Plasma viscosity and erythrocyte sedimentation rate in inflammatory and non-inflammatory rheumatic disorders

Summary Plasma viscosity (PV) and erythrocyte sedimentation rate (ESR) are considered to reflect the complex of acute phase reactants in inflammations. Both tests were studied with regard to their ability to discriminate between inflammatory and non-inflammatory rheumatic diseases. PV and ESR were measured using the Coulter Viscometer II and the Westergren method, respectively. ESR was found to be a better parameter for rheumatoid arthritis and ankylosing spondylitis than PV, independent of the chosen reference values, age, gender and the hemoglobin level. ESR may still be regarded as an acceptable parameter for monitoring inflammatory rheumatic diseases.     

强直性脊柱炎检测HLA-B27、ASO、RF、CRP的临床意义

目的探讨HLA-B27、ASO、RF、CRP检测在强直性脊柱炎(AS)诊断与鉴别诊断中的意义。方法抽取ED-TA(K2)抗凝血2ml,采用磁珠酵素免疫法检测HLA-B27,采用胶乳凝集法检测ASO、RF、CRP。结果 31例正常健康者加A-B27、ASO、RF、CRP检测结果均为阴性。108例疑似AS患者中,HLA-B27阳性率为30.6％(33/108)。33例HLA-1327阳性患者中,ASO阳性率为6.1％(2/33),RF阳性率为3.0％(1/33),CRP阳性率为12.1％(4/33)。结论 HLAA-B27的检测可明确AS诊断,特别是在不典型AS诊断中具有重要的临床价值。ASO、RF检测可用于AS的鉴别诊断。疑似AS患者HLA-B27阳性者中,其活动期的CRP比率较低。     

127. Wirbelsäule und Becken — Operationsindikation und chirurgische Technik bei entzündlichen Erkrankungen

Zusammenfassung Drei freie Formenkreise entzündlicher Erkrankungen der Wirbelsäule er Wirbelsäule verlangen in bestimmten Situationen die Indikation zum operativen Vorgehen. 1. Die unspezifische Spondylitis. 2. Die spezifische Spondylitis -hier-die Spondylitis tuberculosa. 3. Entzündliche Veränderungen bzw. ihre Folgen bei Erkrankungen des rheumatischen Formenkreises — hier: Chronische Polyarthritis und Spondylarthritis ankylopoetica. Das Abwägen zwischen konservativen und operativen Vorgehen ist bei diesen Erkrankungen besonders wichtig. Die operative Behandlung ist eindeutig indizierten Fällen vorbehalten. Die möglichen, operativen Zugänge werden geschildert. Die Operationstechniken dargestellt, auf Komplikationsmöglichkeiten eingegangen.     

白细胞介素-1F7基因单核苷酸多态性对强直性脊柱炎易感性与病情的影响

目的 探讨白细胞介素(IL)-1F7基因rs3811047位点单核苷酸多态性(SNP)对强直性脊柱炎(AS)易感性和临床表现型的影响.方法 收集AS患者158例和同期健康献血人群181名,采用连接酶检测反应(LDR-PCR)方法检测IL-1F7基因rs3811047位点SNP,分析其等位基因频率及基因型频率在AS和对照组中的分布,并比较不同基因型AS患者间临床表现型的差别.结果 AS患者和对照人群中rs3811047位点A等位基因频率(12.03%,17.68%)和G等位基因频率(87.97%,82.32%)的分布差异有统计学意义(x2=4.2204,P=0.0399);AA,AG,GG基因型频率在AS中分别为0,24.05%,75.95%,与对照组分布(2.76%,29.83%,67.41%)相比,差异亦有统计学意义(x2=6.2675,P=0.043).AG基因型的AS患者中人类白细胞抗原(HLA)-B27阳性率为70.27%(26/37),明显低于GG基因型AS中HLA-B27的阳性率94.23%(98/104),差异有统计学意义(x2=2.168,P=0.030);其红细胞沉降率和C反应蛋白水平明显亦低于GG基因型组(t=2.971,P=0.013;t=3.300,P=0.001).结论 安徽籍汉族人群AS易感性与IL-1F7基因rs3811047位点SNP有关,其基因型对AS的临床表现型有影响,携带A等位基因患者的炎症表现轻于不携带A等位基因的患者.     

