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。     

An evaluation of the effectiveness of a videotape programme on interobserver reliability in outcome assessment for ankylosing spondylitis

Aims. A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used obsever dependent outcome measures in patients with ankylosing spondylilis (AS). Methods. During a single day, six third-year medical students independently examined five patients with AvS in predetermined order using a Latin Square design, before and after viewing a standardized videotape demonstrating 14 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. Results. Prestandardization reliability coefficients were < 0.80 for three measures. Following standardization 12 reliability coefficients exceeded 0.80. For the majority of measures prestandardization reliability coefficients were high and no further improvement in reliability could be demonstrated. Conclusions. High levels of interobserver agreement were noted prior to viewing the instructional videotape. This may represent the success of undergraduate clinical skills training programmes, or it may be the result of having reviewed an illustrated instructional text just prior to the initial patient examinations. With the exception of chest excursion, high levels of prestandardization reliability, by necessity, precluded the demonstration of significant effects from viewing the videotape. Nevertheless, the data indicate that senior medical students arc capable of reliably performing quantitative measurement in AS. Recent surveys in Canada and Australia, showing a general lack of quantitative clinical measurement in the longitudinal follow up of AS outpatients by rheumatologists, suggest that the lack of quantitation is not due to inability to reliably perform the measurements.     

疑似强直性脊柱炎患者HLA-B27检测与分析

目的通过对872例强直性脊柱炎(AS)疑似患者HLA-B27抗原的检测,分析HLA-B27抗原与AS的相关性及其临床意义。方法选取872例AS疑似患者外周血,采用流式细胞仪检测T淋巴细胞膜上的HLA-B27/B7抗原,并对患者的表达情况进行分析。结果 872例AS疑似患者男女比例为1.8∶1,HLA-B27抗原总阳性率为27.29%,,男女患者阳性率分别为32.50%和17.95%(P0.05),男女患者B27+/B7-单抗表达率(%)分别为39.16±42.79和20.96±33.86(P0.05),平均荧光强度分别为5.35±5.44和3.35±3.87(P0.05),差别显著。结论用流式细胞技术检测T淋巴细胞HLA-B27的有助于AS的诊断和鉴别诊断。