轻度慢性乙型肝炎患者肝脏细胞外基质和超微结构改变与临床相关性分析

目的 探讨轻度慢性乙型肝炎(chb)患者细胞外基质和肝脏超微结构改变与临床的相关性.方法 选择慢性hbv感染者为研究对象,将其分为轻度chb组(66例)和慢性hbv携带组(10例).对所有患者采集血清,并行肝穿刺活检,光镜和电镜下观察样本,将结果与血清生化学等指标进行对比分析.计量资料比较采用t检验,计数资料比较采用χ2检验,等级资料相关性使用非参数spearman 分析.结果 轻度chb组和慢性hbv携带组在alt和ast两项指标上比较差异有统计学意义(t=12.42和7.06,p＜0.05),但hbv dna水平差异无统计学意义(t=0.24,p＞0.05).两组患者血清肝纤维化指标(透明质酸、Ⅲ型胶原、Ⅳ型胶原和层黏连蛋白)差异均无统计学意义(t=0.45、0.95、0.76和1.21,p值均＞0.05).光镜组织学结果显示,轻度chb组中,g2、s2以上的患者为33例,慢性hbv携带组为2例,两组差异有统计学意义(χ2=4.17,p＜0.05).轻度chb组s3～4的患者(17例)明显多于慢性hbv携带组(0例,χ2=4.75,p＜0.05).电镜超微结构表现,狄氏间隙胶原纤维增生、汇管区扩大、贮脂细胞增生等反映肝脏纤维化相关的指标与光镜下纤维化分级相关系数分别为0.351、0.675和0.301(p值分别为0.004、0.000和0.014).结论 电镜下肝脏超微结构改变敏感性较光镜高,对轻度chb患者的病情评估具有重要价值. abstract： objective to investigate the correlations of extracellular matrix and hepatic ultramicrostructural changes with clinical manifestations in patients with mild chronic hepatitis b (chb).methods patients with chronic hbv infections were enrolled and were divided into mild chb group (n=66) and hbv carrier group (n=10).serum samples were collected from patients, and serum hbv markers, hbv dna load and liver fibrosis indexes were measured.all subjects received liver biopsy, and the tissue samples were observed by light microscope and electron microscope.t test and χ2 test were performed for measurement data and enumeration data, respectively.spearman test was used for ranked data.results the differences on alt and ast levels between mild chb group and hbv carrier group were significant (t=12.42, 7.06, p＜0.05), but there was no significant difference on hbv dna load between two groups (t=0.24, p ＞ 0.05).serum liver fibrosis indexes (hyaluronic acid, type Ⅲ collagen,type Ⅳ collagen and laminin protein) in mild chb group were not significantly higher than those in hbv carrier group (t=0.45, 0.95, 0.76 and 1.21, p ＞0.05).in mild chb group, there were 33 patients with ≥g2 and ≥s2, but in hbv carrier group were only 2 patients (χ2=4.17, p ＜ 0.05).seventeen patients in mild chb group were with s3-4, while that was not observed in hbv carrier group (χ2=4.75, p ＜0.05).in mild chb group, hepatic ultramicrostrutural changes on fat storing cell, collagen protein and portal area were correlated with fibrosis grades, and the correlation coefficients were 0.351, 0.675 and 0.301, respectively (p=0.004, 0.000 and 0.014).conclusion electron microscope is of higher sensitivity than light microscope in observing hepatic ultramicrostructural changes, which is effective in evaluating the severity of mild chb.     

