CAJ | 학술논문

背景：疼痛一直为强直性脊柱炎的主要临床表现，目前治疗多以口服非类固醇抗炎药为主，效果有限且毒副作用大，目前尚没有一种经济、有效治疗强直性脊柱炎疼痛症状的方案。 　　目的：探讨强直性脊柱炎患者术后关节疼痛缓解与异体输血的相互关系及其机制。 　　方法：回顾分析了88例因强直性脊柱炎驼背行单节段后凸截骨矫形合并髋关节疼痛患者的临床资料，对比术中新鲜异体全血输注、自体与异体全血混合输注、自体全血回输3组患者髋关节疼痛目测类比评分、白细胞计数、淋巴细胞计数及免疫球蛋白浓度的变化，并利用流式细胞技术分析外周血中与自身免疫性疾病密切相关的Th17及Treg细胞亚群的数量与比例变化。 　　结果与结论：新鲜异体全血输注、自体与异体全血混合输注者术后髋关节疼痛症状明显改善，其白细胞数量、淋巴细胞数量及免疫球蛋白浓度无明显变化，但流式细胞技术检测显示强直性脊柱炎患者外周血中与自身免疫性疾病密切相关的Th17/Treg比例明显升高。结果可见异体全血输注可能通过纠正Th17/Treg平衡进而改善患者的免疫状态，减轻其关节疼痛。
배경：동통일직위강직성척주염적주요림상표현，목전치료다이구복비류고순항염약위주，효과유한차독부작용대，목전상몰유일충경제、유효치료강직성척주염동통증상적방안。 　　목적：탐토강직성척주염환자술후관절동통완해여이체수혈적상호관계급기궤제。 　　방법：회고분석료88례인강직성척주염타배행단절단후철절골교형합병관관절동통환자적림상자료，대비술중신선이체전혈수주、자체여이체전혈혼합수주、자체전혈회수3조환자관관절동통목측류비평분、백세포계수、림파세포계수급면역구단백농도적변화，병이용류식세포기술분석외주혈중여자신면역성질병밀절상관적Th17급Treg세포아군적수량여비례변화。 　　결과여결론：신선이체전혈수주、자체여이체전혈혼합수주자술후관관절동통증상명현개선，기백세포수량、림파세포수량급면역구단백농도무명현변화，단류식세포기술검측현시강직성척주염환자외주혈중여자신면역성질병밀절상관적Th17/Treg비례명현승고。결과가견이체전혈수주가능통과규정Th17/Treg평형진이개선환자적면역상태，감경기관절동통。
BACKGROUND:Pain is the main clinical manifestation for ankylosing spondylitis. At present, nonsteroid anti-inflammatory drugs are oral y taken, but the effects are limited and toxic and side effects are more. Thus, there is no effective scheme for treatment of pain induced by ankylosing spondylitis. OBJECTIVE:To investigate the correlation between postoperative joint pain al eviation and al ogeneic blood transfusion, and the mechanisms. METHODS:We retrospectively analyzed clinical data of 88 ankylosing spondylitis patients combined with kyphosis who received only one section of osteotomy surgery merging hip joint pain. We compared the visual analog scale score of hip joint and detected the variation of leucocytes, lymphocytes and immunoglobulin concentrations before and after the operation in the groups of fresh al ogeneic whole blood transfusion, autologous whole blood transfusion, and mixed transfusion of al ogeneic and autologous whole blood. Flow cytometry was used to analyze the number and ratio of peripheral blood Th17 cells and Treg cells which were both highly associated with autoimmune diseases. RESULTS AND CONCLUSION:The symptom of hip arthralgia obviously improved in both groups transfused by fresh al ogeneic whole blood or al ogeneic-autologous mixed whole blood. However, no obvious variation was detected in leucocytes, lymphocytes and immunoglobin concentration. However, flow cytometry results indicated that Th17/Treg proportion associated with autoimmune diseases was increased remarkably in peripheral blood of ankylosing spondylitis patients. Results suggested that al ogeneic whole blood transfusion can al eviate patients’ joint pain by correcting the imbalance of Th17/Treg which may improve their immune state.