未分化脊柱关节病83例临床分析

目的　了解未分化脊柱关节病 (uSpA)的发病情况及临床特点。方法　收集半年内就诊于门诊的 10 2例血清阴性脊柱关节病患者 ,其中 83例属uSpA ,均不符合国际上通用的强直性脊柱炎 (AS)或其他肯定的血清阴性脊柱关节病 (如银屑病性关节炎、瑞特综合征、肠病性关节炎等 )的诊断标准 (如修订的纽约标准、美国风湿病学学会分类标准 ) ,对此 83例进行了临床分析。结果　uS pA患者男女比例为 1 6∶1,女性比例较AS组明显高 ,平均年龄 2 8 8岁 ,平均病程 3 1年。临床症状较AS轻 ,均无腰椎活动受限 ;uSpA组患者HLA B2 7阳性率低于AS组 ;有 4例晚起病的 (5 0岁以后 )AS患者 ;不一定有骶髂关节炎 ;普通X线及CT诊断骶髂关节炎者分别占 34 %和 73%。 89 1%符合Amor标准 ,85 6 %符合欧洲脊柱关节病研究组 (ESSG)标准。结论　uSpA在血清阴性脊柱关节病中占很大比重 ,临床工作中应给予足够的重视。推荐用Amor和ESSG标准进行诊断。该病的治疗和转归还有待于长期的随诊观察。     

未分化脊柱关节病分类标准的临床验证

目的：通过临床资料来验证脊柱关节病的2个分类标准，即Amor标准和欧洲脊柱关节病研究组（ESSG）标准。方法：采用1995－1999年以慢性腰痛及关节病（炎）为主诉的临床病例（包括门诊和住院病例），分别用Amor标准和ESSG标准进行诊断。结果：用Amor标准诊断的敏感性是 88．2％，特异性是99．7％, 阳性预测值是99．7％，阴性预测值是89．8％；用ESSG标准诊断的敏感性是92．0％，特异性是97．9％，阳性预测值是97．7％，阴性预测值是92．7％。两种标准的敏感性及特异性比较差异无显著性（P＞0．05）。结论：Amor标准和ESSG标准对我国相关人群的临床诊断均具有较高的敏感性和特异性，并且两种标准间无统计学差异，可以相互替代。     

脊柱关节病五例家系调查

脊柱关节病五例家系调查黄烽，赵华，施桂英脊柱关节病（ＳｐＡｓ）是青年男性常见多发的一组风湿性疾病，包括强直性脊柱炎（ＡＳ）与幼年强直性脊柱炎（ＪＡＳ），Ｒｅｉｔｅｒ综合征（ＲＳ）或反应性关节炎，银屑病脊柱关节病，炎性肠病脊柱关节病等，一些学者将白塞病...     

未分化脊柱关节病的诊断与治疗

未分化脊柱关节病是一类具有典型脊柱关节病表现的临床综合征，但不符合强直性脊柱炎、银屑病关节炎、肠炎性关节病、瑞特综合征的诊断标准。临床上存在诊断的不确定性，常常被误诊误治，值得注意。     

幼年脊柱关节病的早期特征

幼年脊柱关节病（ｊｕｖｅｎｉｌｅｏｎｓｅｔｓｐｏｎｄｙｌｏａｒｔｈｒｏｐａｔｈｉｅｓ,ＪＳｐＡ）系指１６岁以前发病的一组与ＨＬＡＢ２７相关的关节滑膜、肌腱端、腱鞘和滑囊的临床状况、综合征和疾病,肠道和泌尿道感染常为激发因子,脊柱炎和骶髂关节炎贯穿全病程,并可伴发关节外表现。由此可见,ＪＳｐＡ的疾病范围很广,它既包括一些具有明确临床、实验室和Ｘ线片特征,并符合有关诊断条件的脊柱关节病和综合征,如幼年强直性脊柱炎（ＪＡＳ）、幼年赖特综合征、幼年反应性关节炎和幼年银屑病关节炎及炎性肠病关节炎等（…     

