强直性脊柱炎HLA-B27亚型及其首发临床表现特征

HLA-B27 subtypes of ankylosing spondylitis and their first clinical manifestation

目的探讨强直性脊柱炎(ankylosing spondylitis,AS)HLA-B27亚型及其首发临床特征。方法 476例AS患者,测定其HLA-B27基因型。比较不同HLA-B27亚型AS患者首发临床表现的差异。结果 476例AS患者中,HLA-B27阳性的患者437例。最常见的HLA-B27亚型是HLA-B*2704(90%)和HLA-B*2705(8.6%)。HLA-B*2704和HLA-B*2705阳性患者中,最常见首发受累部位是中轴关节,其次为外周关节,继之是中轴关节和外周关节同时发病者。HLA-B*2704与HLAB*2705亚型AS患者首发受累部位发生率比较,首发受累的部位如中轴关节、外周关节、髋关节、中轴关节+外周关节、中轴关节+髋关节和外周关节+髋关节等差异无统计学意义(P>0.05),但葡萄膜炎发生率比较,差异有统计学意义(P=0.041)。结论特定的HLA-B27亚型可能与AS某些特异的临床表现相关。HLA-B*2705亚型较HLA-B*2704亚型的AS患者更易发生葡萄膜炎。

Objective This study aimed to investigate the HLA-B27 subtypes of ankylosing spondylitis （AS）and their initial symptoms. Methods This study included 476 patients with AS. Direct sequencing was used to identify the HLA-B27 genotype. Clinical initial symptoms were compared among patients with various HLA-B27 subtypes. Results Of the 476 AS patients ,437 （91.8%）were HLA-B27-positive. The most prevalent subtypes were HLA-B ＊ 2704（90% ） and HLA-B ＊ 2705 （8.6%）. In the HLA-B ＊ 2704- and 2705-positive patients, axial joint was the most common first affected site followed by peripheral joint and then the both sites at the same time. However, there was no significant difference in incidence of the first affected sites such as axial joint, peripheral joint, hip joint, ax- ial joint ＋ peripheral joint,axial joint ＋ hip joint and peripheral joint ＋ hip joint between the subtypes（ P 〉 0. 05 ）. Compared with HLA-B ＊ 2704-positive patients, HLA-B ＊ 2705- patients demonstrated a significant increase in the incidence of uveitis （ P = 0. 041 ）. Conclusion Specific HLA-B27 subtypes are positively associated with particular initial symptoms. AS patients with HLA-B ＊ 2705 has a higher risk of uveitis than AS patients with HLA-B ＊ 2704 does.