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

摘要

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、α1-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① HLA-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%)；② HLA-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)；③ HLA-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)；④ HLA-B27阳性组 ESR、CRP 均较阴性组明显增高(P<0.05)；两组α1-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.%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 α1-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 ① 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%). ② 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). ③ 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). ④ 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 α1-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.