慢性乙型肝炎患者外周血cd8+t细胞tim-3表达及意义

目的 分析慢性乙型肝炎(chb)患者外周血单个核细胞(pbmc)中cd8+t细胞免疫球蛋白和黏蛋白结构域分子-3(tim-3)的表达及其意义.方法 用流式细胞术检测58例chb患者和16名健康体检者pbmc中cd8+t细胞tim-3的表达水平.采用酶联免疫斑点试验(elispot)检测tim-3单克隆抗体阻断tim-3/tim-3l通路前后hla-a2阳性患者pbmc中产生ifnγ的hbv特异性细胞毒性t淋巴细胞(ctl)数量的改变.阻断前后斑点数量的比较采用配对t检验,定量资料用spearman非参数检验进行相关性分析.结果 chb患者pbmc中cd8+t淋巴细胞tim-3分子表达水平为(14.2±8.98)％,明显高于健康体检者的(4.80±2.92)％,差异有统计学意义(x2=92.48,p＜0.05).16例重度chb患者和42例轻度chb患者cd8+t细胞tim-3表达分别为( 19.54±10.95)％和(9.58±7.30)％,差异有统计学意义(x2=77.24,p＜0.05).tim-3单克隆抗体阻断tim-3通路前,chb患者pbmc中产生ifnγ的hbv特异性ctl数量为7.27 ±3.14,阻断后为19.62 ±4.97,差异有统计学意义(t=2.95,p ＜0.05).结论 chb患者pbmc中cd8+t细胞高表达tim-3分子抑制了hbv特异性ctl功能,阻断tim-3通路可以促进表达ifnγ的hbv特异性ctl增殖,增强抗病毒效应. abstract： objective to investigate the expression of t cell immunoglobulin-and mucin-domaincontaining molecule-3 (tim-3) in peripheral cd8 +t cells and its significance in patients with chronic hepatitis b (chb).methods fifty-eight chb patients and 16 healthy controls were enrolled.tim-3 expression in cds + t cells was detected by flow cytometry,and quantities of ifnγ-producing hbv-specific cytotoxic t lymphocytes (ctls) in hla-a2 positive subjects were detected by enzyme-linked immunosorbent spot (elispot) test before and after the blockade of tim-3/tim-3l pathway.paired t test was performed to compare the quantities of ctls before and after the blockade,and nonparametric spearman correlation analysis was performed to explore the correlation in quantitive data.results tim-3 expression in chb patients was (14.2 ± 8.98 )％,which was higher than that of healthy controls (4.80 ± 2.92)％,and the difference was of statistical significance (x2 =92.48,p ＜ 0.05 ) tim-3 expressions in 16 severe chb patients and 42 mild chb patients were ( 19.54 ± 10.95) ％ and (9.58 ± 7.30) ％,respectively,and the difference was statistically significant (x2 =77.24,p ＜ 0.05 ). before the blockade of tim-3/tim-3l pathway,ifnγ-producing hbv-specific ctls were 7.27 ± 3.14,and it increased to 19.62 ± 4.97 after the blockade ( t =2.95,p ＜ 0.05 ).conclusion the upregulation of tim-3 on peripheral cd8 + t cells may inhibit hbv-specific ctls,and the blockade of tim-3 pathway can enhance the proliferation of ifnγ-producing hbv-specific ctls,thus can enhance antiviral effect.     

