)岁。记录术前、术后1周和末次随访时疼痛模拟VAS(visual analog scale)评分和伤残ODI(Oswestry disability index)指数,分析比较各时间节点参数变化。结果 随访13～16个月,平均(13.9±1.1)个月。术后骨水泥渗漏13例,均未发生脊髓神经根压迫症状。所纳入患者术后腰背部疼痛明显减轻或消失,术后2 d下床活动无受限。VAS评分由术前(7.1±0.9)分降至术后1周(3.3±0.7)分(P=0.000);末次随访时(2.0±0.7)分(与术前比较P=0.000;与术后1周比较P=0.000)。ODI指数由术后1周(27.8±3.8)%降至末次随访(14.3±1.6)%(P=0.000)。结论 骨水泥强化治疗伴强直性脊柱炎的骨质疏松性椎体骨折可有效缓解腰背部疼痛,改善患者的生存质量。     

白塞氏（Behcet‘s）病1例伴发强直性脊椎炎及其家系调查

先证者,男,３９岁,反复发作的口腔,生殖器溃疡１０年,腰,背,髋关节明显酸疼,弯腰,转体,行走困难６年,胸背部毛囊产皮损３年,间断发热半年。腰椎ＣＴ片示骨质增生和椎间隙变窄。ＨＬＡ－Ｂ２７（＋）,针刺反应（＋）。其中一,二级亲属中另有不同程度的强直性脊柱炎患者５位,均不伴有白塞氏病。本家系调查提示,不仅强直性脊椎炎具有明显遗传倾向,而且决定强直性脊椎炎和白塞氏病的基因位点,具有一定相互关联。     

Etanercept: in ankylosing spondylitis

Etanercept is a dimeric fusion protein based on the p75 tumor necrosis factor (TNF) receptor. It binds to TNFalpha and blocks its biological activity. Subcutaneous etanercept is effective in the treatment of rheumatoid arthritis, psoriatic arthritis, and polyarticular-course juvenile rheumatoid arthritis. More recently, etanercept has shown efficacy in the treatment of adults with ankylosing spondylitis. In randomized, double-blind, placebo-controlled trials, subcutaneous etanercept 25mg twice weekly for 6-24 weeks significantly reduced disease activity in patients with active ankylosing spondylitis. In the largest trial, etanercept produced a response rate of 57% compared with 22% for placebo after 24 weeks (response was determined via the validated ASAS 20 response criteria developed by the Assessments in Ankylosing Spondylitis [ASAS] Working Group). Etanercept therapy significantly improved health-related quality of life in patients with ankylosing spondylitis compared with placebo. The greatest improvements in a 16-week study were seen in the domains of physical functioning, physical role, bodily pain, vitality, and social functioning. Etanercept was generally well tolerated, with few serious adverse events or treatment withdrawals. The most common adverse events were injection-site reactions and minor upper respiratory tract infections.     

Etanercept

? Etanercept is a dimeric fusion protein based on the p75 tumor necrosis factor (TNF) receptor. It binds to TNFα and blocks its biological activity. ? Subcutaneous etanercept is effective in the treatment of rheumatoid arthritis, psoriatic arthritis, and polyarticular-course juvenile rheumatoid arthritis. More recently, etanercept has shown efficacy in the treatment of adults with ankylosing spondylitis. ? In randomized, double-blind, placebo-controlled trials, subcutaneous etanercept 25mg twice weekly for 6–24 weeks significantly reduced disease activity in patients with active ankylosing spondylitis. In the largest trial, etanercept produced a response rate of 57% compared with 22% for placebo after 24 weeks (response was determined via the validated ASAS 20 response criteria developed by the Assessments in Ankylosing Spondylitis [ASAS] Working Group). ? Etanercept therapy significantly improved health-related quality of life in patients with ankylosing spondylitis compared with placebo. The greatest improvements in a 16-week study were seen in the domains of physical functioning, physical role, bodily pain, vitality, and social functioning. ? Etanercept was generally well tolerated, with few serious adverse events or treatment withdrawals. The most common adverse events were injection-site reactions and minor upper respiratory tract infections.     