流式细胞术分析外周血辅助性T17细胞在强直性脊柱炎患者外周血的表达及其意义

目的 检测强直性脊柱炎(AS)患者外周血辅助性T17(Th17)细胞的表达,探讨其在AS发病机制中的作用.方法 用流式细胞术检测20例AS患者和15名健康对照者外周血Th17[白细胞介素(IL)-17]、Th1[干扰素(IFN)-γ]、Th2(IL-4)细胞及人类白细胞抗原(HLA)-B27,同时检测红细胞沉降率(ESR)、C反应蛋白(CRp)等,并分析Th17细胞与Th1、Th2、HLA-B27及AS活动性指标的相关性.采用t检验和Spearman相关分析.结果 AS患者外周血Th17细胞[(2.6±0.8)%]高于对照组[(1.1±0.4)%](P＜0.01);Th1(IFN-γ)细胞[(3.9±0.8)%]低于对照组[(5.1±1.3)%](P＜0.05);Th2(IL-4)细胞[(4.1±1.6)%]比对照组[(3.1±1.4)%]升高,但差异无统计学意义(P＞0.05);Th17细胞与HLA-B27百分数及与HLA-B27平均荧光强度、ESR、CRP无相关性(P＞0.05);但是,Th17细胞表达水平有随HLA-B27百分数及HLA-B27平均荧光强度增加升高的趋势.结论 AS患者外周血Th1细胞减少,而Th17细胞增加,AS患者体内存在Th细胞的失衡,Th17比例变化是反映AS整个复杂免疫反应异常的一个重要环节.

Abstract：

Objective To detect the expression of T helper 17 (Th17) cells in the peripheral blood of patient with ankylosing spondylitis (AS),and discuss its role in thc pathogenesis of AS.Methods Twenty AS patients and fifteen healthy controls were enrolled in the study.Th17 (IL-17),Th1 (IFN-γ),Th2 (IL-4)cells and HLA-B27 of their peripheral blood were analyzed by flow cytometry,at the same time,the levels of ESR and CRP were also measured in order to analyze thc relation of Th17 and HLA-B27,ESR as well as the CRP level.The statistical analysis was carried out with single-sample t-test and Speraman's correlation test.Results The level of Th17 cells was significantly higher in the perpipheral blood of AS patients[(2.6±0.8 )%] than those in healthy controls[ (1.1±0.4)% ] (P＜0.01).The level of Th 1 cells was significantly lower in the peripheral blood of AS patients[(3.9±0.8)%] than those in healthy controls[(5.1±1.3)%] (P＜0.01)and the level of Th2 cells was not different in the peripheral blood of AS patients[(4.1±1.6)%] when compared to healthy controls[ (3.1±1.4)% ] (P＞0.05).Th 17 cells was not significantly correlated with the percentage and mean fluorescent intensity of HLA-B27,ESR,CRP(P＞0.05); but there was a tendency that increased expression level of Th17 cells was associated with elevated percentage and mean fluorescent intensity of HLA-B27.Conclusion The level of Th1 cells is decreased,but Th17 is increased in the peripheral blood of AS patients.Th cells are imbalance in AS,patients.The change of Th17 cells may be an important part of the pathogenesis of AS.     

An increase of blood squamous cell carcinoma antigen in Pseudomonas aeruginosa spondylitis

Squamous cell carcinoma antigen (SCCA) is traditionally engaged for detecting and following up malignancy from a squamous cell origin. We encountered an unusual increase of blood SCCA but no other cancer markers in a patient associated with an infective lumbar spondylitis due to Pseudomonas aeruginosa. An overshooting of Th1 expression, such as tumor necrosis factor alpha, bumped up by his uremia as a result of P. aeruginosa infection may hasten SCCA. Therefore, SCCA might additionally serve as a serological marker for infection besides squamous cell cancer, and its false-positive increase also highlights the appropriateness of tumor marker screening.     

The ever-expanding association between rheumatologic diseases and tuberculosis

We summarized most of the rheumatologic manifestations of tuberculosis (TB) and the occurrence of Mycobacterium tuberculosis disease associated with rheumatologic diseases. We established 4 different categories: (1) direct musculoskeletal involvement of M. tuberculosis, including spondylitis, osteomyelitis, septic arthritis, and tenosynovitis; (2) M. tuberculosis as an infectious pathogen in rheumatologic diseases, particularly with the use of newer agents such as tumor necrosis factor-α inhibitors; (3) antimycobacterial drug-induced rheumatologic syndromes, including tendinopathy, drug-induced lupus, and others; and (4) reactive immunologic phenomena caused by TB, such as reactive arthritis, erythema nodosum, and others. In addition, Bacille-Calmette-Guérin vaccination used for the prevention of TB or as a chemotherapeutic agent for bladder carcinoma also may be associated with musculoskeletal adverse events. We conclude that M. tuberculosis can directly or indirectly affect the musculoskeletal system.     