细胞内外ifnγ和il-4在评估儿童慢性乙型肝炎th1/th2应答中的价值

目的 检测细胞内外ifnγ和il-4水平,评估慢性乙型肝炎(chb)和hbv携带患儿th1/th2应答状态.方法 收集2007年5月-2009年2月54例住院患儿,将其分为chb组(23例)和hbv携带组(31例),另外选取34名健康儿童作为对照.采用elisa法检测研究对象全血细胞外ifnγ和il-4,采用流式细胞术检测细胞内ifnγ和il-4.方差齐者行方差分析,不齐者行非参数kruskal-wallis检验分析.结果 elisa法检测发现,ifnγ、il-4水平和th1/th2比值在chb组、hbv携带组和健康对照组间差异无统计学意义(f=0.342、0.020和0.507,p值均＞0.05).流式细胞术检测发现细胞内ifnγ水平在chb组、hbv携带组和健康对照组分别为(7.68±4.62)、(11.71±4.36)和(13.61±6.71)μg/ml,th1/th2比值分别为0.96±0.30、1.67±0.76和2.11±1.12,差异有统计学意义(f=0.255和0.140,p＜0.05或＜0.01);il-4水平在三组间的差异无统计学意义(f=0.425,p＞0.05).结论 chb和hbv携带组患儿细胞内因子表达失衡,细胞免疫功能受到抑制.与elisa法相比,流式细胞技术能够更加真实、准确地反映th1和th2的应答状态. abstract： objective to evaluate extracellular and intracellular ifnγ and il-4 levels in assessing th1/th2 balance in children with chronic hepatitis b (chb) and asymptomatic carriers.methods fiftyfour hospitalized children including 23 chb patients and 31 asymptomatic carriers were collected from may 2007 to february 2009.thirty-four healthy children were served as control.serum ifnγ and il-4 levels were measured by enzyme-linked immunosorbent assay (elisa) and intracellular ifnγand il-4 levels were detected by flow cytometer.analysis of variance (for homogenous variance) and kruskal-wallis test (for non-homogenous variance) were performed.results the differences on extracellular ifnγ, il-4 and th1/th2 among chb, asymptomatic carriers and control groups were not statistically significant (f=0.342, 0.020 and 0.507, p ＞ 0.05); while the intracellular ifnγlevels were (7.68 ± 4.62), (11.71 ±4.36) and (13.61 ±6.71) μg/ml, and th1/th2 ratios were 0.96 ±0.30, 1.67 ±0.76 and 2.11 ± 1.12in three groups respectively (f=0.255 and 0.140, p ＜ 0.05 or ＜ 0.01).the differences in intracellular il-4 levels among three groups were not significant (f=0.425, p ＞ 0.05).conclusions cytokine balance is affected in chb children and asymptomatic carriers, and flow cytometry analysis is considered as a better method in evaluating the status of th1/th2 balance.     

抗-hbc阳性淋巴瘤患者化疗期间应用拉米夫定抗病毒治疗预防肝功能损害和hbv激活

目的 探讨拉米夫定对乙型肝炎核心抗体(抗-hbc)阳性淋巴瘤患者化疗后病毒激活和肝功能损害的预防作用.方法 79例hbsag(-)而抗-hbc(+)的淋巴瘤患者分为拉米夫定治疗组(37例)和对照组(42例).两组患者均进行联合化疗,期间观察肝功能损害和hbv激活情况,并用ssps 13.0软件进行统计学分析.结果 预防性应用拉米夫定治疗的37例患者中,化疗后出现肝功能损害Ⅰ～Ⅱ期11例(29.7%),Ⅲ～Ⅳ期2例(5.4%),hbv激活2例(5.4%),而且这2例患者均出现hbv ymdd基因变异.42例化疗时未进行抗病毒治疗的患者中,化疗后出现肝功能损害Ⅰ～Ⅱ期19例(45.2%),Ⅲ～Ⅳ期7例(16.7%),hbv激活12例(28.6%),与拉米夫定治疗组比较差异均具有统计学意义(χ2值分别为79.0、8.7和79.0,p值＜0.05或＜0.01).结论 hbsag(-)而抗-hbc(+)淋巴瘤患者进行化疗时预防性应用拉米夫定可以减少肝脏损害的发生和hbv的激活. abstract： objective to evaluate the effectiveness of lamivudine in preventing liver damages and hbv dna reactivation in anti-hbc positive lymphoma patients after chemotherapy.methods seventy-nine lymphoma patients who were negative in hbsag and positive in anti-hbc were enrolled and were divided into lamivudine group (n=37) and control group (n=42).both groups received chemotherapy.liver damages and hbv reactivation were observed, and the data were analyzed with software spss 13.0.results in lamivudine group, liver damages Ⅰ or Ⅱ was observed in 11 patients (11/37, 29.7%), and liver damages Ⅲ or Ⅳ was observed in 2 (2/37, 5.4%); two patients (2/37, 5.4%) developed hbv reactivation, and both of them had hbv ymdd mutations.in control group, 19 (19/42, 45.2%) patients experienced liver damages Ⅰ or Ⅱ, 7 (7/42, 16.7%) experienced liver damages Ⅲ or Ⅳ; 12 (12/42, 28.6%) patients experienced hbv reactivation, the differences between the two groups were of statistical significance (χ2=79.0, 8.7 and 79.0, p ＜ 0.05 or ＜ 0.01).conclusion lamivudine can reduce liver damages and hbv reactivation in hbsag negative and anti-hbc positive patients with lymphoma during chemotherapy.     

