维生素D及其受体在强直性脊柱炎患者中的表达及其临床意义

目的：研究As患者PBMC维生素D受体（VDR）mRNA的表达及血清25-羟维生素D,和1,25-二羟维生素D3的水平,探讨其与AS疾病活动性（BASDAI、CRP、ESR）的相关性。方法：选取26例AS患者（As组）和年龄、性别与之相匹配的13名健康志愿者（健康对照组）。采用SYBRGreenI实时荧光定量PCR检测两组受检者PBMC的VDRmRNA表达水平,应用ELISA法检测两组受检者血清25-羟维生素D3和1,25-二羟维生素D3水平,分析VDRmRNA表达水平、血清25-羟维生素D3和1,25-二羟维生素D3水平与临床相关指标（BASDAI、CRP、ESR）的关系。结果：As患者PBMC的VDRmRNA表达水平明显高于健康对照组（P〈0．01）,VDRmRNA表达水平与临床相关指标（BASDAI、CRP、ESR）无关（P〉0．05）。AS患者血清25．羟维生素D3、1,25-二羟维生素D3水平分别为（5．3±2．6）μg／L、（12．8±6．0）ng／L,明显低于健康对照组（14．7±3．5）μg/L、（32．6±18．5）ng／L（P均〈0．01）。AS患者血清1,25-二羟维生素D3的水平与BASDAI（r=-0．481,P〈0．05）、ESR（r=-0．535,P〈0．01）、CRP（r=-0．674,P〈0．01）均呈负相关。血清25-羟维生素D,水平与BASDAI、CRP、ESR无关（P〉0．05）。结论：As患者VDRmRNA表达水平升高,但与As的疾病活动无关。As患者血清1,25-二羟维生素D3水平下降,与疾病活动呈负相关,可作为AS疾病活动的指标之一。AS患者PBMC的VDR活化可能与1,25-二羟维生素D,的作用无关。     

来氟米特治疗强直性脊柱炎的疗效观察

目的观察来氟米特治疗强直性脊柱炎的疗效和安全性。方法53例强直性脊柱炎患者给予来氟米特治疗,并随访6月,分别在治疗前、治疗后3个月、6个月记录患者症状、体征、AS活动指数(BASDAI)、AS功能指数(BASFI)、红细胞沉降率(ESR)、C-反应蛋白浓度(CRP)。结果在治疗后与治疗前比较,患者的腰背痛、晨僵时间均改善,指地距、BASDAI、BASFI、ESR、CRP均下降(P<0.05);枕壁距、扩胸度、Schober试验改善无统计学意义(P>0.05)。不良反应主要为胃肠道症状和肝功能异常。结论来氟米特治疗强直性脊柱炎有较好的疗效,不良反应轻,易耐受。     

依那西普联合沙利度胺治疗强直性脊柱炎的临床研究

目的评价肿瘤坏死因子抑制剂依那西普联合沙利度胺治疗强直性脊柱炎（AS）的临床疗效和安全性。方法应用依那西普治疗52例AS患者,25mg／次,每周1次,疗程12周,同时加用沙利度胺50—100mg每晚一次,记录治疗前后患者的症状、体征、AS疾病活动指数（BASDAI）、AS的功能指数（BASFI）、红细胞沉降率（ESR）及C-反应蛋白（CRP）等实验室指标及不良反应。结果依那西普治疗后患者的脊柱痛与夜间痛程度、晨僵时间均改善,指地距、BASDAI、BASFI均下降,与治疗前比较均有统计学差异（P〈0．05）。最常见的不良反应主要是注射部位反应和上呼吸道感染。结论依那西普联合沙利度胺对AS有显著的临床疗效,无严重不良反应。     

Relationship between some acute phase reactants and the Bath Ankylosing Spondylitis Disease Activity Index in patients with ankylosing spondylitis

