[Reactive arthritis: current characteristics and the role of Chlamydia infections in development of a clinical picture].
[Reactive arthritis: current characteristics and the role of Chlamydia infections in development of a clinical picture].
复制标题
[反应性关节炎：衣原体感染的当前特征和在临床情况发展中的作用]。
作者：
Doroshenko IuA;Nikonova En
目的
研究当今反应性关节炎（ReA）的特点和衣原体感染对ReA临床表现的影响。
材料和方法
120名ReA患者进入试验。泌尿生殖道变异占85%，小肠结肠炎型占15%。ReA的病因学是通过诊断尿道或宫颈上皮刮片中衣原体和支原体感染的特殊方法（细胞学检测、酶免疫测定、聚合酶链反应、支原体检测培养技术）确定的。抗衣原体抗体检测采用酶免疫法和间接免疫荧光法。采用因子分析和间接连续图像识别法。
结果
在所有病例中，肠结肠炎性ReA之前都有急性肠道感染。在尿源性ReA中，疾病以尿道炎（62.7%）、结膜炎（2.0%）、关节炎（31.4%）或距骨痛（3.9%）开始。最初，完整的Reiter三联征的发生率为15%，不完整的（三个体征中的两个）为46.7%。首发以少关节病变为主（65%），晚期多关节炎多见（49.6%）。疼痛最常见于下脊柱（60.5%）。在54.2%的ReA病例中获得了周围关节和脊柱退行性营养不良改变的X线证据。对60例患者进行了衣原体和支原体感染的检查。ReA的病原学为衣原体、脲原体和衣原体脲原体，分别占43.3%和35%。16.7%的病例病因不明。泌尿生殖系统、眼部、皮肤粘膜、心血管、淋巴结等关节外症状发生率分别为61.7%、22.5%、13.3%、76.7%和13.3%。
结论
目前，ReA最典型的特点是：发病时临床症状的多态性，晚期以多关节型为主，关节外表现的发生率高。因子分析表明，ReA的临床表现是由“活动性”和“不良病程”两个因子构成的。
AIM
To examine present-day peculiarities of reactive arthritis (ReA) and effects of chlamydial infection on ReA clinical manifestations.
MATERIAL AND METHODS
120 ReA patients entered the trial. Urogenital variant was in 85%, enterocolitic in 15% of the patients. Etiology of ReA was defined with special methods diagnosing chlamydial and ureaplasma infection in scrapes from urethral or cervical epithelium (a cytological test, an enzyme immunoassay, polymerase chain reaction, cultural technique of ureaplasma detection). Antichlamydial antibodies were identified with enzyme immunoassay and reaction of indirect immunofluorescence. Factor analysis and indirect consecutive image recognition were applied.
RESULTS
In all the cases, enterocolitic ReA was preceded by acute intestinal infection. In urogenic ReA the disease started with urethritis (62.7%), conjunctivitis (2.0%), arthritis (31.4%) or talalgia (3.9%). Initially, the occurrence of a full Reiter's triad was 15%, incomplete (two signs of the three)--46.7%. The debute was characterized by predominant oligoarticular lesion (65%), in the advanced stage polyarthritis was frequently diagnosed (49.6%). Pain most frequently located in the low spine (60.5%). X-ray evidence on degenerative-dystrophic alterations of the peripheral joints and spine was obtained in 54.2% ReA cases. 60 patients were examined for chlamydial and ureaplasma infection. The etiology of ReA was chlamydial, ureaplasmic and chlamydo-ureaplasma in 43.3, and 35%, respectively. The etiology was not identified in 16.7% cases. Such extraarticular symptoms as urogenital, ocular, skin and mucosal, cardiovascular, lymph nodes were observed in 61.7, 22.5, 13.3, 76.7 and 13.3%, respectively.
CONCLUSION
At present, ReA is characterized by the following most typical features: polymorphism of clinical symptoms at the disease onset, predominance of polyarticular variant of articular involvement at the advanced stage of ReA, high incidence of extraarticular manifestations. The factor analysis shows that clinical picture of ReA is established by "activity" and "unfavourable course" factors.