恩替卡韦治疗慢加急性乙型肝炎肝衰竭的疗效和预测因素研究

目的 评价恩替卡韦治疗慢加急性乙型肝炎肝衰竭的疗效以及影响疗效的相关因素.方法 108例慢加急性乙型肝炎肝衰竭患者分为恩替卡韦治疗组(53例)和对照组(55例),观察患者入组后48周内不同时点hbv dna载量、肝功能以及存活状况,应用cox regression模型分析影响恩替卡韦疗效的相关因素.结果 恩替卡韦治疗组和对照组共有70例患者死亡,其中66例发生在12周内.从第3周起,两组患者的累计生存率开始显示出统计学差异(88.7% vs.70.9%,χ2=5.357,p＜0.05).恩替卡韦治疗组48周累计存活率为47.2%(25/53),对照组为23.6%(13/55),两组比较差异有统计学意义(χ2=7.432,p＜0.01).恩替卡韦治疗组中,年龄≤40岁、总胆红素(tbil)＜513μmol/l、凝血酶原国际标准化比率(inr)＜2.5的患者死亡的相对危险度分别下降74.9%、75.3%和76.0%.结论 恩替卡韦可明显提高慢加急性乙型肝炎肝衰竭患者的生存率,患者年龄、胆红素水平和凝血功能是影响恩替卡韦疗效的主要因素. abstract： objective to evaluate the therapeutic efficacy and its related factors of entecavir treatment for patients with acute on chronic hepatitis b liver failure (achblf).methods one hundred and eight patients with achblf were enrolled and divided into entecavir group (n=53) and control group (n=55).hbv dna level, liver function and 48-week survival rate were observed, and c ox regression model was established to identify the factors which may affect the efficacy of entecavir treatment.results totally 70 patients died in the study and 66 died within 12 weeks.the statistical difference on cumulative survival rate between two groups was observed from the third week on (χ2=5.357, p ＜ 0.05).the 48-weekcumulative survival rate in entecavir group was 47.2% (25/53), while that in the control group was 23.6%(13/55) (χ2=7.432, p ＜ 0.01).in entecavir group, for patients aged ＜ 40 with serum bilirubin level ＜513 μnol/l and international normalized ratio (inr) ＜ 2.5, the fatality rates decreased 74.9%, 75.3%and 76.0%, respectively.conclusions entecavir may improve the survival rate of patients with achblf.age, serum bilirubin level and inr are major factors related to the therapeutic efficacy.     

