益肾温经祛湿法治疗强直性脊柱炎的临床观察

目的观察益肾温经祛湿法治疗肾虚寒凝型强直性脊柱炎的临床疗效。方法44例患者随机分为治疗组和对照组,治疗组采用益肾温经祛湿的中药协定方,对照组采用缓解病情的西药。疗程3个月。治疗前后评价Bath强脊功能指数(BASFI)、强脊疾病活动指数(BASDAI)、指地距、扩胸度、枕壁距、Schober试验、血沉、C-反应蛋白及血尿常规、肝肾功能。结果治疗后两组BASDAI、BASFI、C-反应蛋白均有显著性改善,治疗组BASFI改善优于对照组,治疗组治疗前后血沉、指地距变化有统计学意义(P<0.05),两组Schober试验、枕壁距、扩胸度变化均无统计学意义(P>0.05)。治疗组总有效率为76.2%,对照组为65.2%(P>0.05)。治疗组中医证候改善优于对照组。结论益肾温经祛湿法疗效较好。     

补肾强督方治疗强直性脊柱炎患者259例临床研究

目的：探讨补肾强督方治疗强直性脊柱炎（AS）的临床疗效与安全性.方法：本研究共入选259例门诊和住院患者,予补肾强督方治疗,每日1剂,早晚分服,疗程6个月,治疗前后评价如下疗效指标：患者健康综合评分（BAS-G）、疾病活动指数（BASDAI）、功能指数（BASFI）、全身痛Likert四级评分、脊柱痛Likert四级评分、晨僵时间、医生总体评价、枕墙距、指地距、颌柄距、胸廓活动度、Schober征、脊柱活动度、＂4＂字试验、血沉（ESR）、C反应蛋白（CRP）,并观察血常规、尿常规、肝肾功能等药物安全性指标.结果：259例患者经用补肾强督方治疗6个月后,除枕墙距、颌柄距无明显改变外,其余指标均有显著改善.259例患者均未出现血常规、尿常规改变及肝肾功能损害.结论：补肾强督方对AS有较好疗效,且安全可靠.     

1型肿瘤坏死因子受体脱落氨肽酶调控因子在强直性脊柱炎患者外周血中的表达

目的研究强直性脊柱炎(AS)中1型肿瘤坏死因子(TNF)受体脱落氨肽酶调控因子(ARTS-1)的表达和调节作用。方法对AS患者(n=61)和正常对照者(n=40)分别抽提外周血总RNA并逆转录为cDNA,通过RT-PCR法定量分析其ARTS-1的表达水平。以Bath强直性脊柱炎活动性指标作为病情评估标准:≤4分为病情稳定,≥5分为病情活动。结果AS组的ARTS-1 mRNA表达水平为0.83±0.73,明显高于正常对照组的0.35±0.40(P=0.0011);但病情活动患者与病情稳定患者之间的表达差异无统计学意义(P=0.6509),病情稳定患者有增高趋势。结论ARTS-1 mRNA的表达可能参与了AS的发病与病情转归;而病情活动患者与病情稳定患者ARTS-1表达差异不明显,可能与ARTS-1在稳定体内TNF系统的动态平衡方面的双相调节作用有关。     

The Burden of Ankylosing Spondylitis in Spain

Objective:  To investigate the burden of ankylosing spondylitis (AS) in Spain, as baseline for economic evaluation of the use of biological agents.
Methods:  A cross-sectional retrospective observational study was performed in 601 patients with AS in Spain, using a methodology developed in studies in the United Kingdom and Canada. Patients were mailed a questionnaire asking about their health-care consumption, out-of-pocket expenses, work capacity, need for informal care during the past 3 months, as well as quality of life. Patient's current functional status and disease activity level was assessed using the Bath functional and disease activity indexes (BASFI and BASDAI).
Results:  The mean age (median) was 47.8 (12.4) years, and the mean disease duration was 18.8 years. Eighty percent of patients were male, and slightly more than half of patients below 65 years of age were working. The mean (median) BASDAI and BASFI scores were 4.3 (2.5) and 3.8 (2.9),respectively, and all levels of disease severity were represented. The mean (median) total annual cost per patient is estimated at €20,328 (€7920). Direct health care represented 22.8%, investments (adaptations of house and devices) and informal care 43.5%, and productivity losses 33.7%. Costs increased significantly with worsening disease, in particular diminishing physical function, covering a range between €5000 and €75,000 per patient and year. The mean (median) utility was 0.59 (0.30). Utility showed a significant inverse relation with BASFI and BASDAI, covering a range from 0.80 for patients with BASFI/BASDAI below 3 to 0.25 for patients with BASFI/BASDAI greater than 7.
Conclusions:  As in studies in other countries, all types of costs accelerate steeply with worsening disease while utility decreases significantly, indicating the need to prevent disease progression.     