中药配合针灸治疗强直性脊柱炎疗效观察

目的 观察中药配合针灸治疗强直性脊柱炎的疗效及不良反应. 方法 46例强直性脊柱炎患者在知情同意情况下,按数字表法随机分为观察组与对照组各23例,对照组给予中药治疗,观察组采用针灸配合中药治疗,两组疗程均为1个月,观察两组临床治疗效果. 结果 观察组显效18例（78.3%）、有效3例（13.0%）、无效2例（8.7%）、总有效率为91.3%,明显高于对照组的11例（47.8%）、8例（34.8%）、4例（17.4%）、82.6%,两组间总有效率差异有统计学意义（χ^2=4.572,P＜0.05）.观察组患者发生红疹1例,疼痛1例;对照组出现红疹1例,瘙痒1例;所有症状均较轻微,不影响治疗.两组均未发生严重不良反应. 结论 中药配合针灸治疗强直性脊柱炎疗效满意,且无明显的不良反应,值得临床推广应用.     

颌眉角的最优选择及其在强直性脊柱炎后凸畸形矫形设计中的应用

目的探索不同范围颌眉角对颈椎强直性脊柱炎（ankylosingspondylitis,AS）患者日常生活的影响,确定最优的颌眉角范围,进而为截骨矫形设计提供理论依据。方法选取我科收治的25例颈椎强直的 AS 胸腰段后凸畸形患者,所有患者矫形前后均完成视野相关生活质量功能及期望评分调查问卷表。不考虑手术与否,按照自然站立位颌眉角将所有外观照所对应病例（ n＝50）分为6组：A 组,CBVA＜0°;B组,0°≤CBVA＜10;C 组,10°≤CBVA＜20°;D组,20°≤CBVA＜30°;E 组,30°≤CBVA＜40°;F组, CBVA≥40°。将6组患者每项调查问卷项目进行比较分析,多组间比较时采用Kruskal-Wallis检验,组间两两比较采用Mann-Whitney检验。结果总体评价：C组（10～20）°获得最优的期望值评价,P＜0.05。B、C、D 组（0～30）°获得较其它组更好的功能评价,P＜0.05,但三组间差异无统计学意义。形象评价：A、B、C 组（＜20°）较其它组获得更好的形象满意度及期望值,P＜0.05,但三组间差异无统计学意义。户外活动：A、B、C、D组（＜30°）在多数项目上较其它组获得更好的功能评价及期望值评价。室内活动：C、D组（10～30）°在多数项目上较其它组获得较好的功能评价及期望评价。结论颌眉角在10°～20°时,患者视野相关活动功能及满意度最高,因此,10°～20°为颌眉角的最佳矫正角度。     

两种截骨矫形术式治疗强直性脊柱炎重度胸腰椎后凸畸形的临床效果与并发症分析

目的比较两种截骨矫形术式治疗强直性脊柱炎（ankylosingspondylitis,AS）重度胸腰椎后凸畸形的临床效果及围手术期并发症。方法将2009年5月至2013年12月,33例后凸＞70°的AS重度胸腰椎后凸畸形患者,根据截骨术式的不同分为两组。双节段（ pedicle subtraction osteotomy,PSO ）组（18例）：均为男性,年龄19～47（平均34.8±10.6）岁;脊柱后凸Cobb’s角（82.6±17.5）°（70～108）°;C7铅垂线与骶骨后上角之间的垂直距离（ sagittal vertical axis,SVA ）为（18.3±14.8） cm （11～35） cm;站立位颌眉垂线角为（67.2±21.9）°（43～130）°;单节段（ closing-opening wedge osteotomy,COWO ）组（15例）：男13例,女2例,年龄22～43（平均31.2±8.5）岁,脊柱后凸Cobb’s角（76.3±11.2）°（73～98）°;SVA为（16.7±7.3） cm （10～26） cm;颌眉垂线角为（63.5±15.6）°（ 47～86）°。比较两组的临床矫形效果及围手术期并发症。结果双节段PSO组脊柱后凸角、颌眉垂线角以及SVA矫正率分别为（74.2±8.3）%,（86.2±9.5）%和（83.6±10.2）%;COWO组脊柱后凸角、颌眉垂线角以及SVA矫正率分别为（70.2±6.5）%,（86.6±8.3）%和（88.0±8.7）%,以上矫正率两组之间差异无统计学意义（ P＞0.05）;但在手术时间和出血量上,两节段PSO组明显高于COWO组（ P＜0.05）。COWO组围手术期并发症发生率显著高于双节段PSO组（ P＜0.05）,尤其以术中螺钉松动和截骨断端移位发生率高。结论对AS重度胸腰椎后凸畸形患者,单节段COWO可以取得与双节段PSO相似的临床效果,且单节段COWO手术时间短,出血量少,但围手术期并发症相对要高。