深圳市3个社区5922名居民强直性脊柱炎的流行病学调查

背景:强直性脊柱炎等风湿性疾病的流行病学调查在深圳市缺如。全面了解强直性脊柱炎在深圳市流行的情况可为有关部门制订卫生规划提供依据。目的:了解深圳市强直性脊柱炎等风湿性疾病的流行情况。设计:随机整群抽取,横断面调查。单位:广东医学院深圳风湿病研究所。对象:于2001-12/2004-06从深圳市3个地区(水乡点、山区点和外来人口聚居点)中各随机整群抽取一个居民点(村民点),经年龄标准化后16岁以上为调查对象,共计6684名,实际调查了5922名,受检率为88.6%,其中男性为2659名,女性为3263名,分别为44.9%与55.1%,男女比例为1∶1.23。方法:第1,2期询问过筛,由调查人员挨家挨户上门调查,对调查对象逐人按调查表内容进行询问、记录。第3期由风湿病专科医师对1、2期询问阳性者进行体格检查。第4期对疑似强直性脊柱炎病例,行人类白细胞抗原-B27抗原检测和X射线摄片,其中包括骨盆平片、腰椎正侧位片;必要时加照脊柱其他部位及周围关节。主要观察指标:风湿病症状频率;强直性脊柱炎患病率;人类白细胞抗原B27抗原阳性频率;并与国内外部分城市相关数据做比较。结果:①一般风湿病症状频率为21.6%,风湿病症状频率以膝关节为最高,依次为腰、肩、颈和手。女性各部位的症状频率显著高于男性(P<0.05)。因风湿病不得不停止工作的,共13例,占4.7%。②强直性脊柱炎患病率为0.37%,男女性患病率之比约为4.5∶1,多数患者是在青年起病。③人类白细胞抗原B27抗原阳性频率为5.0%。④强直性脊柱炎误诊率、早期诊断率和长期不合理用药率分别为64%,27%和73%。结论:深圳市强直性脊柱炎(0.37%)患病率高于国内北京(0.26%)、汕头地区(0.26%)和美国(0.20%)、希腊西方白种人(0.24%),可能与深圳市人口结构青壮年比例较多有关。     

HLA—B＊27基因亚型与强直性脊柱炎的相关性研究

强直性脊柱炎（AS）是一种慢性进行性风湿疾病,是与人类白细胞抗原B＊27关联最强的一种疾病,本文就HLA—B＊27的结构、多态性、分布及主要的发病机制进行综述。     

流式细胞术检测人类白细胞抗原-B27在诊断强直性脊柱炎中的价值

目的 探讨应用流式细胞术检测人类白细胞抗原-B27（HLA-B27）对临床强直性脊柱炎（AS）的诊断价值.方法 应用流式细胞仪检测947例临床疑似AS患者的T淋巴细胞上的HLA-B27抗原,采用流式细胞仪（FCM）自带的数据获取与分析软件获取数据并进行分析.结果 947例患者HLA-B27抗原阳性率为44.8%,男女比例为4.3∶1,其中95.6%HLA-B27抗原阳性的患者确诊为AS.结论 利用流式细胞术检测HLA-B27有助于AS的诊断,检测快速,特异性、稳定性均较好.     

广东潮州地区强直性脊柱炎患者HLA．B27的检测与临床相关性研究

目的检测强直性脊柱炎（Ankylosing spondylitis,AS）患者HLA．B27抗原表达情况,并分析其与临床情况的关系。方法选择我院2008年5月到2011年5月期间150例AS患者,按HLA．B27抗原表达分为两组：HLA—B27阳性组（n=108）及HLA—B27阴性组（n=42）。分别检测两组血标本血沉、C反应蛋白、Ot1一酸性糖蛋白水平,并检查心电图、骨盆正位片和腰椎正侧位,比较两组的发病年龄、性别比、临床症状。结果①HLA—B27阴性组以31～45岁年龄段为主（占阴性组52．4％）,阳性组以16～30岁年龄段为主（占阳性组57．4％）;②HLA—B27阳性组较阴性组全身症状更为严重（P〈0．05）;而两组在下腰痛、髋部疼痛、中轴关节炎、外周关节炎、眼炎方面进行比较无明显差异（P〉0．05）;③HLA．B27阴性组较多表现为在窦缓和／或传导阻滞,而HLA．B27阳性组则较多表现为左室高电压（P〈0．05）;④HLA．B27阳性组ESR、CRP均较阴性组明显增高（P〈0．05）;两组仅1一酸性糖蛋白无明显差异（P〉0．05）。结论AS患者临床症状与HLA—B27抗原有很高的相关性,HLA．B27抗原阴性患者与阳性患者相比病情较轻,预后较好。     