A study of subcutaneous rhizolysis in the treatment of chronic backache

Subcutaneous rhizolysis is defined as cutting the nerves to the posterior intervertebral joints. Although a blind procedure, it has proved safe in several centres and provides relief of pain in about two thirds of those who suffer from intractable, persistent backache. Some conditions such as ankylosing spondylitis and previous spinal fusion are clinically unsuitable, but this technique, which is described, is recommended for consideration before all major surgical procedures for back pain are undertaken.     

强直性脊柱炎患者血液HLA-B27的临床参考值的预测

目的 以实时荧光定量PCR（FQ-PCR）检测可疑患者HLA-B27的定量水平,研究强直性脊柱炎（AS）与HLA-B27的相关性,明确HLA-B27的检测值范围并用于AS的确诊诊断.方法 针对本院2005年~2010年收集的168例骶髂关节及下腰部疼痛等症状疑似AS病例进行回顾性分析,获得所有病例外周静脉血标本,然后通过实时荧光定量PCR进行HLA-B27的定量检测,疑似病例分为AS患者、HLA-B27阳性的非AS患者、HLA-B27阴性的非AS患者三组,根据临床体征、影像学进行确诊病情,同时选取健康体检者52例外周静脉血标本的HLA B-27测定结果进行对照,统计分析各变量与AS存在之间的关系.结果 AS患者、HLA-B27阳性的非AS患者、HLA-B27阴性的非AS患者、健康体检者的HLA-B27循环阈值（ct）平均值分别为：26.3 copies/ml、17.5 copies/ml、6.2 copies/ml、4.9 copies/ml,单变量分析表明,HLA-B27与化脓性关节炎明显相关（P＜0.05）.结论 AS患者HLA-B27定量分析循环阈值（ct）的95%参考值范围为（17.3~35.3）copies/ml,HLA-B27定量分析可作为疾病发病的参照影响因素及预测因素.     

Ankylosing Spondylitis in a Large Kindred: Clinical and Genetic Studies

In a kindred of 66 members spanning four generations, seven cases of ankylosing spondylitis (AS) have been found. Four of these were in a single sibship of 13. AS was associated with HL-A27 in three of the four involved siblings, but close linkage was shown to be unlikely. Knowledge of HL-A genotype has made possible informed counseling for younger members of the sibship of 13, some of whom, as teenagers, already have back pain.     

Human Lymphocyte Antigen, HL–A27, in Japanese Patients with Ankylosing Spondylitis

A high association of HL–A27 specificity with ankylosing spondylitis was found in Japanese patients in spite of a very low frequency of this specificity in a normal Japanese population. These findings coincide well with those in Caucasian patients, and indicate the strong relationship between the susceptibility to ankylosing spondylitis and HL–A27 specificity beyond racial differences.
No particular HL–A patterns were noted in patients with the ossification of the posterior longitudinal ligament of the cervical vertebrae. This observation provides an evidence that this disease is etiologically different from ankylosing spondylitis.     

Cell-mediated immunity in the rheumatoid diseases. I. Skin testing and mitogenic responses in sero-negative arthritides.

Cellular immunity has been investigated in patients with various kinds of sero-negative arthritis. The incidence of cutaneous response to recall antigen streptokinase-streptodornase (SK-SD), and the ability to mount a primary cutaneous response to dinitrochlorobenzene (DNCB) have been examined in patients with ankylosing spondylitis and psoriatic arthritis. The results were not significantly different from normal. In vitro lymphocyte transformation in the presence of phytohaemagglutinin (PHA), concanavalin A (Con A), and pokeweed mitogen (PWM) has been measured using peripheral blood lymphocytes from patients with ankylosing spondylitis, psoriatic arthritis and Reiter's disease. In comparison with a control group, significantly reduced responses were found to a low dose of PHA in the ankylosing spondylitis and Reiter disease patients. Significant increase in response occurred to a high dose of PHA, in patients with psoriatic arthritis and Reiter's disease, and to PWM in Reiter's disease patients. The in vitro results in the ankylosing spondylitis, psoriatic arthritis and Reiter's disease patients suggest some abnormality in the T-cell population in sero-negative arthritis.     