慢性hbv感染者肝组织中smad蛋白的表达及其与肝纤维化的相关性

目的 观察smad2/3、smad4、磷酸化smad3( p-smad3)蛋白在人肝纤维化组织中的表达,探讨smad蛋白及其介导的生物学信号在肝纤维化发生中的作用机制.方法 以肝组织活检病理诊断区分131例慢性hbv感染者纤维化程度,免疫组化法检测肝组织中smad2/3、smad4和p-smad3蛋白的表达并进行定量分析.结果smad2/3、smad4、p-smad3蛋白主要见于纤维间隔、汇管区和中央静脉周围成纤维细胞、肝窦及部分肝细胞质内均可见表达.肝组织smad2/3、smad4、p-smad3蛋白与肝纤维化程度有非常显著性正相关(r分别是0.81、0.58和0.68,p=0.000).三种蛋白间也具有非常显著性正相关(r分别是0.75、0.87和0.84,p=0.000).结论 肝组织smad2/3、smad4、p-smad3蛋白表达与慢性hbv感染肝纤维化程度相关,smad2/3、p-smad3、smad4信号的增强可能促讲了肝纤维化的讲展. abstract： objective to evaluate the association of smad2/3,smad4 and p-smad3 protein expressions in tissue with liver fibrosis in patients with chronic hbv infections.methods liver biopsy was performed to determine the liver fibrosis grades in 131 cases of chronic hbv infections.immunohistochemistry and semiquantitative analysis were applied to detect the expression of smad2/3,smad4 and p-smad3 proteins in liver tissues.results smad2/3,smad4 and p-smad3 were detected mainly in fibrous septum,portal areas,myofibroblasts,sinus and cytoplasm in the liver tissue.the expression of smad2/3,smad4 and p-smad3 was increased with the development of fibrosis ( r =0.81,0.58and 0.68,p =0.000),and a strong positive correlation was observed among three proteins (r =0.75,0.87and 0.84,p =0.000).conclusion the expression of smad2/3,smad4 and p-smad3 is correlated with liver fibrosis in chronic hbv infection,which suggests that the up-regulation of smad proteins may be involved in the progression of liver fibrosis.     

toll样受体9基因多态性与hbv感染结局的相关性研究

目的 研究toll样受体(tlr)9基因单核苷酸多态性(snp)与hbv感染临床转归的相关性.方法 应用实时荧光定量pcr方法检测96例慢性乙型重型肝炎患者、156例慢性乙型肝炎患者和151例hbv感染自发清除者tlr9基因启动子区a-1923c、t-1486c、t-1237c 3个位点的snp分型,分析各位点的基因型及组间差异.计量资料采用方差分析,计数资料采用χ2或fisher精确概率法检验.结果 tlr9基因a-1923c位点ac基因型在慢性乙型肝炎组的频率(3.8%)低于hbv感染自发清除组(11.3%)(χ2=6.082,p＜0.05),但在慢性乙型重型肝炎组(8.3%)与hbv感染自发清除组间基因型频率分布没有统计学差异(χ2=0.552,p＞0.05);重型肝炎组与自发清除组、慢性乙型肝炎组与自发清除组间t-1486c和t-1237c位点的基因型频率分布差异无统计学意义(χ2值分别为1.534和0.745,p值均＞0.05).结论 tlr9基因a-1923c位点ac基因型与hbv感染的自发清除存在相关性,但与hbv感染的慢性化和重症化无明显相关性;t-1486c、t-1237c位点的基因多态性与hbv感染结局之间没有相关性. abstract： objective to investigate whether the clinical outcomes of hbv infection are associated with single nucleotide polymorphisms of toll-like receptor (tlr) 9 gene promoter region.methods the polymorphisms of three positions at tlr9 gene promoter region including a-1923c, t-1486c and t-1237c were detected using real-time fluorescence quantitative polymerase chain reaction in 96 patients with severe chronic hepatitis b, 156 patients with chronic hepatitis b and 151 cases of hbv spontaneous clearance, then the differences between the groups were analyzed.analysis of variance was performed for measurement data,and χ2 test or fisher exact probability test were used for enumeration data.results the frequency of ac genotype at tlr9 gene a-1923c site in chronic hepatitis b group was 3.8%, which was significantly lower than that in hbv spontaneous clearance group (11.3%) (χ2=6.082, p ＜ 0.05), but no significant difference was found between severe chronic hepatitis b group (8.3%) and hbv spontaneous clearance group (χ2=0.552, p ＞0.05).no significant differences of genotype distribution were found between chronic severe hepatitis b group and hbv spontaneous clearance group , chronic hepatitis b group and hbv spontaneous clearance group at polymorphism sites of t-1486c and t-1237c (χ2=1.534 and 0.745, p ＞ 0.05).conclusions genotype ac at tlr9 gene a-1923c site is associated with hbv spontaneous clearance, but not correlated with chronic hbv infection and liver failure; there is no correlation of polymorphisms in t-1486c and t-1237c at tlr9 gene promoter region with the clinical outcomes of hbv infection.     