HLA—B＊27基因亚型与强直性脊柱炎临床特征的相关性

目的比较不同HLA—B＊27亚型的强直性脊柱炎患者的临床症状、实验室和影像学检查结果,分析其与基因亚型的相关性。方法应用PCR—SSP方法检测HLA—B＊27抗原阳性的强直性脊柱炎患者（ankylosing spondylitis,AS）70例,应用Olerup高分辨PCR—SSP试剂检测HLA—B＊27的基因亚型,并分析亚型与临床特征的相关性。结果70例样本共检出B＊270447例（67．1％）、B＊270520例（28．6％）两种基因亚型,另有3例因为等位基因同质性而无法判定型别。HLA—B＊2704与B＊2705亚型患者的临床表现、实验室参数之间的差异无统计学意义。结论本地区AS患者HLA—B＊27亚型以B＊2704和B＊2705为主,且B＊2704最多见：HLA—B＊27各弧珏5I与临床特征的相关件无统计学意义．     

348例强直性脊柱炎患者HLA-B_(27)抗原检测

目的　检测强直性脊柱炎 (AS)患者HLA B2 7抗原。方法　用特异性HLA B2 7抗血清对 3 4 8例AS患者和 72名健康者进行HLA B2 7检测。结果　 3 4 8例AS中HLA B2 7阳性者 3 2 9例 ,阳性率 94.5 % ,其中弱阳性者 67例 (19.2 % ) ,多为早期患者 ;阳性者 168例 (48.3 % ) ,多为中、晚期患者 ;强阳性者 94例 (2 7.0 % ) ,亦多为中、晚期患者。早期AS患者HLA B2 7总阳性率为 91.8% ,其中以弱阳性为多 (65 .8% ) ,明显高于中、晚期患者 (P <0 .0 1) ;中期AS患者HLA B2 7总阳性率 94.9% ,其中以阳性为多 (5 5 .9% ) ,其次为强阳性 (3 2 .3 % ) ,均明显高于早期患者 (P <0 .0 1) ;晚期AS患者HLA B2 7总阳性率为 95 .7% ,中亦以阳性为多 (5 6.1% ) ,其次为强阳性 (3 2 .4% ) ,均明显高于早期患者 (P <0 .0 1) ;中、晚期AS患者的弱阳性、阳性、强阳性比较均无显著差异 (P >0 .0 5 )。 72名健康者中HLA B2 7阳性 3例 ,阳性率为 4.2 % ,其中弱阳性 2名 ,阳性 1名。结论　AS与HLA B2 7相关性强 ,HLA B2 7检测可成为诊断AS的一项指标     

强直性脊柱炎与HLA—B27

强直性脊柱炎是HLA关联最强的疾病。HLA－B27由22个以上同种异型基因型（亚型：B*2701-B*22)组成，不同亚型核苷酸序列之间只存在个别位点的差异，其亚型具有分布不同的种族和人种充行情况，以B*2705分布最广。近年来建立了大量的AS动物模型，人类B27转基因鼠实验证实B27分子是AS的原发关联成分。PCR－SSP等DNA分型技术和流式细胞术克服了传统的血清学分型技术检测HLA－B27的众多弊端，成为临床辅助诊断强直性脊柱炎的重要手段。     

深圳市强直性脊柱炎的患病率及患者生活质量调查

目的该文旨在全面了解强直性脊柱炎(AS)在深圳市流行的情况及其患者的生活质量。方法随机整群抽取深圳市3个地区(本地水乡点、本地山区点和城区外来人口聚居点)16岁以上成人为调查对象共计6684名,实际调查了5922名。采用世界卫生组织(WHO)社区性控制风湿病规划(COP-CORD)调查程序。生活质量调查依据WHO对生活质量的定义和描述,参照中文普适性生活质量量表中生活质量的评分方法,从生理、心理、社会适应能力3个维度、18个健康领域,具体用42个不同的指标来描述。结果AS患病率为0.37%;AS误诊率、早期诊断率和长期不合理用药率分别为64%、27%和73%。AS患者在生理分值、心理分值、社会适应能力分值及总生活质量分值为(81.71±10.27)、(75.93±13.86)、(84.36±12.44)、(80.51±10.90),都明显低于正常人(95.63±5.22)、(91.51±7.94)、(98.46±4.73)、(95.14±5.16)。结论深圳市AS患病率高于国内北京、汕头地区和美国、希腊西方白种人,可能与深圳市人口结构青壮年比例较高有关。AS诊治情况不容乐观,需加强风湿病专科建设。AS患者的生活质量明显下降,有必要从多角度对AS患者进行治疗和康复教育。     

疑似强直性脊柱炎患者人类白细胞相关抗原B27检测

强直性脊柱炎(AS)是一种常见的自身免疫性风湿病,其临床特点是累及脊柱和外周大关节,早期的临床表现有很大的差异性.     

