TLR-2、TLR-4在强直性脊柱炎患者外周血单个核细胞中的表达及其临床意义

目的：探讨TLR-2和TLR-4在AS患者PBMC中的表达及其临床意义。方法：选择AS患者及健康志愿者各30例,分为AS组和健康对照组。采用RT-PCR及蛋白免疫印迹技术检测两组受检者PBMC中TLR-2和TLR-4的表达水平。结果：As组TLR-2mRNA、TLR4mRNA表达水平分别为1．59±1．43、0．60±0．73,均高于健康对照组的0．06±0．04、0．06±0．39（JP均〈0．05）。AS组TLR-4蛋白表达水平为12．0±8．6,高于健康对照组的4．5±2．1（P〈0．05）。AS患者的BASDAI、BASFI与TLR-2mRNA表达水平呈正相关（r分别为0．759、0．664,P〈0．01）;AS患者的BASDAI与TLR-4mRNA表达水平呈正相关（r=0．347,P〈0．01）。结论：AS患者TLR-2、和TLR-4的表达水平高于健康志愿者,并与其自身疾病活动性存在一定程度的相关性,TLR-4或许可以作为评估AS病情活动的有价值的参考指标。     

近期肺炎衣原体感染与强直性脊柱炎疾病活动的研究

目的 研究近期肺炎衣原体感染与强直性脊柱炎(AS)疾病活动的关系.方法 测定79例门诊AS患者和73名健康者血中IgM、IgA和IgG抗肺炎衣原体抗体(CpIgA,CpIgM和CpIgG).收集临床和实验室资料以及疾病活动指数(BASDAI).阳性CpIgM或CpIgA抗体被认为存在近期肺炎衣原体感染.Wilcoxon检验、x2检验、Fisher确切概率法、t检验、方差分析和多因素回归分析用于数据分析.结果 89%(70/79)的AS患者和92%(67/73)的健康者均存在CpIgG抗体,但AS患者CpIgA和CpIgM阳性率[分别为52%(41/79)、80%(63/79)]明显高于健康者[分别为32%(23/73)、21%(15/73)](x2=6.61,P=0.010;x2=44.0,P＜0.01).其中CpIgM相对危险度(OR)=17.1,95%可信区间(CI)7.4～39.5;CpIgA的OR=3.1,95%CI 1.3～7.2.此外,阳性CpIgM抗体与疾病活动有关,且CpIgM转阴伴随疾病活动指数下降.CpIgM或CpIgA与外周关节病变和肌腱附着点无关.结论 近期肺炎衣原体感染与AS高度相关,CpIgM抗体与疾病活动有关,提示近期肺炎衣原体感染是诱发AS疾病活动的关键因素之一.

Abstract：

Objective To investigate the relationship between recent chlamydia pneumoniae (Cp)infection and active ankylosing spondylitis (AS). Methods Seventy nine AS outpatients and 73 normal controls (NC) were enrolled into this study. Serum anti-Cp antibodies (CpIg) were tested using the enzymelinked immunosorbent assay (ELISA). Clinical and experimental data were collected. Patients with positive CpIgM or CpIgA were considered as having a recent Cp infection. Wilcoxon test, Student's t test, χ2 test and multivariate logistic regression were used for statistical analysis. Results Both AS patients and normal controls had a high prevalence for sero-positive CpIgG, which was 89％(70/79) vs 92％(67/73) respectively,while AS patients had a higher frequency of CpIgA and CpIgM when compared with NC [52％(41/79) vs 32％(23/73), χ2=6.61, P=0.010 for CpIgA; 80％(63/79) vs 21％(15/73), χ2=44.031, P＜0.01 for CpIgM]. The presence of CpIgM or CpIgA favored AS, the OR was 17.1 (95％CI 7.4～39.5), or 3.1 (95％CI 1.3～7.2),respectively. In addition, CpIgM was associated with disease activity parameters including ESR (χ2=2.56, P=0.021), CRP (χ2=7.28, P=0.007) and BASDAI (χ2=6.79, P=0.009). Furthermore, consecutive positive CpIgM favored the persistent active or relapsed disease, while negative CpIgM favored a reduced disease activity.There was no correlation between CpIgM/CpIgA and peripheral joint disease and enthesitis. Conclusion Recent Cp infection is highly associated with AS and CpIgM antibody relates with active AS, which indicates that Cp infections may be a critical triggering factor for active AS.     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合改善病情抗风湿药治疗中国人群风湿性疾病的安全性研究

