HLA-B27阳性和阴性患者强直性脊柱炎的临床表现

Sh. F. Erdes, K. V. Sakharova
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The levels of transaminases, uric acid, urea, creatinine, interleukin (IL) 6 and IL17 in blood serum were also examined. Results and discussion. HLA-B27 was detected in 166 (83 %) of 200 patients with AS (in 89.8 % of men and in 73.2 % of women; p = 0.003). Among HLA-B27 positive patients with AS, 63.9 % were men, and among HLA-B27 negative patients, 35.3 % were men (p = 0.002). The mean age of AS onset was 5 years higher in HLA-B27-negative patients, and the disease was about 2 times less likely to occur in childhood in them. Syndesmophytes were detected in 25 % of HLA-B27 positive patients and in 15 % of patients who did not have this antigen (p > 0.05). Syndesmophytes were found in 31.1 % of HLA-B27 positive and 25 % of HLA-B27 negative men. 15 % of women with HLA-B27 and 9 % of women without this antigen had syndesmophytes (p = 0.022). Inflammatory bowel disease was more common in HLA-B27-negative patients, whereas uveitis and psoriasis were less common. 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引用次数: 0

摘要

HLA-B27基因与强直性脊柱炎(AS)之间的联系已被发现近50年。在此期间,人们发现该病的一些临床表现与几乎所有人群的该病一致相关,而另一部分则取决于患者的种族。还定期描述某些民族特有的独特联系。目的:分析AS住院患者的临床特征与HLA-B27水平的关系。材料和方法。va Nasonova风湿病研究所风湿科200例连续AS患者的横断面研究。所有患者都进行了推荐的标准临床检查,以评估AS活动和功能状态。同时检测血清转氨酶、尿酸、尿素、肌酐、白细胞介素(IL) 6、IL17水平。结果和讨论。200例AS患者中有166例(83%)检测到HLA-B27(男性为89.8%,女性为73.2%;P = 0.003)。HLA-B27阳性AS患者中男性占63.9%,HLA-B27阴性患者中男性占35.3% (p = 0.002)。hla - b27阴性患者AS发病的平均年龄比正常患者高5岁,儿童期发病的可能性低2倍。25%的HLA-B27阳性患者和15%的未携带该抗原的患者检测到伴胫病(p >0.05)。在HLA-B27阳性和阴性男性中分别有31.1%和25%的并发真菌。15%携带HLA-B27的女性和9%不携带该抗原的女性患有综合征(p = 0.022)。炎症性肠病在hla - b27阴性患者中更为常见,而葡萄膜炎和牛皮癣则不太常见。HLA-B27阳性和阴性患者的活动率、关节炎和胃炎发病率相似。血清il - 17浓度在HLA-B27阴性组比HLA-B27阳性组高6倍(p = 0.012)。结论。在俄罗斯的AS患者群体中,HLA-B27与大多数族裔群体的特征相关(例如,发病较早),但并非在所有族裔群体中都发现相关(例如,病程较严重,关节炎和结肠炎发病率较高)。此外,HLA-B27阴性患者血清中il - 17的浓度比HLA-B27阳性患者高6倍。这可能表明在缺乏HLA-B27基因的情况下,AS的发病机制存在非规范机制,有待进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical picture of ankylosing spondylitis in HLA-B27 positive and negative patients
The link between the HLA-B27 gene and ankylosing spondylitis (AS) has been known for almost 50 years. During this time, it has been discovered that some of the clinical manifestations of the disease are uniformly associated with the disease in almost all populations, while the other part depends on the ethnicity of the patients. Unique associations characteristic only of certain ethnic groups are also periodically described. Objective: to analyze the clinical features of the inpatient population with AS in relation to their HLA-B27 status. Material and methods. Cross sectional study of 200 consecutive AS patients admitted to the rheumatology department of the V.A. Nasonova Research Institute of Rheumatology. All patients underwent standard clinical examination recommended for assessment of AS activity and functional status. The levels of transaminases, uric acid, urea, creatinine, interleukin (IL) 6 and IL17 in blood serum were also examined. Results and discussion. HLA-B27 was detected in 166 (83 %) of 200 patients with AS (in 89.8 % of men and in 73.2 % of women; p = 0.003). Among HLA-B27 positive patients with AS, 63.9 % were men, and among HLA-B27 negative patients, 35.3 % were men (p = 0.002). The mean age of AS onset was 5 years higher in HLA-B27-negative patients, and the disease was about 2 times less likely to occur in childhood in them. Syndesmophytes were detected in 25 % of HLA-B27 positive patients and in 15 % of patients who did not have this antigen (p > 0.05). Syndesmophytes were found in 31.1 % of HLA-B27 positive and 25 % of HLA-B27 negative men. 15 % of women with HLA-B27 and 9 % of women without this antigen had syndesmophytes (p = 0.022). Inflammatory bowel disease was more common in HLA-B27-negative patients, whereas uveitis and psoriasis were less common. Activity rates and incidence of arthritis and enthesitis were similar in HLA-B27 positive and negative patients. Serum concentration of IL17 was six times higher in HLA-B27 negative patients than in HLA-B27 positive patients (p = 0.012). Conclusion. In the Russia’s AS patient population there are associations with HLA-B27, characteristic for most ethnic groups (e. g., earlier onset of the disease) and associations not found in all ethnic groups (e. g., a more severe course, a higher incidence of arthritis and enthesitis). In addition, the concentration of IL17 in the blood serum of HLA-B27 negative patients was six times higher than that of HLA-B27 positive patients. This may indicate non-canonical mechanisms of pathogenesis of AS that develop in the absence of the HLA-B27 gene, which requires further research.
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