强直性脊柱炎的诊断与治疗进展.pptVIP

希望生物制剂（类克）让更多AS患者迈开腿大步走向人生新的旅程 * 谢 谢 AS是常见的风湿免疫性疾病，临床表现多样，以脊柱和四肢关节为主要病变，随着病程的延长，病情的加深，强直患者的骶髂关节、腰椎、胸椎、颈椎均可出现受累的情况，在X线片上显示脊柱形成竹节状的骨性强直，有的则形成不同程度的驼背畸形，严重者不仅行动不便，而且两眼只能看地面的问号体形，极像虾人，因此，强直不治疗，随着病情的加深，患者会变虾人。 A、B、C三图为同一病变部位不同检测方法下结果。 A图：MRI显示关节突骨髓水肿部位在病理切片可见单个核细胞浸润（B图，HE染色），免疫组化分析单个核细胞构成，显示CD3+T淋巴细胞高表达。提示CD3+T淋巴细胞可能在骨髓水肿的病理过程中发挥重要作用。 病理表现可见弥漫性炎性细胞浸润 Ankylosing spondylitis (AS) is a chronic inflammatory disease which affects primarily the sacroiliac joints and the spine. In patients with active disease, magnetic resonance imaging (MRI) of the spine shows areas of bone marrow edema, the histopathological equivalent of which is unknown. In this study we correlate inflammation in the spine of patients with AS as revealed by histological examination with bone marrow edema as detected by MRI. We have compared the histopathological findings of zygapophyseal joints from 8 patients with AS (age: 30 to 64, disease duration 7 to 33 years) undergoing spinal surgery with findings in MRI. For histopathological analysis, we quantified infiltrates of CD3+, CD4+ and CD8+ T cells as well as CD20+ B cells immunohistochemically. Bone marrow edema was evaluated in hematoxylin and eosin stained sections and quantified as the percentage of the bone marrow area involved. All patients with AS showed interstitial mononuclear cell infiltrates and various degrees of bone marrow edema (range from 10% to 60%) in histopathological analysis. However, in only three of eight patients histopathological inflammation and edema in the zygapophyseal joints correlated with bone marrow edema in zygapophyseal joints of the lumbar spine as detected by MRI. Interestingly, two of these patients showed the highest histological score for bone marrow edema (60%). This first study correlating histopathological changes in the spine of patients with AS with findings in MRI scans suggests that a substantial degree of bone marrow inflammation and edema is necessary to be detected by MRI. 解剖区域指软骨下或关节周围的骨髓，与SpA骶髂关节炎相关的BM