OBJECTIVES: The aims of this study were to investigate a possible relationship between the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and some acute phase reactant (APR) levels in patients with ankylosing spondylitis (AS). METHODS: Twenty outpatients who fulfilled the modified New York criteria for AS were included in the study. Laboratory activity was assessed by examining erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), haptoglobin (Hp), and beta2 microglobulin (beta2MG). Disease activity was assessed according to the BASDAI, which includes a 10-point visual analogue scale to measure pain, fatigue, morning stiffness, swelling, and areas of local tenderness. RESULTS: When APR values were analyzed for the BASDAI, a positive correlation between CRP and BASDAI was observed (r = 0.556, P < 0.05). There was no clear, statistically significant correlation between BASDAI and the other APRs (ESR, r = 0.328, P > 0.05; Hp, r = 0.035, P > 0.05; and beta2MG, r = -0.190, P > 0.05). CONCLUSIONS: Our data suggest that CRP is a better marker of disease activity than ESR, Hp, and beta2MG.     

Relationship between Vitamin D levels and pain and disease activity in patients with newly diagnosed axial spondyloarthritis

ObjectivesTo explore the relationship between Vitamin D levels and pain and disease activity in patients with newly diagnosed axial spondyloarthritis (axSpA).MethodsA convenience sample of 131 newly diagnosed axSpA patients and 60 healthy controls was recruited from July 2016 to December 2018. Serum 25-hydroxyvitamin D [25(OH)D] was measured to assess vitamin D levels. Disease activity was assessed by objective indicators [Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the Bath Ankylosing Spondylitis Metrology Index (BASMI)], patient-reported questionnaires [the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Bath Ankylosing Spondylitis Functional Index (BASFI)]. Pain intensity and interference were also assessed.ResultsVitamin D insufficiency [serum 25(OH) D levels<50 nmol/L]was found in 46 (35.1%) and 25 (43.3%) of the axSpA patients and the healthy controls, respectively. Female patients had higher risk (OR:4.928; 95% CI: 1.921–12.642) for vitamin D insufficiency than male patients. Vitamin D was positively correlated with CRP, ESR level, the BASFI, and the BASMI. Logistic regression showed that vitamin D levels were not associated with pain, or disease activity in the newly diagnosed axSpA patients. Gender was the only predictive variable for vitamin D levels.ConclusionsVitamin D insufficiency was prevalent in both newly diagnosed axSpA patients and healthy controls. There was no association between vitamin D and pain and disease activity in the newly diagnosed axSpA patients. Monitoring vitamin D levels is important and early intervention for vitamin D insufficiency is needed, especially in female patients.     

Effects of Multidisciplinary Team-Based Nurse-led Transitional Care on Clinical Outcomes and Quality of Life in Patients With Ankylosing Spondylitis

PurposeThe purpose of this study is to investigate the impact of transitional care by a nurse-led multidisciplinary team (MDT) on clinical outcomes and quality of life of patients with ankylosing spondylitis.MethodsA randomized control study design was used. Subjects were allocated randomly to an experimental group and a control group. The experimental group received intensive transitional care by a nurse-led MDT, whereas the control group received routine nursing care. Disease activity, spinal mobility, comprehensive function, health service utilization, and quality of life were assessed at the baseline and at six months with the Bath Ankylosing Spondylitis Metrology Index, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), a health service utilization questionnaire and version 2 of the Short Form-36 health survey.ResultsCompared with the baseline, the BASDAI, BASFI, emergency visits, hospitalizations, hospitalization days, and bodily pain, vitality, mental health, total score, and average score of version 2 of the Short Form-36 health survey were improved in the experimental group (p < .05), whereas only bodily pain, vitality, and role-emotional were improved in the control group (p < .05). At six months, the experimental group exhibited significantly more improvement on the BASDAI, BASFI, hospitalizations, all domains except Role-physical as well as total score and average score (p < .05) compared with the control group.ConclusionA MDT-based nurse-led transitional care improves clinical outcomes and quality of life of patients with ankylosing spondylitis. Future research should be carried out on modes of follow-up and family support.     

