广东潮州地区强直性脊柱炎患者HLA．B27的检测与临床相关性研究

目的检测强直性脊柱炎（Ankylosing spondylitis，AS）患者HLA．B27抗原表达情况，并分析其与临床情况的关系。方法选择我院2008年5月到2011年5月期间150例AS患者，按HLA．B27抗原表达分为两组：HLA—B27阳性组（n=108）及HLA—B27阴性组（n=42）。分别检测两组血标本血沉、C反应蛋白、Ot1一酸性糖蛋白水平，并检查心电图、骨盆正位片和腰椎正侧位，比较两组的发病年龄、性别比、临床症状。结果①HLA—B27阴性组以31～45岁年龄段为主（占阴性组52．4％），阳性组以16～30岁年龄段为主（占阳性组57．4％）；②HLA—B27阳性组较阴性组全身症状更为严重（P〈0．05）；而两组在下腰痛、髋部疼痛、中轴关节炎、外周关节炎、眼炎方面进行比较无明显差异（P〉0．05）；③HLA．B27阴性组较多表现为在窦缓和／或传导阻滞，而HLA．B27阳性组则较多表现为左室高电压（P〈0．05）；④HLA．B27阳性组ESR、CRP均较阴性组明显增高（P〈0．05）；两组仅1一酸性糖蛋白无明显差异（P〉0．05）。结论AS患者临床症状与HLA—B27抗原有很高的相关性，HLA．B27抗原阴性患者与阳性患者相比病情较轻，预后较好。

Investigation of the relationship between clinical manifestation of ankylosing spondylitis and HLA-B27 antigen in Chaozhou, Guangdong Province

Objective To investigate the relationships between clinical manifestation of ankylosing spondylitis （AS） and HLA-B27 antigen by analyzing the expression level of HLA-B27 antigen. Methods During May 2008 and May 2011, 150 AS patients attended our study. According to the expression level of HLA-B27 antigen, these patients were classified into two groups： HLA-B27 negative group and HLA-B27 positive group. The erythrocyte sedimentation rate （ESR）, CRP, and cx 1-AGP, electrocardiogram, anterioposterior radiograph of pelvis, anterior and lateral lumbar vertebral X ray were also examined. The age of onset, sex proportion, and clinical manifestation were compared in the two groups. Results （~ HLA-B27 negative expression mainly ranged from 31 to 45 years old （52.4%）, but positive expression group mainly ranged from 16 to 30 years old （57.4%）. （~）The rate of systemic symptom such as fever, night sweat, and fatigue were higher in HLA-B27 positive group than that in negative group（P〈0.05）. There were no significant statistical differences between the symptoms of two groups including low back pain, hip pain, axial and peripheral arthritis and ophthalmia （P〉0.05）. （~） The major clinical symptom in HLA-B27 negative patients were sinus bradycardia or/and heart block, but left ventricle hyper-voltage in HLA-B27 positive patients （P〈0.05）. （~） The blood ESR and CRP were higher in HLA-B27 positive patients than negative ones （P〈0.05）, and there was no significant statistical difference of α 1-AGP between them （P〉0.05）. Conclusion There was strong relationship between the HLA-B27 antigen expression and clinical symptoms of AS. The major clinical symptom was more severe in HLA-B27 positive patients than negative ones.