强直性脊柱炎患者血清胶原的表达及临床意义(1)
[摘要] 目的 观察胶原在强直性脊柱炎患者血清中的表达。 方法 30例早中期AS患者入组作为AS组，并以30例健康志愿者为对照组。分别检测AS组和对照组受试者外周血清胶原水平。AS组患者评估Bath强直性脊柱炎病情活动指数(BASDAI)、Bath强直性脊柱炎功能指数(BASFI)、Bath强直性脊柱炎测量指数(BASMI)及檢测血沉、C反应蛋白。 结果 AS组胶原水平较健康对照组显著升高(P<0.05)。AS组患者按CT结果分级，Ⅱ、Ⅲ级AS患者外周血清胶原水平均显著高于对照组(P<0.05)；Ⅰ级AS患者外周血清胶原水平与对照组比较无显著差异(P>0.05)。HLA-B27阳性患者血清胶原水平与HLA-B27阴性患者血清胶原水平比较无显著性差异(P>0.05)。Pearson线性相关分析显示胶原水平和BASDAI，BASFI，BASMI，ESR及CRP呈显著正相关(P<0.05)。 结论胶原在AS患者外周血清呈高表达，与AS病情有着密切的关联，可以作为AS病情监测的一个重要指标。
[关键词] 强直性脊柱炎；血清学指标；胶原；检测
[中图分类号] R593.23 [文献标识码] A [文章编号] 1673-9701(2018)05-0021-04
[Abstract] Objective To observe the expression of collagen in serum of patients with ankylosing spondylitis. Methods 30 patients with early and middle stage AS were enrolled in AS group， and 30 healthy volunteers were used as control group. The levels of peripheral serum collagen in AS group and control group were detected. The Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)， Bath Ankylosing Spondylitis Function Index(BASFI)， Bath Ankylosing Spondylitis Measurement Index(BASMI) of patients in the AS group were evaluated. The ESR and C-reactive protein were detected. Results The level of collagen in the AS group was significantly higher than that in the healthy control group (P<0.05). Patients in the AS group were graded according to the CT results. The levels of peripheral blood collagen in patients with grade Ⅱ and Ⅲ AS were significantly higher than those in the control group(P<0.05). There was no significant difference in the level of serum collagen in grade Ⅰ AS group and control group(P>0.05). There was no significant difference in serum collagen level between HLA-B27 positive patients and HLA-B27 negative patients(P>0.05). Pearson linear correlation analysis showed a significant positive correlation between collagen level and BASDAI， BASFI， BASMI， ESR and CRP(P<0.05). Conclusion Collagen is highly expressed in peripheral blood of AS patients， and is closely related to AS condition， which can be used as an important index for monitoring AS condition.
[Key words] Ankylosing spondylitis； Serological indicators； Collagen； Detection
强直性脊柱炎(ankylosing spondylitis， AS)是一种脊柱关节疾病，表现为骶髂关节和脊柱附着点炎症，可引起脊柱纤维化和脊柱强直，甚至导致肌肉、骨骼和肺功能受损[1]，因而具有较高的致残率。目前其病因仍不清楚[2]。胶原蛋白的过度产生是纤维化的生物标志物[3]。本研究通过检测AS患者血清胶原的表达特点，拟探讨血清胶原与AS临床病理参数的关系及其临床应用价值，现报道如下。
1 资料与方法
1.1一般资料
选取2015年5月～2017年3月门诊及住院患者30例作为AS组，其中男26例，女4例；年龄20～50 岁，平均(33.50±10.82)岁；病程4个月～18年，平均(12.68±6.12)年。30例患者人白细胞抗原(HLA)-B27阳性23例，阴性者7例。30例AS患者均符合AS修订纽约分类诊断标准[4]，并且骶髂关节炎的CT检查显示Ⅲ级以内改变。骶髂关节炎的CT表现按照纽约修订AS骶髂关节的CT分级标准分为 4 级：Ⅰ级11例，髂骨关节面局部毛糙，硬化，边缘模糊，关节面下骨质局限性条状硬化，关节间隙清晰。Ⅱ级16例， 骶髂关节面毛糙，模糊，条状硬化，关节面下骨质条状、小斑片状硬化，关节间隙存在。Ⅲ级13例，关节面毛糙，边缘不光整，凹凸不平呈锯齿状、虫噬状改变，局部见线条状硬化，关节面下骨质见多个小囊状、虫噬状骨质破坏，其周围见斑片状、条状骨质硬化，关节间隙模糊，宽窄不等。Ⅳ级0例，骶髂关节面模糊不清，局部见线状、条片状密度增高硬化影，关节间隙消失，完全融合、强直。所有AS患者均排除：(1)患者有其他血清阴性脊柱关节疾病，需要用肾上腺皮质激素治疗；(2)怀孕或哺乳期妇女；(3)合并心脏、严重原发性心血管、肝、肾、造血系统疾病及精神疾病。同时以30例健康志愿者作为对照组，其中男23例，女7例； 年龄22～51岁，平均(35.10±11.06)岁。两组的年龄、性别等一般资料比较无统计学差异(P>0.05)。具有可比性。, http://www.100md.com(朱俊岭 周建尧 阎小萍 侯韬 赵建治 王国芳 韩晓伟)