Two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial

OBJECTIVE: The purpose of this clinical trial was to evaluate the impact of a 4-month comprehensive protocol of strengthening and flexibility exercises developed by our research group versus conventional exercises for patients with Ankylosing Spondylitis (AS) on functional and mobility outcomes. DESIGN: Randomized controlled trial. Forty-five patients diagnosed with AS according to the modified criteria of New York were allocated to control or experimental groups using a random numbers table. The control group was treated with a conventional protocol of physical therapy in AS, whereas the experimental group was treated with the protocol suggested by our research group. The conventional intervention consisted of 20 exercises: motion and flexibility exercises of the cervical, thoracic, and lumbar spine; stretching of the shortened muscles; and chest expansion exercises. The experimental protocol is based on the postural affectation of the AS and the treatment of the shortened muscle chains in these patients according to the Global Posture Reeducation (GPR) method. This intervention employs specific strengthening and flexibility exercises in which the shortened muscle chains are stretched and strengthened. The study lasted 4 mos. During this period, patients received a weekly group session managed by an experienced physiotherapist. Each session lasted an hour, and there were 15 total sessions. Changes in activity, mobility, and functional capacity were evaluated by an assessor blinded to the intervention, using the following previously validated scores from the Bath group: BASMI (tragus to wall distance, modified Schober test, cervical rotation, lumbar side flexion, and intermalleolar distance), BASDAI (The Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (The Bath Ankylosing Spondylitis Functional Index). RESULTS: Both groups showed an improvement (prepost scores) in all the outcome measures, mobility measures of the BASMI index, as well as in BASFI and BASDAI indexes. In the control group, the improvement in tragus to wall distance (P=0.009) and in lumbar side flexion (P=0.02) was statistically significant. Although the rest of the outcomes also improved, they did not reach a significant level (P>0.05). In the experimental group, the improvement in all the clinical measures of the BASMI index (P<0.01) and in the BASFI index (P=0.003) was statistically significant. The intergroup comparison between the improvement (prepost scores) in both groups showed that the experimental group obtained a greater improvement than the control group in all the clinical measures of the BASMI index, except in tragus to wall distance, as well as in the BASFI index. CONCLUSIONS: The experimental protocol developed by our research group, based on the GPR method and specific strengthening and flexibility exercises of the muscle chains, offers promising results in the management of patients suffering from AS. Further trials on this topic are required.     

中药熏蒸配合功能锻炼在早期强直性脊柱炎康复治疗中的应用

目的探讨中药熏蒸配合功能锻炼在早期强直性脊柱炎患者康复护理中的应用效果。方法40例早期强直性脊柱炎患者随机分为对照组与治疗组,各20例。对照组采用口服药物治疗,配合护理护理措施;治疗组在对照组基础上增加中药熏蒸联合功能锻炼。比较2组患者的Bath强直性脊柱炎病情活动性指数(BASDAI)、Bath强直性脊柱炎功能指数(BASFI)、晨僵时间、红细胞沉降率(ESR)、C反应蛋白(CRP)水平。结果治疗后,2组BASDAI和BASFI评分均较治疗前下降,晨僵时间均较治疗前缩短,且治疗组BASDAI评分、BASFI评分和晨僵时间改善优于对照组(P<0.01)。治疗后,2组ESR和CRP水平较治疗前下降,且治疗组ESR和CRP水平低于对照组(P<0.01)。结论在常规药物治疗的基础上,配合中药熏洗和功能锻炼可进一步改善早期强直性脊柱炎患者的炎性指标、肢体功能和日常生活质量。     

Bath强直性脊柱炎计量指数量表的信度和敏感度研究

目的:确定Bath强直性脊柱炎计量指数量表在评价强直性脊柱炎患者功能活动受限方面是否具有良好的信度和敏感度。方法:应用Bath强直性脊柱炎计量指数量表(其中包括可较好反映功能状况的颈椎旋转、耳屏至墙距离、侧屈、以改良Scholer's试验为基础的腰椎屈曲和踝间距等5项简单的临床测量项目),对48例强直性脊柱炎患者进行了量表评定。结果:重复测试间无显著差异,变异系数(CV)为2.49%—7.22%(P>0.05);测试者信度较好,相关系数(r)为0.95—0.98(P<0.05);表明Bath强直性脊柱炎计量指数量表对治疗效果改变具有较好的敏感性(P<0.05)。结论:Bath强直性脊柱炎计量指数量表具有较好的信度和可重复性,对强直性脊柱炎的功能状况改变敏感且测量和评定耗时较少。     