The Reliability and Validity of a Korean Translation of the ASAS Health Index and Environmental Factors in Korean Patients with Axial Spondyloarthritis

The objective of this study was to develop a Korean version of the Assessment of Spondyloarthritis International Society-Health Index/Environmental Factor (ASAS HI/EF) and to evaluate its reliability and validity in Korean patients with axial spondyloarthritis (SpA). A total of 43 patients participated. Translation and cross-cultural adaptation of the ASAS HI/EF was performed according to international standardized guidelines. We also evaluated validity by calculating correlation coefficients between the ASAS-HI/EF score and the clinical parameters. Test-retest reliability was excellent. The correlations among the mean ASAS-HI score and all tools of assessment for SpA were significant. When it came to construct validity, the ASAS HI score was correlated with nocturnal back pain, spinal pain, patients''s global assessment score, the Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis metrology index (BASMI) and EuroQoL visual analogue scale (EQ VAS) (r = 0.353, 0.585, 0.598, 0.637, 0.690, 0.430, and -0.534). The ASAS EF score was also correlated with the patient''s global assessment''s score, BASDAI, BASFI, BASMI, and EQ VAS score (r = 0.375, 0.490, 0.684, 0.485, and -0.554). The Korean version of the ASAS HI/EF can be used in the clinical field to assess and evaluate the state of health of Korean axial SpA patients.

Graphical Abstract

相似文献   

Immune function in ankylosing spondylitics and their relatives: influence of disease and HLA B27.

So as to distinguish the separate influences of ankylosing spondylitis (AS) and possible HLA B27 associated immune response genes on immune response patterns, a battery of immunological tests were performed on fourteen patients with AS and their first-degree relatives. Previously unrecognized AS was detected by clinical and radiological means. Individuals with ankylosing spondylitis had significantly higher serum IgG and IgA concentrations than both their B27 positive and B27 negative relatives. B27 positive relatives had significantly lower phytohaemagglutinin (PHA) lymphocyte transformations than B27 negative relatives (P less than 0.01), while there was no difference between the ankylosing spondylitic and B27 positive groups. Antibody titres to Streptokinase/Streptodornase were significantly higher in the B27 positive individuals, with or without AS, than their B27 negative relatives (P less than 0.005 and P less than 0.02 respectively). These results show that serum immunoglobulin differences were associated with disease, while differences in PHA stimulation and varidase antibody titres were associated with the B27 antigen. These findings may indicate the presence of HLA associated immune response genes including those involved with reactions to a particular antigenic component of Streptokinase/Streptodornase.     

白细胞介素10启动子基因多态性与强直性脊柱炎的易感性

背景：在强直性脊柱炎患者中,基因多态性很可能影响细胞因子的分泌模式。 目的：在中国胶东半岛地区汉族人强直性脊柱炎患者中,探讨白细胞介素10启动子基因的单核苷酸多态性和单体型与强直性脊柱炎易感性的相关性。 方法：用酶联免疫吸附测定法测定血清中白细胞介素10的水平,用聚合酶链反应和限制性片段长度多态性方法对白细胞介素10基因启动子中的-1082A/G、-819C/T和-592C/A位点的单核苷酸多态性进行分析。 结果与结论：收集了110例强直性脊柱炎患者和120例同种族的健康人,强直性脊柱炎患者组血清中白细胞介素10水平明显高于健康对照组(Z=10.9,P < 0.001),单核苷酸多态性分析显示：在强直性脊柱炎患者组和健康对照组之间-592A/C位点基因型分布和等位基因频率没有明显差异,该研究中没有发现-1082GG基因型。强直性脊柱炎患者-1082G等位基因频率较健康对照组增加(P=0.047),通过logistic回归分析,强直性脊柱炎患者-1082AG基因型的比值比为1.993(95%CI：1.046-3.800,P=0.034 ),而-819CC基因型的比值比为3.125(95%CI：1.246-7.836,P=0.015),此外,单体型分析显示与ATA 基因型相比,GCC基因型显著增加了患强直性脊柱炎的风险(OR=2.19,95%CI：1.13- 4.26,P= 0.020)。结果表明白细胞介素10的基因单体型与中国胶东半岛地区汉族人强直性脊柱炎的易感因素相关。     

