强直性脊柱炎患者蛋白酶体基因表达的研究

目的：分析比较强直性脊柱炎（AS）患者与正常对照者之间蛋白酶体（proteasome)的基因表达及生物学功能的差异。方法：用快速蛋白质液相色谱法（FPLC法）分别从10个HLA－B27阳性家族中的AS患者及正常对照者（同一级亲属）的B淋巴细胞系中制备和纯化蛋白酶体，用反转录－聚合酶链式反应（RT－PCR）测定蛋白酶体基因的表达。用三氯乙酸（TCA）沉淀法测定不同的蛋白酶体对125I标记的HLA－B27的降解程度。结果：B27阳性家族中，AS患者与非AS对照者的B细胞内蛋白酶体亚单位LMP2 mRNA的表达差异无显著性，而LPM7和MECL1 mRNA的表达AS患者明显高于非AS对照者（P均＜0．0001），经干扰素（IFN）－γ刺激培养后，非AS对照者的LMP2－LMP7和MECL1mRNA的表达均显著增加（P值分别为0．007，＜0．0001和＜0．0001），而AS组这三种亚单位基因的表达增加均不明显，因此，在INF－γ刺激下AS与非AS组蛋白酶体基因的表达差异无显著性。免疫印迹分析表明AS患者LMP7及MECL1蛋白水平的表达也明显高于非AS对照者，LMP2蛋白的表达两组无明显差别，AS患者蛋白酶体的糜蛋白酶样活性明显增强，对B27的降解作用明显强于非AS的蛋白酶体，孵育4h时的平均降解率为81．8％，而非AS对照者的蛋白酶体的平均降解率为41．9％（P＜0．0001），结论：结果提示蛋白酶体亚单位基因的过度表达及生物学功能的亢进可能是导致HLA－B27阳性者AS发生和发展的重要因素之一。     

Spondylitis following vertebroplasty: a case report

Purpose: Spondylitis is a rare complication of vertebroplasty with only one case report having been published to date. We report a further case of spondylitis after vertebroplasty that was managed successfully with conservative therapy. Methods: The clinical course of a 55-year-old patient with secondary osteoporosis due to liver cirrhosis from alcohol abuse is reported, in whom percutaneous vertebroplasty of three fractured vertebral bodies (L3–L5) was complicated by spondylitis at these levels. Results: Spondylitis of L3–L5 with paravertebral abscess formation and progressive collapse of L5 was detected by magnetic resonance imaging (MRI). Treatment consisted of percutaneous aspiration of the paravertebral abscess and antibiotic therapy. No bacteria was identified despite cultures have been taken before antibiotic treatment. The patient was treated with intravenous ciprofloxacin and consecutive clindamycin for a total of 3 months. One year after the infection the MRI signs of spondylitis have resolved without further collapse of L5. Painlevels have improved significantly, allowing the patient to return to work, but are still higher than immediately after vertebroplasty. Conclusion: Spondylitis is a rare complication of vertebroplasty. In the presented case a satisfactory result could be achieved through conservative antibiotic therapy and restriction of movement.     

99Tc-MDP治疗强直性脊柱炎的疗效观察

目的观察^99Tc-亚甲基二膦酸盐(MDP)注射液治疗强直性脊柱炎的疗效。方法对83例强直性脊柱炎患者静脉滴注^99Tc—MDP，观察治疗前后临床和实验室指标及副作用。结果^99Tc—MDP治疗强直性脊柱炎的总有效率为89％，在减轻临床症状，尤其是改善晨僵和关节活动度方面疗效明显，且无明显副作用。结论用^99Tc—MDP，治疗强直性脊柱炎疗效显著，使用安全。     

Computertomographie und Magnetresonanztomograpie bei tuberkulöser Spondylitis – Literaturübersicht und eigene Beobachtungen

Purpose. The findings of tuberculous spondylitis in MRT have been described extensively. Nevertheless the diagnostic value of both methods in the diagnosis of this severe manifestation of the tuberculous disease was not yet defined definitely. Materials. We performed a review of the recent literature and a retrospective analysis of the findings in ten patients with proven tuberculous spondylitis. Here we evaluated 10 CT and 6 MRT. Results. Major findings in computed tomography (n=10) were osseous sequestration (8/10), subperiostal bone apposition (6/10), abscess of the surrounding tissue (8/10) and calcification of the masses (3/10). In all cases which were examined by MRT (n=6) marrow edema was seen. Affection of the soft tissue was described by means of MRT in 5/6 patients. All patients showed rim enhancement. Conclusions. MRT shows signs of infection (bone marrow edema) which is an early but rather unspecific finding. The commonness of osseous lesions in advanced tuberculous spondylitis suggests a benefit of computed tomography in the later stages. Both methods are complementary in the differential diagnosis of tuberculous and non- specific spondylitis.     