One-year follow-up of two exercise interventions for the management of patients with ankylosing spondylitis: a randomized controlled trial

OBJECTIVE: To assess the long-term effects on functional and mobility outcomes of two exercise interventions for the management of patients with ankylosing spondylitis. DESIGN: In an extended 12-mo follow-up of a randomized controlled trial, 40 patients who were diagnosed with ankylosing spondylitis according to the modified criteria of New York, allocated to control or experimental groups using a random numbers table, and who performed their respective exercise program at least three times per month, were included in this long-term study. The control group was treated during 15 sessions with a conventional exercise regimen in ankylosing spondylitis, whereas the experimental group received 15 sessions of exercises based on the treatment of the shortened muscle chains following the guidelines described by the Global Posture Reeducation method. These patients were followed up and assessed again 1 yr after entering the study, re-applying the same validated indexes: BASMI (Bath Ankylosing Spondylitis Metrology Index [tragus to wall distance, modified Schober test, cervical rotation, lumbar side flexion, and intermalleolar distance]), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), and BASFI (Bath Ankylosing Spondylitis Functional Index). RESULTS: The intragroup comparison between follow-up and post-intervention data showed that both groups decrease their clinical and functional measures during the follow-up period. This decrease was only significant for lumbar side flexion and intermalleolar distance measurements, being more significant in the control group (P = 0.001 and P = 0.002, respectively). Intragroup differences between follow-up and pre-intervention assessments revealed that improvements in all mobility measures of the BASMI index and in the BASFI index were partially maintained at the 12-mo follow-up in the experimental group but not in the control group. The intergroup comparison (unpaired t test analysis) between changes on each outcome during the long-term follow-up (post-follow-up; and pre-follow-up) showed no significant differences in the decrease between post-intervention and follow-up data between the study groups. On the other hand, the intergroup comparison between pre-intervention and follow-up data revealed significant differences in almost all mobility measures of the BASMI index (except for cervical rotation) and in the BASFI index, in favor of the experimental group. CONCLUSIONS: An exercise regimen based on the Global Posture Reeducation method and focusing on specific strengthening and flexibility exercises of the shortened muscle chains offers promising short- and long-term results in the management of patients who have ankylosing spondylitis.     

强直性脊柱炎患者血清白细胞介素-33及可溶性ST2表达水平及意义

目的通过检测强直性脊柱炎（AS）患者血清白细胞介素（IL）-33及可溶性ST2（sST2）水平,探讨IL-33及sST2在AS发病中的作用。方法收集90例AS患者[男72例,女18例,平均年龄（32±10）岁]和30例健康对照者[男22例,女8例,平均年龄（30±14）岁]血清标本,应用酶联免疫吸附试验（ELISA）检测血清IL-33及sST2水平;同时测定红细胞沉降率（ESR）、血清C反应蛋白（CRP）以及应用BASDAI指数评价AS疾病活动度,分析几．33和sST2与ESR、CRP、BASDAI的相关性。结果AS患者血清m．33及sST2水平明显高于健康对照组（P〈0．0001）。在AS患者中,血清IL-33水平与BASDAI呈显著相关性（r=0．219,P〈0．05）,sST2水平与ESR、CRP及BASDAI呈显著相关性（r=0．256,P〈0．05;r=0．372,P〈0．01;r=0．569,P〈0．0001）。结论血清IL-33及sST2在AS的发病过程中起着一定作用,且可能与AS的病情活动有关。     

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.     

Effectiveness of Exercise Programs in Ankylosing Spondylitis: A Meta-Analysis of Randomized Controlled Trials

Objective

To assess the effectiveness of exercise programs on disease activity and function in ankylosing spondylitis (AS) by a systematic review and meta-analysis of randomized controlled trials (RCTs).