以风湿表现为首发症状的神经母细胞瘤误诊为幼年脊柱关节病一例

我院2005年3月收治1例以风湿表现为首发症状的神经母细胞瘤误诊为幼年脊柱关节病，现报告如下。     

127例未分化脊柱关节病五年随访

目的了解未分化脊柱关节病（undifferentiated spondyloarthropathies,uSpA）的临床特点及发展规律。方法分析127例uSpA患者临床特点及5年随访结果。结果127例uSpA患者：（1）男女比例为1．8：1,女性患者起病晚,病情轻,预后较好;（2）病程中腰背部疼痛（93．7％）和外周关节肿痛者（96．0％）最多见;（3）女性腰背部疼痛的首发率明显高于男性（P〈0．05）,男性髋关节、臀区或足跟及其他附着点部位疼痛起病的首发率均高于女性（P〈0．05）;（4）7例以手关节受累为首发症状者均为女性;（5）家族史阳性率42．5％,HLA．B27阳性率52．8％,两性间差异无统计学意义（P〉0．05）;（6）首诊影像学特点,CT对诊断uSpA较X线敏感,两者骶髂关节炎阳性率分别为75．0％（78／104）和60．0％（51／85）。两者诊断骶髂关节炎分级符合率45．6％（31／68）。男性骶髂关节破坏的阳性率高于女性（P〈0．05）;（7）5年随访,18例发展为强直性脊柱炎（ankylosing spondylitis,AS）,1例为炎性肠病关节炎,1例为银屑病关节炎（psoriatic arthritis,PsA）,20例仍为uSpA,16例症状消失。18例确诊AS的患者中男性13例,占72．2％。5年内骶髂关节CT示Ⅱ级以上骶髂关节破坏进展明显,初诊和5年后阳性率分别为3．6％和48．2％。结论uSpA是一组常见的临床症状多样的脊柱关节病,有遗传倾向;男性骶髂关节受累较女性严重;部分患者可进展为AS、PsA及炎性肠病关节炎等其他脊柱关节病。对uSpA患者应密切随访,定期行骶髂关节CT检查有助于早期诊断。     

研究柏林标准以及ESSG标准和Amor标准在中国未分化脊柱关节病诊断中的应用价值

目的评价柏林标准、传统的ESSG及Amor标准在中国未分化脊柱关节病（uSpA）患者诊断中的价值。方法用ESSG标准以及Amor标准里的参数对94例临床诊断为uSpA患者，以及用柏林诊断流程对其中81例有脊柱受累的uSpA患者，以及对123例其他风湿病患者进行资料收集分析。结果94例uSpA患者中85例行人类自细胞抗原（HLA）-B27检查，62例阳性，占73％；81例有脊柱受累的uSpA患者中，40岁前起病占96％，HLA—B27阳性率为69％（51／74）；CRP和戚ESR增高阳性率40％（29／72）；骶髂关节磁共振成像（MRI）阳性率91％（29／32）。ESSG标准、Amor标准诊断uSpA的敏感性分别为70％及64％，特异性分别为93％和94％；柏林诊断流程在中轴受累的uSpA患者中的诊断敏感性和特异性分别为67％及96％。结论新的柏林标准与传统的ESSG和Amor标准类似，在我国诊断uspA方面均具有较好的应用价值；临床上应重视把SpA临床特点和HLA—B27、CRP／ESR以及MRI相结合。     

酷似脊柱关节病的急性淋巴细胞性白血病一例

急性淋巴细胞性白血病更易伴发关节痛、骨痛，误诊率高．大多数被误诊为风湿热、类风湿关节炎等。现将工作中遇到的1例误诊为脊柱关节病的急性淋巴细胞白血病介绍如下。     

脊柱关节病的分类和未分化型脊柱关节病

脊柱关节病实指血清阴性脊柱关节病（ｓｅｒｏｎｅｇａｔｉｖｅｓｐｏｎｄｙｌｏａｒｔｈｒｏｐａｔｈｉｅｓ），其含意一般为强直性脊柱炎、赖特综合征、银屑病关节炎、肠病性关节炎、反应性关节炎的总称。这些病都有各自的分类标准，例如强直性脊柱炎即有纽约标准、罗马...     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.