核素骶髂关节显像对强直性脊柱炎治疗监测的价值

目的 利用核素骶髂关节显像以及骶髂关节与骶骨的核素比值测定方法，探讨其在强直性脊柱炎(AS)治疗监测中的价值。方法 29例临床及CT确诊AS的病人，共58个骶髂关节，先行核素骶髂关节显像及其核素比值测定，然后进行临床药物治疗。治疗后2周再行同样的核素检查方法，观察其变化情况。结果 58个骶髂关节中，有51个骶髂关节示放射性核素呈不同程度浓聚，骶髂关节与骶骨放射性比值明显高于正常；2周后的检查所见其中原有异常的骶髂关节情况明显改善，有51个骶髂关节与骶骨比值均有降低，其中47个降至正常范围。两组比较差异有显著意义。结论 核素骶髂关节显像及其骶髂关节与骶骨核素比值测定，对骶髂关节炎的活动性监测具有重要的应用价值。     

强直性脊柱炎髋关节软组织的扫描电镜和X线能谱观察及其临床意义

目的：采用扫描电镜—Ｘ线能谱联机观察强直性脊柱炎（ＡＳ）髋关节囊和滑膜组织的病理变化，用以指导临床治疗。方法：对６例年青ＡＳ病人的髋关节囊和滑膜组织进行固定、干燥、喷金行扫描电镜观察，并用２例老年股骨头坏死髋关节炎的同名组织作对照。对扫描图象中的组织进行Ｘ线能谱扫描以确定是否存在钙颗粒。结果：ＡＳ组的关节囊和滑膜组织中胶原排列紊乱，其间有钙颗粒沉积。而对照组同名组织仅见胶原排列紊乱，Ｘ线能谱显示无钙峰出现。结论：青年ＡＳ病人髋关节囊和滑膜组织均有成骨现象发生，而老年股骨头坏死髋关节炎同名组织无成骨现象。这种软组织病理变化是影响ＡＳ髋关节功能的主要原因。其关节清理术需将关节囊和滑膜全部切除。     

全髋关节置换治疗强直性脊柱炎髋关节病变的研究进展

强直性脊柱炎是一种好发于青少年男性的血清阴性脊柱关节病，常见症状为腰骶僵硬和疼痛，晚期可发生脊柱强直和四肢大关节改变。自20世纪70年代采用人工全髋关节置换手术治疗强直性脊柱炎患者髋关节病变以来，现已逐渐成为其主要治疗方式。由于强直性脊柱炎患者髋关节局部及全身多系统病变的特殊性。其手术指征、手术方式、假体选择及对手术远期效果与手术并发症的预测仍存在争议。本文时国内外各项研究进展进行综述。     

流式细胞术检测HLA-B27抗原在AS诊断中的应用

目的利用流式细胞术(FCM)检测不同患者T淋巴细胞表面HLA-B27抗原,与传统的血清法(微量淋巴细胞毒试验)比较,评价FCM检测HLA-B27在强直性脊柱炎(AS)诊断中的应用价值。方法采用荧光标记的HLA-B27单抗与T淋巴细胞表面的HLA-B27抗原结合,利用FCM专门分析软件测定HLA-B27-FITC平均荧光强度(FMI),从而间接定量HLA-B27表达情况,并采用血清法对118例AS患者标本进行HLA-B27检测。结果AS患者HLA-B27阳性率为88.9%(105/118),男女比例为5.25∶1,同其他各组比较均有较显著的差异(P<0.01);两种方法比较无明显差异(P>0.1)。结论利用FCM对疑为AS的患者进行HLA-B27抗原检测有助于AS的诊断,方法简便,稳定性好,重复性高,是目前较为理想的方法。     

强直性脊柱炎56例临床分析

目的:总结强直性脊柱炎(AS)的临床特点,提高诊治水平.方法:回顾性分析56例强直性脊柱炎患者的临床资料.结果:56例强直性脊柱炎中,男50例,女6例,平均发病年龄28岁;首发症状为慢性腰痛者43例占76.78%;关节外表现仅见虹膜炎10例占17.85%;骨盆正位片全部有骶髂关节炎占100%;HLA-B27阳性52例占92.85%;25例误诊占44.64%;治疗药物主要有非甾体类抗炎药(NSAIDs)、柳氮磺胺吡呤(SSZ)、甲氨蝶呤(MTX)、糖皮质激素等.结论:强直性脊柱炎多见于青年男性,其首发症状多为慢性腰痛,临床易误诊,骨盆正位片、骶髂关节炎及HLA-B27阳性有助于早期诊断和治疗.     