Achondroplasia with ankylosing spondylitis

A 41-year-old-white man with achondroplasia has been followed intermittently since age 27. During this time, he has complained of neck and back pain with limited mobility in both. Other problems have included temporomandibular joint pain, dysuria without apparent urinary tract infection iritis, anemia, and an elevated gamma globulin fraction. Recently he returned to the clinic complaining of rigidity of the entire spine. Radiographs showed complete fusion of the sacroiliac joints and fusion of the cervical vertebral bodies and apophyseal joints, consistent with ankylosing spondylitis. He was found to be HLA B-27 positive. This case illustrates the importance of considering other diseases whenever atypical orthopedic problems arise in patients with a bone dysplasia.     

长节段椎弓根钉系统内固定与个性化截骨方法治疗强直性脊柱炎后凸畸形

背景：生物力学的观点认为：强直性脊柱炎的矫形在后凸的顶点处截骨最佳,但术中脊髓损伤的风险大。 目的：分析联合应用椎板间截骨+椎体截骨+长节段椎弓根钉系统内固定治疗强直性脊柱炎后凸畸形的临床效果。 方法：强直性脊柱炎患者共36例,均采用PSO(Pedicle Subtraction Osteotomy)截骨+SPO(Smith-Peterson Osteotomy)联合截骨治疗。随访时间3个月至2年。 结果与结论：36例患者未发现植入物修复后矢状位失平衡者,矢状位失衡的改善率为64%。患者植入物修复后胸腰椎后凸角的到恢复,改善率为60%;颌眉角的改善率为98%,疼痛症状缓解程度为64%,ODI指数95%;均未发生拔钉、断钉、断棒现象。说明选择性截骨矫形技术+长节段内固定手术能够获得稳定的内固定疗效,防止出现矢状位失平衡,以及强直性脊柱炎因骨质疏松导致的拔钉、断钉、断棒现象的发生。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

椎弓根螺钉内固定强直性脊柱炎后凸畸形：病例及文献分析

背景：强直性脊柱炎后凸畸形患者,根据畸形的严重程度,采用单节段或两节段经椎弓根螺钉置入内固定矫形,可取得良好的矫形效果。 目的：对经椎弓根螺钉内固定治疗强直性脊柱炎后凸畸形临床应用结果及研究文献进行多层次探讨分析。 方法：对解放军306医院骨科椎弓根螺钉内固定治疗强直性脊柱炎后凸畸形的16例临床病例进行分析,并以电子检索的方式对CNKI数据库2002/2011椎弓根螺钉内固定治疗强直性脊柱炎后凸畸形研究文献进行检索,采用检索词为“螺钉;强直性脊柱炎;后凸”,共检索相关文献48篇,进行数据特征等的深入分析。 结果与结论：强直性脊柱炎是一种以侵犯中轴脊椎关节为特征的慢性疾病,晚期常合并胸段或胸腰段脊柱后凸畸形,经胸段脊椎屈曲增加,患者往往无法平视,严重的甚至肋骨下缘挤压内脏致心肺功能障碍,影响日常生活及美观,采用脊柱截骨,经椎弓根螺钉置入内固定矫形治疗,可取得良好的效果。     

湖北籍汉族强直性脊柱炎患者白细胞介素1受体拮抗剂基因的多态性

背景：白细胞介素1是强直性脊柱炎易感基因之一,其多态性与疾病易感性相关,不同人群的研究结果不尽相同。 目的：分析中国湖北汉族人群中白细胞介素1受体拮抗剂基因多态性与强直性脊柱炎的相关性。 方法：自140名强直性脊柱炎患者及130名健康对照者外周血中提取DNA,采用PCR方法检测白细胞介素1受体拮抗剂基因第二内含子VNTR复等位基因多态性。所有受试者均为3代或3代以上居住于湖北的汉族人。 结果与结论：强直性脊柱炎患者中白细胞介素1受体拮抗剂基因*2等位基因频率显著高于健康对照者(P < 0.05)。提示强直性脊柱炎与白细胞介素1受体拮抗剂基因*2等位基因相关联。     