目的 评价注射用重组人Ⅱ型肿瘤坏死因子α受体-抗体融合蛋白(rhTNFR:Fc)治疗大样本量风湿性疾病患者的安全性.方法 观察从2006年5月至2009年3月间使用rhTNFR:Fc治疗的类风湿关节炎(RA)、强直性脊柱炎(AS)、幼年特发性关节炎(JIA)和银屑病关节炎(PsA)患者治疗期间内所发生的不良事件.结果 共对2041病例患者进行观察,其中RA 1388例,AS 421例,其他232例.其中RA中不良事件发生率为13.47％,最常见的为注射部位反应(2.67％)、皮疹(1.87％)和转氨酶升高(1.80％).AS总的不良事件发生率为10.45％,常见的是注射部位反应(5.23％)、转氨酶升高(2.38％)和皮疹(0.71％).全部感染的发生率为2.40％,最常见的感染为上呼吸道感染.本次研究中未观察到严重不良事件、死亡、结核病和恶性肿瘤的发生.结论 rhTNFR:Fc治疗RA、AS等风湿性疾病具有良好的安全性.     

两种输液滴速调节方法在类克治疗强直性脊柱炎中的应用比较

目的比较类克(注射用英夫利西单抗)推荐药液滴速控制和均匀滴速控制在类克治疗强直性脊柱炎(AS)中的应用,寻求一种安全、有效、简捷的类克输液治疗方法,便于临床操作使用。方法选用类克治疗的强直性脊柱炎患者122例次,随机分为两组,每组各61例次。对照组采用类克推荐药物滴速控制,实验组采用均匀滴速控制,比较两组的不良反应发生率、输液时间、患者满意度、护士满意度。结果两组不良反应率无显著差异(P>0.05),输液时间符合药物使用要求,实验组患者满意度、护士满意度明显提高(P<0.05)。结论均匀滴速控制在类克输注中应用方便、安全、简捷,护患满意度高,值得推广。     

Pelvis-shoulder coordination during level walking in patients with ankylosing spondylitis

Pelvis-shoulder coordination while walking may, as a consequence of changes in spinal structure and posture, be susceptible to modifications in ankylosing spondylitis (AS) sufferers. We designed an explanatory, cross-sectional trial to assess whether Pelvis-shoulder coordination during walking in AS patients differs from that in healthy subjects. Seventeen AS patients and 10 healthy sex- and age-matched subjects were enrolled. Gait analysis was performed in order to define the time-distance and kinematic characteristics during walking. Pelvis-shoulder coordination was calculated in terms of the continuous estimate of relative phase (CRP) between the pelvis and shoulder girdles on the transversal plane for the whole gait cycle (GC), as well as for its sub-phases. No differences were found between patients and controls as regards mean velocity, cadence and stride length. When kinematic variables were compared with those of healthy controls, AS patients displayed greater pelvic tilt and increased hip flexion in both the loading response (LR) and pre-swing (PSw) sub-phases. The CRP mean values significantly differed between groups. Moreover, patients displayed a peculiar CRP pattern, chiefly in the LR, terminal stance and PSw sub-phases. This visual consideration was confirmed by the analysis of the CRP mean values in these sub-phases of the GC. Our results suggest that the walking pattern of AS patients is characterized by altered Pelvis-shoulder coordination during the GC.     

Potential utility of anti‐TNF drugs in synovial chondromatosis associated with ankylosing spondylitis

We describe a previously unreported association of ankylosing spondylitis with synovial chondromatosis, and briefly review previously reported cases and treatment of synovial chondromatosis in patients with other immune‐mediated inflammatory arthritides. A 20‐year‐old man with ankylosing spondylitis whose axial disease was in remission with nonsteroidal anti‐inflammatory drugs and oral disease‐modifying anti‐rheumatic drugs developed recurrent right knee pain and swelling. Magnetic resonance imaging of his right knee revealed calcified loose bodies, suggestive of synovial chondromatosis. While waiting for the surgical intervention and other invasive therapy previously reported in patients with synovial chondromatosis, a trial of etanercept eliminated the pain and swelling of the knee; however, the loose bodies have persisted during the 2‐year follow‐up. Thus, synovial chondromatosis should be considered in the differential diagnoses of a refractory monoarticular pain and swelling in patients with otherwise controlled inflammatory arthritis. Our report advocates a trial of anti‐tumor necrosis factor drugs, which might delay the need for invasive therapy in patients with synovial chondromatosis.