Combined anterior and posterior surgery for treatment of cervical fracture-dislocation in patients with ankylosing spondylitis

To discuss the pathological characteristics of cervical spinal fracture complicating ankylosing spondyli-tis-(AS) and the effect of combined anterior and posterior operation. Methods: Eighteen AS patients with traumatic cervical fracture-dislocation were treated operatively from January 2000 to January 2006. The symptom duration of AS was 14.5 years on average. Three cases had undergone osteotomy in lumbar spine. There were 4 cases of Grade A, 3 cases of Grade B, 9 cases of Grade C and 2 cases of Grade D accord-ing to Frankel's score. There were 15 cases of Grade Ⅲ dislocation and 3 cases of Grade Ⅱ. All patients underwent surgical procedures by combined anterior and posterior approach.Results: There were 4 anterior-posterior procedures, 8 anterior-posterior-anterior procedures and 6 posterior-an-terior procedures. Seven patients had one stage operation and 11 cases underwent two stage surgeries. There was certain extent of neorological improvement in 14 incomplete paraplegic patients, but no improvement in 4 complete paraplegic patients. The follow-up period was 21.2 months on average and the time for bone fusion was 3.6 months. There were 4 complications during operation and a long-term complication in follow-up. Conclusions: The study suggests that anterior com-bined with posterior approach makes the spine stable and relieves the pressure immediately. It is a reasonable surgical strategy for treatment of cervical spinal fracture-dislocation with AS.     

强直性脊柱炎合并恶性肿瘤31例

目的:分析强直性脊柱炎患者合并恶性肿瘤的临床特点. 方法:选择北京大学第一医院2006年1月至2014年7月明确诊断为强直性脊柱炎合并恶性肿瘤的31例住院患者,与同时期住院的强直性脊柱炎未合并肿瘤患者的临床特点进行比较. 并对其一般情况、强直性脊柱炎的临床与影像学表现、肿瘤的特征、预后等进行回顾性分析. 结果:31 例患者包括男性27 例( 87%) ,女性4 例( 13%) ,确诊强直性脊柱炎的平均年龄为( 43 ± 17 )岁(16~76岁);首次确诊肿瘤的平均年龄为(60 ± 12)岁(31~87岁),其中27例患者的肿瘤发生在强直性脊柱炎确诊之后. 31例患者确诊强直性脊柱炎时均存在典型的影像学表现,大部分未接受针对强直性脊柱炎的规范化治疗. 合并的恶性肿瘤者包括膀胱癌7例,血液系统肿瘤6例,肺癌5例,肾癌5例,前列腺癌、肾盂癌、乳腺癌、胃癌、直肠癌、神经内分泌瘤各2例,结肠癌和食管癌各1例. 结论:强直性脊柱炎存在合并恶性肿瘤的风险,以膀胱癌最多见,其次是血液系统肿瘤,临床上需要关注.     

Posttraumatische Spondylitis an der Halswirbelsäule

Spondylitis of the cervical spine is often caused by hematogenous spread; it is a rare complication of trauma. MRI allows a relatively early diagnosis, and bone lesions are clearly revealed by computer tomography. The goal of treatment is to cure the inflammation while preserving the normal anatomical alignment of the cervical spine. When paresis has already developed a surgical intervention must be performed as soon as possible to prevent permanent neurological deficits.     

137. Fusionsoperationen an der instabilen Halswirbelsäule

Zusammenfassung Anhand von 856 Spondylitiskranken wird der Wandel der Behandlung in den letzten 10 Jahren aufgezeigt. Die konservative Behandlung von 1952–1964 mit Gipsbett und Stützkorsett führte in der Regel zu einer ausgeprägten Gibbusbildung. Die seit 1964 im Vordergrund stehende Absceß- und Herdoperation mit nachfolgender krankengymnastischen Behandlung verhinderte die Gibbusbildung und verkürzte die Behandlungszeit von früher durchschnittlich 950 Tage auf 100 Tage.     

MR-Bildgebung bei seronegativen Spondyloarthritiden

Zusammenfassung Von 25 Patienten mit der klinischen Verdachtdiagnose einer Sakroiliitis zeigten konventionelle R?ntgenaufnahmen bei 10 Patienten keine Auff?lligkeiten. In 13 F?llen konnte mittels CT und MRT eine Sakroilitis nachgewiesen werden. Bei 2 Patienten mit unauff?lligen konventionellen R?ntgenaufnahmen und CT zeigten sich para- und intraartikul?re MR-Signalver?nderungen, die auf eine Sakroilitis verd?chtig waren. Bei 18 Patienten mit der sicheren Diagnose einer ankylosierenden Spondylitis und konventionellen R?ntgenaufnahmen der thorakolumbalen übergangsregion fanden sich bei MR-Untersuchungen destruktive Romanus und entzündliche Anderson-L?sionen. Bei 10 Patienten entsprachen die MR-Ver?nderungen einer aktiven entzündlichen Enthesitis an der diskovertebralen Verbindungszone. In 8 F?llen fanden sich fokale und lineare Signal?nderungen innerhalb der Diszintervertebralis, die einer aktiven Entzündung entsprachen. Bei seronegativen Spondylitiden findet sich in der MRT offensichtlich h?ufig ein atypisches Bild: in mehr als 50 % der F?lle treten Weichteilver?nderungen wie bei einer Enthesitis auf. Diese k?nnten die differentialdiagnostische Abgrenzung von seronegativen Spondylitiden erlauben. In 9 F?llen waren Verteilung und Ausdehnung der Weichteilver?nderungen unterschiedlich, n?mlich den Ver?nderungen in der Enthesitis. Bei 5 Patienten mit der Diagnose eines Reitersyndroms und Kalkaneus Enthesitis ergab die MR-Untersuchung Ver?nderungen wie bei einer akuten Entzündung und entsprachen damit genau dem Befund an der diskovertebralen übergangszone und den Kollateralligamenten an den kleinen Handgelenken. Eingegangen am 1. April 1996 Angenommen am 16. April 1996