Atrioventricular conduction time in ankylosing spondylitis. Distribution of P-R intervals in patients and their relatives

The frequency of cardiac conduction disturbance in ankylosing spondylitis is discussed. Risk of such disturbance in the patients' relatives is, to our knowledge, not known. To examine these problems, ECG records of 99 patients with ankylosing spondylitis and 132 of their adult first degree relatives were obtained. P-R intervals were determined by standardized methods and compared with P-R intervals of the controls. The distribution of P-R intervals both in the patients and their relatives was close to the controls'. Four cases of first degree AV block were found among the patients (P-R intervals 0.21-0.26 sec), one of them had aortic valve insufficiency. The single case of pronounced conduction delay (P-R interval 0.42 sec) was recorded in an otherwise healthy HLA B27-positive relative. One male secondary case of ankylosing spondylitis had a P-R interval of 0.22 sec. Patients who had experienced acute anterior uveitis had relatively long P-R intervals, while patients with psoriasis had relatively short P-R intervals. The conclusion was that cardiac conduction disturbance was not frequent in patients with ankylosing spondylitis or in their relatives.     

Psychological correlates of pain behavior in patients with chronic low back pain

Pain behaviors that are excessive for the degree of known physical disease are common in patients with chronic low back pain and are frequently assumed to arise from a comorbid depressive illness. Although some studies have confirmed an association between depression and excessive pain behavior, methodologic problems (such as the use of depression ratings that also recorded symptoms attributable to physical disease) make interpretation of this finding difficult. We recruited 54 consecutive patients with chronic (>6 months) low back pain from a hospital clinic. Subjects completed self-rated assessments of anxiety and depression (Hospital Anxiety and Depression Scale) designed to be minimally affected by physical symptoms, along with assessments of disability (ODQ), pain (visual analogue scale), pain behavior (Waddell checklist), and physical impairment. Seventeen subjects (31%) exhibited excessive pain behavior. Overall, they were no more depressed or anxious than the remainder, although men with excessive pain behavior showed a trend toward being more depressed. Patients with excessive pain behavior were more disabled (self-rated and observer-rated), reported greater pain, and were more likely to be female and to have pain of shorter duration. Pain behavior did not correlate with anxiety or depression, but correlated with measures of disability and pain intensity. Factor analysis revealed that physical disability, pain intensity, and pain behavior loaded heavily on the first factor. Anxiety and depression loaded together on a separate factor. We conclude that pain behaviors were not related to anxiety or depression in our group, although gender differences between groups could have contributed to our negative findings. Pain behaviors may influence other physical measures. Further studies are required to investigate the relation between depression and pain behavior while controlling for gender differences.     

强直性脊柱炎患者外周血T细胞凋亡及凋亡相关蛋白的表达

目的探讨强直性脊柱炎患者外周血T细胞凋亡相关蛋白的表达以及T细胞凋亡状况,分析其在疾病免疫发病机制的作用。方法CT检查患者骶髂关节并分级。尼龙棉柱法分离患者外周血T细胞,PI染色结合流式细胞术检测T细胞凋亡率,免疫组化法检测T细胞促凋亡蛋白FADD、Caspase．3、Caspase-8和抗凋亡蛋白FLIP表达。结果与健康对照相比,强直性脊柱炎患者外周血T细胞凋亡率明显降低（P〈0．05）;促凋亡蛋白FADD、Caspase-3、Caspase-8百分率均明显降低（P〈0．05）,抗凋亡蛋白FLIP百分率明显升高（P〈0．05）。结论强直性脊柱炎患者外周血T细胞凋亡蛋白及抗凋亡蛋白表达异常和T细胞凋亡不足与患者免疫学发病机制相关。     

强直性脊柱炎患者血清IL-17含量初步分析

目的：通过检测强直性脊柱炎患者血清IL-17水平变化,探讨IL-17在强直性脊柱炎发病中的作用。方法：用ELISA检测62例强直性脊柱炎患者血清IL-17含量。结果：强直性脊柱炎患者血清IL-17水平非常显著地高于正常对照组（P〈0.001）。结论：IL-17在强直性脊柱炎的发病中发挥着重要作用。