HLA-B~* 27基因亚型与强直性脊柱炎的相关性调查

强直性脊柱炎(AS)是一种慢性、进行性和炎性疾病,主要累及骶髂关节、脊柱和四肢关节,具有很强的家族凝聚性,与HLA-B*27有很强的相关性[1].现已发现HLA-B*27存在54种亚型,编码23种蛋白质[2].     

Disability in ankylosing spondylitis

Purpose: This study was designed to examine the functional loss in ankylosing spondylitis and explore the relationship between disability and various factors such as age, disease duration, disease activity, spinal mobility, chest expansion, peripheral joint involvement, radiological changes, and psychosocial well-being. Method: Forty-two patients were included in this crosssectional study. Results: The results showed that 37 patients had mild to moderate disability, two patients had severe disability, and three patients did not report any functional loss. Spearman correlation analyses showed that disability was strongly correlated with spinal mobility measures, disease activity measures, and disease duration. Also, patients with peripheral joint involvement had greater disability. When the predictive effect of five independent variables was studied by multiple regression analysis, it was found that the most powerful predictors of functional loss in AS patients were cervical rotation, modified Schober's test, and pain. Conclusions: These data suggest that functionalconsequences of AS are constituted by multiple impairments and each needs to be managed by an integrated physiatric approach.     

Disability in ankylosing spondylitis

Purpose: This study was designed to examine the functional loss in ankylosing spondylitis and explore the relationship between disability and various factors such as age, disease duration, disease activity, spinal mobility, chest expansion, peripheral joint involvement, radiological changes, and psychosocial well-being. Method: Forty-two patients were included in this crosssectional study. Results: The results showed that 37 patients had mild to moderate disability, two patients had severe disability, and three patients did not report any functional loss. Spearman correlation analyses showed that disability was strongly correlated with spinal mobility measures, disease activity measures, and disease duration. Also, patients with peripheral joint involvement had greater disability. When the predictive effect of five independent variables was studied by multiple regression analysis, it was found that the most powerful predictors of functional loss in AS patients were cervical rotation, modified Schober's test, and pain. Conclusions: These data suggest that functionalconsequences of AS are constituted by multiple impairments and each needs to be managed by an integrated physiatric approach.     

Spine fractures in ankylosing spondylitis

Patients with ankylosing spondylitis are susceptible to spine fracture, usually in the cervical spine. Less frequently, the thoracic and lumbar spine is affected. The fracture line may involve anterior and posterior elements. Frequently, it extends through the entire width of the spine. As a result the fracture tends to be unstable and may cause neurologic damage. Prompt immobilization and reduction of the dislocated spine followed by stabilization may prevent neurologic damage. We report a 45-year-old man who fell and sustained a fracture dislocation of L2 vertebra. The patient was operated and stabilized with Harrington rods. A deep wound infection developed, which did not respond to antibiotic therapy and led to removal of the rods. In spite of bed immobilization with a body jacket the fracture remained unstable and dislocated. As a result the patient sustained severe neurologic damage. Many fractures in patients with ankylosing spondylitis occur following minor trauma. We feel that a very important aspect of ankylosing spondylitis management is prevention of these fractures. Alerting patients of their spine fragility and teaching then how to evade situations leading to spinal trauma may help in avoiding this situation.     

Fatigue in ankylosing spondylitis.

OBJECTIVE: To review the literature on fatigue in ankylosing spondylitis (AS), the tools of its measurement, relation with the other parameters of the disease, treatment and its relation with exercises. MATERIALS AND METHODS: Medline, Embase, Pascal and Cochrane library databases were searched with the keywords fatigue, spondyloarthropathy, ankylosing spondylitis, evaluation, assessment, outcome, exercise, and rehabilitation. A total of 21 papers were reviewed. RESULTS: Fatigue is a frequent complaint of patients with AS. It is assessed mainly on a visual analog scale and is one of the parameters of the disease activity index Bath Ankylosing Spondylitis Disease Activity Index BASDAI. Fatigue has a strong relation with the other symptoms of AS (stiffness and pain). It is negatively influenced by sleep disorders. Quality of life of these patients is considerably reduced. Anti-TNF therapy seem to ameliorate fatigue more than nonsteroidal anti-inflammatory drug therapy. Regular physical activity is recommended to help alleviate the fatigue. DISCUSSION: No valid, relevant composite tool of multidimensional and multifactorial characters exists to assess fatigue in AS. Treatment such as anti-TNF therapy may facilitate rehabilitation. Regular physical activity helps alleviate fatigue and improves quality of life.