Postural control is altered in patients with ankylosing spondylitis

Background

Ankylosing spondylitis is a chronic inflammatory disorder that can lead to increased axial and peripheral joint stiffness, impairing joint mobility. Impaired axial mobility due to vertebral ankylosis may result in changes in standing postural control. Little research has addressed changes in standing postural control in the ankylosing spondylitis population, nor how these issues might affect clinical understanding and treatment.

Methods

Sixteen ankylosing spondylitis patients, and 17 healthy controls participated. Each individual completed two 120-second quiet standing trials with eyes open and eyes closed, while standing upon two force platforms. Net center of pressure displacement and mean power frequency in the frontal and sagittal planes were calculated. A Spearman's rank correlation analysis was performed between net center of pressure measures and several clinical measures of disease activity.

Findings

Frontal plane net center of pressure displacement and frequency content, and sagittal plane net center of pressure displacement were significantly greater within the ankylosing spondylitis patient group. Ankylosing spondylitis patients demonstrated a significant increase in frontal plane net center of pressure displacement in the eyes-closed condition. Net center of pressure displacement and frequency were significantly correlated to the Bath Ankylosing Spondylitis Functional Index, and individual components of the Bath Ankylosing Spondylitis Metrology Index.

Interpretation

Quiet standing postural control was altered particularly so in the frontal plane in patients with ankylosing spondylitis, which may be associated with increased fall risk. Posturographic measures of postural control may serve as valuable clinical tools for the monitoring of disease progression and disease status in ankylosing spondylitis.     

血清非磷酸化MGP蛋白（dpMGP）对强直性脊柱炎的诊断意义

目的研究强直性脊柱炎（AS）患者血清dpMGP浓度水平及其诊断价值,探索dpMGP与AS炎症与骨化病程的关系。方法将82例AS病人及75例健康对照纳入该横断性研究。评估AS病人各项临床指标（年龄、性别、病程、疾病活动度）以及反映骨代谢或炎症的生物标记（血沉（ESR）、C反应蛋白（CRP）、骨钙素（OC）、骨碱性磷酸酶（BALP））。疾病活动度依据BASDAI评分标准。利用竞争性ELISA法检测AS病人dpMGP血清浓度。将上述指标与对照组进行比较性分析。利用ROC曲线回归分析dpMGP作为AS诊断指标的价值。通过运用统计学相关分析的方法,研究dpMGP及AS炎症与骨重建病程关联。结果 AS患者dpMGP浓度（mean（SD）,9.2（2）nmol/l）低于对照组（mean（SD）,13.7（4.5））,P〈0.01。同样结果见于20-40岁（mean（SD）,9.6（2）nmol/l）及40-60岁（mean（SD）,9（2.1）nmol/l）年龄组。两年龄组dpMGP浓度比较差异并不明显。ROC曲线回归分析显示dpMGP=11.5nmol/l（截断点）时诊断特异性及敏感性分别为83%、88%,youden指数为0.56,AUC为0.81,其诊断效力可为中级。炎症相关生物标记ESR、CRP,以及骨重建相关生物标志BALP、OC与dpMGP关联性并不明显。结论 AS病人血清dpMGP可作为一种新的血清诊断指标及反映骨化进展的生物标志。     

