CAJ | 학술논문

目的研究成人强直性脊柱炎(AS)患者肺炎支原体(MP)感染与疾病活动性的关系.方法选取我院门诊AS患者66例;对照组选取类风湿关节炎(RA)31例,骨关节炎(OA)25例,健康人群(NC)36名.根据抗肺炎支原体抗体(anti-MP IgM)将AS患者分成MP感染组和非MP感染组,比较和分析4周以内上呼吸道感染史、白细胞、疾病活动指数(BASDAI)、红细胞沉降率(ESR)、C反应蛋白(CRP)、免疫球蛋白以及骶髂关节损害程度、脊柱活动度(Schober测量和胸廓活动度).结果 66例AS患者抗MP抗体检测发现,阳性检出率为52%(34/66),与RA(6%)、OA(4%)、NC(11%)比较,差异有统计学意义(P＜0.01).MP感染组的疾病活动也显著高于非MP感染组,其中BASDAI(4.0±1.1对3.0±1.9,P=0.017),ESR[(44±32)mm/1 h对(28±23)mm/1 h,P=0.029],CRP[(40±38)mg/L对(22±21)mg/L,P=0.025],血清总IgG水平[(18±3)g/L对(16±5)g/L,P=0.027],但与总IgA和IgM无关.两组的骶髂关节分级、Schober测量和胸廓扩张度差异无统计学意义.抗MP抗体阳性的AS患者中只有44%出现呼吸道症状,但有呼吸道症状的AS患者中,71%的患者抗MP抗体阳性,与无呼吸道症状组比较,差异具有统计学意义(P=0.027).结论 AS患者的MP感染与疾病的活动性密切相关,可能是AS发病的主要诱发因素.
목적 연구성인강직성척주염(AS)환자폐염지원체(MP)감염여질병활동성적관계.방법 선취아원문진AS환자66례;대조조선취류풍습관절염(RA)31례,골관절염(OA)25례,건강인군(NC)36명.근거항폐염지원체항체(anti-MP IgM)장AS환자분성MP감염조화비MP감염조,비교화분석4주이내상호흡도감염사、백세포、질병활동지수(BASDAI)、홍세포침강솔(ESR)、C반응단백(CRP)、면역구단백이급저가관절손해정도、척주활동도(Schober측량화흉곽활동도).결과 66례AS환자항MP항체검측발현,양성검출솔위52%(34/66),여RA(6%)、OA(4%)、NC(11%)비교,차이유통계학의의(P＜0.01).MP감염조적질병활동야현저고우비MP감염조,기중BASDAI(4.0±1.1대3.0±1.9,P=0.017),ESR[(44±32)mm/1 h대(28±23)mm/1 h,P=0.029],CRP[(40±38)mg/L대(22±21)mg/L,P=0.025],혈청총IgG수평[(18±3)g/L대(16±5)g/L,P=0.027],단여총IgA화IgM무관.량조적저가관절분급、Schober측량화흉곽확장도차이무통계학의의.항MP항체양성적AS환자중지유44%출현호흡도증상,단유호흡도증상적AS환자중,71%적환자항MP항체양성,여무호흡도증상조비교,차이구유통계학의의(P=0.027).결론 AS환자적MP감염여질병적활동성밀절상관,가능시AS발병적주요유발인소.
Objective To investigate the association of Mycoplasma pneumoniae(MP) infection with disease activity of ankylosing spondylitis. Methods A total of 158 subjects in our hospital were enrolled in this study, including patients with ankylosing spondylitis(AS, n=66), rheumatoid arthritis (RA, n=31),osteoarthritis(OA, n=25) and normal controls(NC, n=36). MP infection was defined as anti-MP IgM antibody positive. Anti-MP IgM antibodies were determined by a mycoplasma pneumoniae(Mac strain)membrane-based agglutination test. AS patients were divided into two groups: MP infection group and non-MP infection group. T-test was used for statistical analysis of age, blood white cells, ESR, CRP, immunoglobulin, BASDAI index, global assessment on VAS scale, Schober test and chest expansion reflecting spinal mobility.χ2-test was used to compare the positive rate of MP infection in different groups. Gender difference and prevalence of clinical infection in past four weeks between MP infection and MP-free group in AS patients was also compared. Ridit analysis was used to analyze the association of MP infection with degree of sacroiliac damage on CT. Results The prevalence of MP infection in AS (52%, 34/66) was much higher than that in rheumatoid arthritis (RA, 6%, P＜0.01 ), osteoarthritis(OA, 4%, P＜0.01 ) and normal controls (NC, 11%, P＜0.01) . Compared with the non-MP infection group, the MP infection group had more active disease in term of BASDAI(4.0±1.1 vs 3.0±1.9, P=0.017), ESR[(44±32) mm/1h vs (28±23) mm/1h, P=0.029], CRP [(40±38) mg/L vs (22±21) mg/L, P=0.025] serum total IgG level [(18±3) g/L vs (16±5) g/L, P=0.027],but not in serum total IgA and IgM. Regarding to the sacroiliac joint and spinal mobility, MP infection group did not exhibit any association with the sacroiliac grading on CT, Schober test and expansion. In AS patients with MP infection, only 44.1%(15/34) was complicated by clinical manifestations of upper respiratory tract in the past 4 weeks. However, a higher prevalence of MP infection was found in AS patients with clinical manifestation of upper respiratory tract, compared with those with negative clinical manifestation(71% vs 42%,P=0.027). Conclusion Mycoplasma pneumoniae is the most common reported pathogen in ankylosing spondylitis and relates to the disease activity of AS. MP infection is probably a principal triggering factor in the pathogenesis of AS.