乙型肝炎病毒基因s区准种特点与临床转归关系的初步研究

目的 初步探讨hbv基因s区的准种特点与乙型肝炎病毒(hbv)感染临床转归的关系.方法 选择慢性hbv携带者、慢性乙型肝炎患者、慢性重型肝炎患者各3例,所有患者均为男性,且hbv基因型均为c型.扩增患者血清中hbv基因s区片段并克隆,每份样本挑选20个克隆进行测序,并用spss 15.0软件进行统计分析.结果 慢性hbv携带者以及慢性乙型肝炎患者的hbv基因s区准种复杂度小于慢性重型乙型肝炎患者,但差异无统计学意义(t=1.7,p=0.26).对于hbv s区t细胞表位的第45、47和85位氨基酸,慢性乙型肝炎患者的准种构成情况比hbv携带者复杂(p=0.01),与慢性重型乙型肝炎的差别无统计学意义(p=0.06),计算机模拟分析提示优势克隆和非优势克隆的t细胞表位均能与ctl受体有效结合.结论 hbv基因s区部分t细胞表位的准种构成差异可能与hbv慢性感染的临床转归相关. abstract： objective to investigate the association of hepatitis b virus(hbv) s gene quasispecies with the outcome of hbv infection.methods serum samples were collected from three chronic hbv carriers, three chronic hepatitis b and three chronic severe hepatitis b patients.all subjects were male and with hbv genotype c.hbv s gene was amplified, and 20 clones of hbv fragment were randomly selected and sequenced from each sample.spss 15.0 software was adopted for analysis.results quasispecies complexity of hbv s gene in chronic hbv carriers and chronic hepatitis b tended lower than that of the severe chronic hepatitis b, but the difference was not of statistical significance (p＞0.05).in t cell epitope 45, 47, 85 amino acid sites of the hbv s gene, the constitution of quasispecies in the chronic hepatitis b was more complex than that of the hbv carriers (p=0.01), but compared with the severe chronic hepatitis, the difference was not significant (p=0.06).the computer model showed that both the dominant clones and the non dominant clones could effectively bind to the receptors of cytotoxic t lymphocytes.conclusion quasispecies in some t cell epitopes of hbv s gene may be related with the clinical outcome of hepatitis b.     

乙型肝炎肝硬化患者核苷(酸)类药物治疗期间新发肝癌的危险因素分析

目的 观察乙型肝炎肝硬化患者经核苷(酸)类药物治疗期间新发肝癌的情况,并分析其发病的危险因素.方法 采集中山大学附属第三医院2008年4月-2011年6月门诊随访的用核苷(酸)类药物抗病毒治疗的141例乙型肝炎肝硬化患者的病历资料,回顾性调查其人口学资料及临床指标,包括病毒学和生化学应答等,并采用单因素分析及多因素cox回归分析评估治疗期间新发肝癌的危险因素.结果 随访32.5个月(6.4 ～87.6个月),141例乙型肝炎肝硬化患者中,发生肝癌15例,肝癌的年平均发病率为3.8％.统计学分析显示,基线hbeag阳性和有肝癌家族史者核苷(酸)类药物抗病毒治疗期间新发肝癌的风险显著升高(rr=4.524和3.858,p＜0.05),是新发肝癌的独立危险因素.结论 乙型肝炎肝硬化患者口服核苷(酸)类药物抗病毒治疗仍有发生肝癌的风险,基线hbeag阳性和有肝癌家族史的患者发生肝癌的风险较高. abstract： objective to survey the incidence of hepatocellular carcinoma (hcc) in patients with hbv-related cirrhosis receiving nucleos(t)ide analogues treatment and to assess its risk factors.methods a total of 141 patients with hbv-related liver cirrhosis receiving nucleos(t) ide therapy from april 2008 to june 2011 were enrolled.the clinical data including virological and biochemical tests were retrospectively analyzed.univariate and multivariate cox proportional hazards regression model was used to identify the risk factors of hcc occurrence.results patients were followed up for 6.4 to 87.6 months with a median followup time of 32.5 months.during the follow-up period,15 out of 141 patients developed hcc with an average annual incidence rate of 3.8％.hcc incidence was higher in hbeag positive cirrhosis and in those with family history of liver cancer ( rr =4.524 and 3.858,p ＜ 0.05 ).conclusions patients with hbv-related cirrhosis have a high incidence rate of hcc even they recieve nucleos (t) ide analogues treatment.hbeag positive cirrhosis and family history of liver cancer are independent risk factors for hcc.     