扩散峰度成像在评价强直性脊柱炎骶髂关节病变炎性活动中的价值

目的探讨扩散峰度成像(diffusion kurtosis imaging,DKI)在评价强直性脊柱炎(ankylosing spondylitis,AS)骶髂关节病变炎性活动中的价值。材料与方法纳入符合诊断强直性脊柱炎标准的患者31例,其中男性21例,女性10例,根据患者临床生化指标红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)和BASDAI(Bath Ankylosing Spondylitis Disease Activity Index)评分分为活动组和稳定组。分别行MRI扫描(T2-weighted imaging、DKI)。在T2WI上观察双侧骶髂关节病变的影像学表现。计算BASDAI评分和加拿大脊柱关节研究协会(Spondyloarthritis Research Consortium of Canada,SPARCC)评分并行相关性分析。测量平均峰度值(mean kurtosis,MK)、平均扩散系数(mean diffusivity,MD)和表观扩散系数(apparent diffusion coefficient,ADC)并进行统计学分析。结果所有AS患者双侧骶髂关节均受累,关节面下骨质不同程度骨髓水肿,在13例稳定组中,有8例出现了关节面骨质吸收和2例关节面下囊变。骨髓水肿在T2WI、DKI和DKI-ADC图上均显示高信号或稍高信号。AS患者的SPARCC和BASDAI评分具有较强的相关性(P0.01)。稳定组MK、MD和ADC值分别为1.03±0.05、(1.37±0.04)×10~(-3) mm~2/s和(0.98±0.18)×10~(-3) mm~2/s,活动组为0.89±0.03、(1.4±0.04)×10~(-3) mm~2/s和(1.32±0.18)×10~(-3) mm~2/s。活动组和稳定组的MK和ADC值差异具有统计学意义(P0.05),而MD值差异则不具有统计学意义(P0.05)。结论 DKI可以作为评价AS活动性的一种有效方法,MK和ADC值能为AS的诊断、鉴别和疾病疗效的评估提供帮助,有望成为AS潜在的"影像生物学标记"。     

彩色多普勒在脊柱关节病患者疾病活动性评价中的作用

背景脊柱关节病是一组累及脊柱、外周关节、关节周围结构及关节外组织的疾病,多侵犯青壮年男性,发病率及致残率均较高.对脊柱关节炎患者进行疾病活动性评估,对指导治疗和提示预后均有重要意义,但目前临床上对脊柱关节炎至今尚无一种普遍认同的疾病活动性评估标准.目的探讨彩色多普勒超声在脊柱关节炎患者疾病活动性判断中的作用. 设计以患者为研究对象的非随机自身对照的临床研究.单位所有患者均为中山大学附属第三医院风湿科门诊或住院患者,超声检查也均在该院超声科进行.对象纳入满足1991年欧洲脊柱关节病研究组关于脊柱关节炎的分类标准并愿意接受附着点彩色多普勒超声检查的脊柱关节炎患者共30例,其中男24例,女6例.方法采用彩色多普勒超声和半定量法对每例脊柱关节炎患者下肢18个附着点的血流进行测定,超声检查前先抽血查血沉、C反应蛋白,并同时评定毕氏强直性脊柱炎疾病活动指数.主要观察指标观察脊柱关节炎患者肌腱韧带附着点血流、血沉、C反应蛋白及毕氏强直性脊柱炎疾病活动指数相互之间的相关关系.结果30例脊柱关节炎患者中有80.0%的脊柱关节炎患者至少在1个附着点检测到异常血流;全部受检的540个附着点中,84个呈血流阳性,阳性率为15.6%;患者各个附着点血流值的总和与血沉、C反应蛋白、毕氏强直性脊柱炎疾病活动指数总评均存在正相关,其相关系数分别为0.658,0.428和0.821(P均＜0.05);血沉和C反应蛋白与毕氏强直性脊柱炎疾病活动指数总评间也存在正相关,其相关系数分别为0.675和0.368(P均＜0.05);附着点血流与毕氏强直性脊柱炎疾病活动指数总评的相关程度均较血沉、C反应蛋白与毕氏强直性脊柱炎疾病活动指数总评高.结论利用彩色多普勒超声测定脊柱关节炎患者下肢附着点血流,可反映脊柱关节炎患者疾病活动性,为临床选择治疗方案提供依据,对脊柱关节炎患者的疗效观察和预后判断也有重要意义.     

