行为干预护理对强直性脊柱炎患者生活质量的影响

目的分析行为干预护理对强直性脊柱炎患者生活质量的影响。方法采用电脑随机法将2017年10月至2019年2月收治的83例强直性脊柱炎患者分为对照组(41例)和试验组(42例)。对照组给予一般性护理干预,试验组在此基础上给予行为干预护理。比较两组患者干预前、后的上下肢运动功能及SF-36各项评分。结果干预前,两组患者上下肢运动功能、SF-36各项评分无显著差异(P>0.05);干预后,试验组上下肢运动功能及SF-36评分明显高于对照组,差异有统计学意义(P<0.05)。结论针对强直性脊柱炎患者实施行为干预护理,可有效改善患者肢体功能,提升其生活质量,值得临床推广应用。     

脊柱三扳法对早中期强直性脊柱炎胸腰椎活动的影响

目的探讨脊柱三扳法治疗早中期强直性脊柱炎(AS)的疗效。方法 60例AS早中期患者按照进入研究的顺序分为药物组(n=30)和手法组(n=30)。药物组口服柳氮磺胺吡啶和正清风痛宁缓释片;手法组在此基础上接受脊椎三扳手法。按自行研制AS调查表在治疗前和治疗后第1、3、6个月对两组患者进行随访。结果治疗3个月时,手法组的腰椎活动度和指-地距离优于药物组(P<0.05);治疗6个月时,手法组腰椎活动度、指-地距离、胸廓活动度和VAS评分均优于药物组(P<0.05)。结论脊柱三扳法可以改善早中期AS患者的胸腰椎活动范围。     

强直性脊柱炎患者 TNF-α表达水平测定分析

目的：通过比较强直性脊柱炎（AS）患者与健康人之间 TNF-α的表达差异,探讨其在该病发病机制中的作用。方法采用酶联免疫吸附法（ELISA）测定强直性脊柱炎患者和健康人血浆中 TNF-α蛋白含量;荧光定量 RT-PCR 法对外周血单个核细胞中 TNF-αmRNA 表达量进行测定。结果强直性脊柱炎患者血浆 TNF-α含量（26．307±15．737 ng/L）高于健康人（11．147±13．868 ng/L）,P ＜0．05,差异有统计学意义;强直性脊柱炎患者外周血单个核细胞 TNF-αmRNA 表达量（0．0024±0．0177）显著高于健康人（0．0014±0．0004）,且 P ＜0．05,差异有统计学意义。结论AS 患者 TNF-α表达量高于健康人,是强直性脊柱炎发病机制中一种重要细胞因子。     

Nutrition in Spondyloarthritis and Related Immune-Mediated Disorders

Recent research on the pathogenesis of spondyloarthritis and related immune-mediated diseases associated with human leukocyte antigen class I molecule B27 (HLA-B27) has led to significant progress in terms of management and prognosis, with multiple treatments being constantly evaluated and implemented. Correlations between the genetic background of spondyloarthritis and inflammatory bowel diseases and the inflammatory processes involving gut microbiota have been established. This knowledge has allowed progress in pharmacological therapy. The role of diet in the pathogenesis and treatment of diseases pertaining to the HLA-B27 spectrum is of great significance, considering possible future applications in individualized medicine. Diet impacts the composition of gut microbiota, representing a substrate for the synthesis of metabolites affecting the mucosal immune system. Certain pro-inflammatory mediators, such as emulsifiers and microparticles, induce a more profound cytokine response, promoting inflammation. Numerous diets, including the low-starch diet, the Mediterranean diet, diets with low contents of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (low-FODMAP diets), gluten-free diets and fasting, have been analysed and correlated with patients’ symptomatology and dietary adherence. The aim of this review is to provide an extensive perspective on the diets available to patients with spondyloarthritis and related immune-mediated disorders.     

坚骨胶囊联合常规方案治疗强直性脊柱炎合并骨质疏松的临床观察

目的:观察坚骨胶囊联合常规方案治疗强直性脊柱炎合并骨质疏松的临床疗效和安全性。方法:90例强直性脊柱炎合并骨质疏松患者按随机数字表法均分为对照组、观察一组和观察二组。对照组患者给予柳氮磺吡啶片1.0 g,口服,bid;塞来昔布胶囊0.2 g,口服,bid。观察一组患者在对照组治疗的基础上给予阿伦磷酸钠70 mg,每周1次。观察二组患者在对照组治疗的基础上给予坚骨胶囊1.75 g,口服,tid。3组患者均以4周为1个疗程,共治疗6个疗程。观察3组患者的临床疗效,治疗前后中医症状积分及体征,实验室指标,疾病活动度指标,骨代谢生化指标,各部位骨密度值和足跟骨强度指数及不良反应发生情况。结果:治疗后观察二组患者总有效率>观察一组>对照组,3组比较差异有统计学意义(P<0.05)。治疗后3组患者中医症状积分、枕墙距、指地距、颌柄距、实验室指标、疾病活动度指标、骨钙素(BGP)、I型前胶原羧基末端前肽(PICP)、双氢嘧啶脱氢酶(DPD)、I型胶原羧基端吡啶并啉交联肽(ICTP)均显著低于同组治疗前,且观察一组、观察二组均低于对照组;胸廓活动度、脊柱前弯受限、脊柱活动度、甲状旁腺素(PTH)、骨碱性磷酸酶(BALP)、各部位骨密度值及足跟骨强度指数均显著高于同组治疗前,且观察一组、观察二组均高于对照组,差异均有统计学意义(P<0.05),但观察一组与观察二组比较差异无统计学意义(P>0.05)。3组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:坚骨胶囊治疗强直性脊柱炎合并骨质疏松疗效显著,安全性较好。     

The distribution of clinical findings in Bechterew's syndrome (ankylosing spondylitis) suggests distinct genetic subgroups

One hundred and twenty-two consecutive patients hospitalized for ankylosing spondylitis (AS) were reexamined. The frequency of clinical signs and results of tests for associations are presented. Psoriasis was associated with a distal pattern of peripheral arthropathy. Spinal rigidity was predominantly seen in males. Males with phalangeal arthropathy exhibited preserved spinal mobility. This was the case also when HLA B27 positives and patients who did not have psoriasis were considered separately. HLA B27 positive patients in this group had frequently experienced acute anterior uveitis. It seems possible that the disease in such males is the result of combined predisposition to ankylosing spondylitis and psoriatic arthropathy. Hip arthropathy was frequently present in males with spinal rigidity. The associations observed confirm that AS is a heterogenous group of diseases. The term "syndrome" may be suitable for such a heterogenous group, and we prefer the term "Bechterew's syndrome" as the name of this group. When these new findings are added to the previous observations that acute anterior uveitis probably is a clinical, sex-influenced characteristic of HLA B27 positive Bechterew's syndrome, that HLA B27 negative patients with Bechterew's syndrome frequently had psoriasis and were HLA B13 and B17 negative, and that psoriasis was frequent in HLA B27 positive patients as well, we tentatively conclude that different and interacting genetic mechanisms may be involved in the etiology of Bechterew's syndrome.