强直性脊柱炎并骨质疏松97例临床观察

研究强直性脊柱炎(AS)骨质疏松和骨量减少的发生情况、相关因素及与骨代谢指标的关系.选97例AS患者作为观察组,分别检测其血沉(ESR)、C-反应蛋白(CBP)、HLA-B27、血钙(Ca)、血磷(P)、碱性磷酸酶(ALP),并进行全身疼痛评分、中医症状积分评定和晨僵时间、BATH功能指数(BASFI)、病情活动指数(BASDI)、颌柄距、指地距、枕墙距、Schober试验、胸阔活动度、脊柱活动度;用双能X线法(DEXA)测定腰椎、股骨颈、股骨转子部、Ward's三角区骨密度(BMD),检测骨钙素(BGP)、降钙素(H-CT)、甲状旁腺激素(PTH);42例检测了尿脱氧吡啶啉(D-Pyr).选102名健康人作为对照组,分别测定其腰椎、股骨颈、股骨转子部、Ward's三角区骨密度(BMD),31例检测了BGP、PTH、D-Pyr、Ca、P、ALP.结果AS患者发生骨质疏松者42例(42.27%),骨量减少者36例(37.11%);AS患者BGP较对照组显著降低,并与腰椎、股骨近端BMD呈正相关.PTH、尿D-Pyr较对照组显著增高,并与股骨近端BMD呈负相关.AS患者中急时相反应物ESR与腰椎、股骨近端BMD呈显著负相关,CBP与AS患者腰椎、股骨颈、三角BMD呈显著负相关,ESR、CRP与尿D-Pyr呈显著的正相关.腰椎BMD与全身疼痛评分、中轴关节压痛指数呈负相关性,股骨近端BMD与指地距、BASFI、BASDAI呈显著负相关,与Schober试验、脊柱活动度呈显著正相关.AS患者的腰椎BMD与HLA-B27显示了负相关性.表明骨质疏松或骨量减少在AS中普遍存在,其发生与遗传、废用、免疫炎症等因素相关.AS患者骨代谢的失衡以骨生成的减少、骨吸收的增加为特点;PTH的增高及免疫炎性反应与AS患者骨吸收的增加有关.     

CLINICAL OBSERVATION ON 40 CASES OF ANKYLOSING SPONDYLITIS TREATED WITH ACUPUNCTURE AND CHINESE DRUGS

Ankylosing spondylitis(AS)is a systemic dis-ease marked by chronicinflammation of the sacro-iliacjoint and the spinal column.Its pathologic changesare inflammation of the attachment point of the mus-cle tendons and ligaments,rigidity,deformity andeven severe dysfunction of the spineinthelate stage.This disease is mostly seenin young and middle-agedpeople,possesses an obviousfamilial disposition andisclosely related to human leukocyte antigen(HLA)-B27.But its pathogenic causes remain unknown …     

何世东治疗强直性脊柱炎临床经验

强直性脊柱炎是脊柱关节炎常见的临床类型,好发于青年男性,以中轴关节受累为主,可伴发关节外表现,严重者可发生脊柱畸形和关节强直,是一种慢性炎症性疾病。何老临证潜心研究,注重强直性脊柱炎病变的核心,从临床常见的证型着手,攻克难治之疾,何老认为该病根源在于肾虚,肾虚累及肝脾,脾胃不足则后天之气血精微无以生化,筋脉骨骼失去滋养。肝不足则血虚,继而筋脉失养,发生该病。     

ERAP1 reduces accumulation of aberrant and disulfide-linked forms of HLA-B27 on the cell surface

ObjectiveEndoplasmic reticulum (ER) aminopeptidase 1 (ERAP1) variants contribute to the risk of ankylosing spondylitis in HLA-B27 positive individuals, implying a disease-related interaction between these gene products. The aim of this study was to determine whether reduced ERAP1 expression would alter the cell surface expression of HLA-B27 and the formation of aberrant disulfide-linked forms that have been implicated in the pathogenesis of spondyloarthritis.MethodsERAP1 expression was knocked down in monocytic U937 cells expressing HLA-B27 and endogenous HLA class I. The effect of ERAP1 knockdown on the accumulation HLA-B alleles (B18, B51, and B27) was assessed using immunoprecipitation, isoelectric focusing, and immunoblotting, as well as flow cytometry with antibodies specific for different forms of HLA-B27. Cell surface expression of aberrant disulfide-linked HLA-B27 dimers was assessed by immunoprecipitation and electrophoresis on non-reducing polyacrylamide gels.ResultsERAP1 knockdown increased the accumulation of HLA-B27 on the cell surface including disulfide-linked dimers, but had no effect on levels of HLA-B18 or -B51. Antibodies with unique specificity for HLA-B27 confirmed increased cell surface expression of complexes shown previously to contain long peptides. IFN-γ treatment resulted in striking increases in the expression of disulfide-linked HLA-B27 heavy chains, even in cells with normal ERAP1 expression.ConclusionsOur results suggest that normal levels of ERAP1 reduce the accumulation of aberrant and disulfide-linked forms of HLA-B27 in monocytes, and thus help to maintain the integrity of cell surface HLA-B27 complexes.