Nurse-Guided Completion of the BASDAI Questionnaire in Ankylosing Spondylitis Patients with Low Literacy

The objective of this study was to assess nurse-guided patient completion of the Bath Ankylosing Spondylitis Activity Index (BASDAI). Between April and June 2008, all consecutive patients diagnosed with ankylosing spondylitis in a university clinic who were over 18 years old were enrolled in this study. Demographic data and socioeconomic status were collected by a questionnaire. First, the BASDAI forms were completed by the patient (self-report). The forms were completed again by the patient, this time with the guidance of an experienced study nurse (nurse-guided). If the absolute value of difference of self-reported and nurse-guided BASDAI was $ 1 cm (the minimum clinically important difference), these patients were defined as discordant. One hundred sixty-two patients (101 male, 62%; 61 female, 38%); mean age 35.6 years (standard deviation [SD] 11.4); and with a mean disease duration of 12.7 years (SD 7.8), were enrolled in the study. Mean BASDAI scores were no different between self-reported (3.07, SD 2.31) and nurse-guided (2.89, SD 2.31) scores. Thirty-eight patients (23.4%) had discordant results. Comparing the discordant to non-discordant patients, the discordant patients had more active disease (53% versus 27%, P = 0.004); were older (39 years, SD 11, versus 34 years, SD 11, P = 0.029); were more frequently female (58% versus 32%, P = 0.003); had # 8 years' education (55% versus 22%, P < 0.001); and read the newspaper less (24% versus 50%, P = 0.005), respectively. After logistic regression analysis, the main factors explaining the discordance were: length of education, 3.1 (range 1.21–7.88); age, 1.19 (range 0.97–1.46); and frequency of newspaper reading, 2.63 (0.96–7.18). The BASDAI should be carefully evaluated in older patients with low literacy, and nurse-guided questionnaire completion may be an alternative approach in this subgroup.     

Inverse correlation between CD4+ CD25high CD127low/- regulatory T-cells and serum immunoglobulin A in patients with new-onset ankylosing spondylitis

This study investigated the role of regulatory T (T(reg)) cells in patients with new-onset, treatment-na?ve ankylosing spondylitis (AS). Levels of CD4(+)CD25(high)CD127(low/-) T(reg) cells in the peripheral blood of 14 AS patients and 18 age-matched healthy volunteers were investigated by flow cytometry and correlations with serum levels of immunoglobulin A (IgA) and AS activity, as assessed by the Bath AS Disease Activity Index (BASDAI), were analysed. The number of peripheral blood CD4(+)CD25(high)CD127(low/-) T(reg) cells in AS patients was found to be significantly lower than in healthy controls and was inversely correlated with serum IgA levels. There was no significant correlation between CD4(+)CD25(high)CD127(low/-) T(reg) cell numbers and BASDAI scores. It is concluded that CD4(+)CD25(high)CD127(low/-) T(reg) cells may play a role in the pathogenesis and activity of AS.     

强直性脊柱炎患者股骨密度与腰椎椎体骨折的相关性

目的:之前的观点认为强直性脊柱炎患者易发生椎体骨折是由于其继发性弥漫性的骨质疏松,而近年对强直性脊柱炎患者的骨矿物密度和椎体骨折的研究发现,两者之间并无相关性.文章旨在调查强直性脊柱炎患者腰椎椎体骨折与临床、实验室及影像学指标的相关性.方法:对65例强直性脊柱炎患者及62例健康体检者进行对比观察,每例受试者均拍摄腰椎平片判断有无椎体骨折,评估疾病活动性包括C-反应蛋白、血沉水平、指地距、Schober指数、Bath指数以及韧带骨赘评分,应用双能X射线吸收法测定腰椎及股骨骨密度.结果:65例强直性脊柱炎中有10例出现腰椎椎体骨折,占15.4%,其中楔形变4例,双凹畸形6例.强直性脊柱炎患者的腰椎和股骨骨密度均明显低于对照组(P<0.01).有椎体骨折和无椎体骨折的强直性脊柱炎患者相比,其Schober指数、指地距、Bath指数、韧带骨赘评分以及转子间骨密度差异均有显著性意义(P<0.01).多元Logistic回归分析发现,强直性脊柱炎患者转子间骨密度与腰椎椎体骨折的发生有独立相关性(P=0.041).结论:强直性脊柱炎的股骨尤其是转子问低骨密度值与腰椎椎体骨折发生的危险性具有相关性.