[关键词] 强直性脊柱炎；血清学指标；胶原；检测
[中图分类号] R593.23 [文献标识码] A [文章编号] 1673-9701(2018)05-0021-04
[Abstract] Objective To observe the expression of collagen in serum of patients with ankylosing spondylitis. Methods 30 patients with early and middle stage AS were enrolled in AS group， and 30 healthy volunteers were used as control group. The levels of peripheral serum collagen in AS group and control group were detected. The Bath Ankylosing Spondylitis Disease Activity Index(BASDAI)， Bath Ankylosing Spondylitis Function Index(BASFI)， Bath Ankylosing Spondylitis Measurement Index(BASMI) of patients in the AS group were evaluated. The ESR and C-reactive protein were detected. Results The level of collagen in the AS group was significantly higher than that in the healthy control group (P<0.05). Patients in the AS group were graded according to the CT results. The levels of peripheral blood collagen in patients with grade Ⅱ and Ⅲ AS were significantly higher than those in the control group(P<0.05). There was no significant difference in the level of serum collagen in grade Ⅰ AS group and control group(P>0.05). There was no significant difference in serum collagen level between HLA-B27 positive patients and HLA-B27 negative patients(P>0.05). Pearson linear correlation analysis showed a significant positive correlation between collagen level and BASDAI， BASFI， BASMI， ESR and CRP(P<0.05). Conclusion Collagen is highly expressed in peripheral blood of AS patients， and is closely related to AS condition， which can be used as an important index for monitoring AS condition.
[Key words] Ankylosing spondylitis； Serological indicators； Collagen； Detection
强直性脊柱炎(ankylosing spondylitis， AS)是一种脊柱关节疾病，表现为骶髂关节和脊柱附着点炎症，可引起脊柱纤维化和脊柱强直，甚至导致肌肉、骨骼和肺功能受损[1]，因而具有较高的致残率。目前其病因仍不清楚[2]。胶原蛋白的过度产生是纤维化的生物标志物[3]。本研究通过检测AS患者血清胶原的表达特点，拟探讨血清胶原与AS临床病理参数的关系及其临床应用价值，现报道如下。
1 资料与方法
1.1一般资料
选取2015年5月～2017年3月门诊及住院患者30例作为AS组，其中男26例，女4例；年龄20～50 岁，平均(33.50±10.82)岁；病程4个月～18年，平均(12.68±6.12)年。30例患者人白细胞抗原(HLA)-B27阳性23例，阴性者7例。30例AS患者均符合AS修订纽约分类诊断标准[4]，并且骶髂关节炎的CT检查显示Ⅲ级以内改变。骶髂关节炎的CT表现按照纽约修订AS骶髂关节的CT分级标准分为 4 级：Ⅰ级11例，髂骨关节面局部毛糙，硬化，边缘模糊，关节面下骨质局限性条状硬化，关节间隙清晰。Ⅱ级16例， 骶髂关节面毛糙，模糊，条状硬化，关节面下骨质条状、小斑片状硬化，关节间隙存在。Ⅲ级13例，关节面毛糙，边缘不光整，凹凸不平呈锯齿状、虫噬状改变，局部见线条状硬化，关节面下骨质见多个小囊状、虫噬状骨质破坏，其周围见斑片状、条状骨质硬化，关节间隙模糊，宽窄不等。Ⅳ级0例，骶髂关节面模糊不清，局部见线状、条片状密度增高硬化影，关节间隙消失，完全融合、强直。所有AS患者均排除：(1)患者有其他血清阴性脊柱关节疾病，需要用肾上腺皮质激素治疗；(2)怀孕或哺乳期妇女；(3)合并心脏、严重原发性心血管、肝、肾、造血系统疾病及精神疾病。同时以30例健康志愿者作为对照组，其中男23例，女7例； 年龄22～51岁，平均(35.10±11.06)岁。两组的年龄、性别等一般资料比较无统计学差异(P>0.05)。具有可比性。, http://www.100md.com(朱俊岭 周建尧 阎小萍 侯韬 赵建治 王国芳 韩晓伟)