早期强直性脊柱炎CR与CT的临床分析

目的:探讨CR与CT对早期强直性脊柱炎的诊断价值。方法:对18例临床诊断为早期强直性脊柱炎的CR与CT征象及临床资料进行分析。结果:CR、CT不同程度显示了早期强直性脊柱炎的病变部位、形态改变和受累关节范围,CT可显示受累关节面的细微变化。结论:CR平片作为首选方法,对有可疑病例,结合CT扫描可提高病变的显示率。     

Atrioventricular Conduction Time in Ankylosing Spondylitis

ABSTRACT The frequency of cardiac conduction disturbance in ankylosing spondylitis is discussed. Risk of such disturbance in the patients' relatives is, to our knowledge, not known. To examine these problems, ECG records of 99 patients with ankylosing spondylitis and 132 of their adult first degree relatives were obtained. P-R intervals were determined by standardized methods and compared with P-R intervals of the controls. The distribution of P-R intervals both in the patients and their relatives was close to the controls'. Four cases of first degree AV block were found among the patients (P-R intervals 0.21-0.26 sec), one of them had aortic valve insufficiency. The single case of pronounced conduction delay (P-R interval 0.42 sec) was recorded in an otherwise healthy HLA B27-positive relative. One male secondary case of ankylosing spondylitis had a P-R interval of 0.22 sec. Patients who had experienced acute anterior uveitis had relatively long P-R intervals, while patients with psoriasis had relatively short P-R intervals. The conclusion was that cardiac conduction disturbance was not frequent in patients with ankylosing spondylitis or in their relatives.     

骶髂关节检查法在强直性脊柱炎诊断中的应用

目的:明确临床常用的骶髂关节检查法在强直性脊柱炎诊断中的作用及重要性。方法:对经确诊的70例强直性脊柱炎的骶髂关节临床检查以及影像学和实验室检查结果进行回顾性分析。结果:所有患者的骶髂关节检查均为阳性,其中以"4"字试验和叩击试验的阳性率最高,而骨盆分离和挤压试验次之。早期患者的疼痛量化评分(NRS)明显高于晚期(P<0.05)。结论:骶髂关节检查法在强直性脊柱炎的诊断,特别是早期初步诊断中起着不可替代的重要作用。     

幼年特发性关节炎229例的诊断和分型

目的了解我国北方地区幼年特发性关节炎（JIA）各型发病比率,对JIA的诊断和分类标准使用提供参考意见。方法对2000年1月-2001年12月本院住院的慢性关节炎患儿,用2004年修订的JIA分类标准进行回顾性分析。结果229例中以JIA分类标准分析诊断成立者196例。JIA 196例中全身型55例（28%）;少关节型21例（10.7%）;多关节型11例（5.6%）,其中类风湿因子（RF）阳性3例,RF阴性8例;与附着点炎性反应相关关节炎（ERA）106例（54%）;未分类3例（1.5%）;未见到银屑病性关节炎,无少关节扩展型。结论我国北方地区JIA全身型、ERA发病比率明显高于国外,而少关节型比率较国外明显降低,多关节型略少于国外。JIA诊断分类标准优于幼年类风湿关节炎。     

强直性脊柱炎易感基因IL-1RN和TNF-α的单核苷酸多态性的研究

目的检测中国深圳地区汉族强直性脊柱炎(AS)患者IL-1RN和TNF-α基因的单核苷酸多态性(SNPs)。方法在54名AS患者和42名健康对照者中,采用基因芯片技术对IL-1外显子6上SNPs(31017C/G、30735T/C)、TNF-α启动子上的SNPs(-857C/T)进行基因分型,分析单个位点的等位基因频率和基因型频率是否与AS相关,采用SAS软件分析数据。结果AS患者中,IL-1RN的31017C/G的等位基因G频率和30735T/C的等位基因C频率(分别是60.42%vs36.36%,32%vs17.19%)和IL-1RN的31017C/G的基因型GG频率和30735T/C的基因型CT频率(分别是43.75%vs12.12%,64%vs39.39%)显著性高于健康对照者,差异具有统计学意义(P<0.01)。TNF-α的-857C/T的等位基因T频率(25%vs9.52%)和基因型CT频率(42.59%vs19.05%)也显著高于健康对照者(P<0.01)。在健康人中31017CG/857CC基因型组合要显著高于AS患者(P<0.01),在AS患者中31017GG/30735CT/857CT基因型组合要显著高于健康对照者(P<0.05),其差异均具有统计学意义。结论IL-1RN基因的31017C/G和30735T/C的两个SNPs及其基因型频率与中国深圳汉族AS之间存在显著相关性,31017CG/857CC基因组合可能是保护性的基因组合,而31017GG/30735CT/857CT组合可能增加AS患病的易感性。