肺炎衣原体感染与强直性脊柱炎相关的临床及病理研究

目的 研究强直性脊柱炎(as)患者体内血液循环和关节腔内肺炎衣原体感染情况,寻找肺炎衣原体导致as的临床证据.方法 收集33例as患者和22名健康献血者的外周血,酶联免疫法(elisa)检测血清中igg/igm抗体,免疫荧光法(ifa)和聚合酶链反应(pcr)检测外周血单个核细胞中衣原体脂多糖(lps)抗原和肺炎衣原体核酸,同时收集患者的临床资料.另采用免疫组织化学法检测9例髋关节置换的as患者和13例骨折患者滑膜中的衣原体lps抗原.结果 as患者外周血肺炎衣原体igm、lps和pcr的阳性率均显著高于健康献血者(分别为78.8％vs.22.7％,x2=16.867,p=0.000;66.7％vs.31.8％,x2 =6.431,p=0.011;33.3％vs.9.1％,x2 =4.298,p=0.038).肺炎衣原体pcr阳性与红细胞沉降率(esr)和c反应蛋白(crp)水平相关(z=-2.774 和-2.829,p值均为0.004).77.8％ (7/9)的as患者的滑膜中可检测到含有衣原体lps抗原的炎性细胞,而骨折患者滑膜中仅30.8％ (4/13)病例中检测到含有衣原体lps抗原的炎性细胞(p=0.08).结论 肺炎衣原体在as患者外周血和滑膜中有很高的感染率,肺炎衣原体感染可能与as 发病相关. abstract： objective to investigate the association of chlamydia pneumoniae infection with ankylosing spondylitis (as).methods serum samples were obtained from 33 as patients and 22 healthy controls.enzyme-linked immunosorbent assay (elisa) was applied to mearsure serum anti-chlamydia pneumoniae antibodies (igm/igg),while immunofluorescence assay (ifa) was used to detect chlamydia pneumoniae lps antigen,and polymerase chain reaction (pcr) was used to amplify chlamydia pneumoniae dna in peripheral blood cells. immunohistochemistical technique was applied to examine chlamydia pneumoniae lps antigen in synovial tissue from another 9 as patients who received total hip replacement and 13 patients with comminuted femoral fractures.results the positive rates of chlamydia pneumoniae igm,lps antigen and chlamydia pneumoniae dna were higher in as patients than those in healthy controls (78.8％ vs 22.7％,x2 =16.867,p =0.000; 66.7％ vs 31.8％,x2 =6.431,p =0.011; 33.3％ vs 9.1％,x2 =4.298,p =0.038).chlamydia pneumoniae dna positive rate was correlated with erythrocyte sedimentation rate (esr) and c-reactive protein (crp) levels (z =-2.774 and -2.829,p =0.004).in synovial tissues,chlamydial lps-containing inflammatory cells were observed in 77.8％ (7/9) as patients,while those in fracture patients was 30.8％ ( 4/13 ) ( p =0.08 ).conclusion chlamydia pneumoniae infection is common in blood circulation and joint cavity of as patients and may be associated with the pathogenesis of as.