腸道菌感染在血清陰性脊椎關節病變之致病角色

The Role of Enteric Organisms in Sero- Negative Spondyloarthropathy

僵直性脊椎炎與Reiter's syndrome是血清陰性脊椎關節病變代表性疾病。除了遺傳基因HLA-B27之重要因素外後天細菌感染亦被認為上述疾病的誘發因素。本科選擇門診或住院診斷為僵直性脊椎炎患者43例，9例Reiter病人及對照組（非上述病變者）34例之大便，作Salmonella, Shigella, Klebsiella等菌之特別培養，以測定上述細菌是否存在，另選擇7例診斷為Reiter's Syndrome，與8例正常人之淋巴球以Yersinia 03，08來刺激，以測定其淋巴球 移形反應。研究結果顯示43例脊椎炎者有22例(51％)大便培養長出Klebsiella菌，而34例對照者僅6例(17.6％)為陽性，僅有1例脊椎炎培養出Salmonella菌，而淋巴球移形試驗在Reiter's Syndrane，脊椎炎與正常人作比較，無明顯之差異。Klebsiella Pneumonia易發現在僵直性脊椎炎病患，而Reiter's Syndrome病人淋巴球移形試驗結果顯示， 除了Yersinia菌外，尚有其它的致病菌，而在不同人種或地區其致病性亦不同。

Within one year, stool examination for Klebsiella, Shigella, and Salmonella were performed on 43 ankylosing spondylitis (AS), 9 Reiter's syndrome (RS), and 34 other diseases' patients. T lymphocyte proliferative response to Yersinia enterocolitica was tested in 7 RS patients and 8 normal healthy people. In 43 AS patients, Klebsiella pneumonia was isolated from 22 patients (51%). However, none of our 9 RS patients yielded positive stool eulture for Klebsiella. In 34 patients with other rheumatic diseases, we can only demonstrate positive Klebsiella culture in 6 patients(18%). One patient had Salmonella in his stool. No significant difference between healthy people and RS patients was noted on lymphocyte proliferation with heat-treated Yersinia 03 and 08. Although the HLA-B27 positive rate in AS and RS between Caucasian and Chinese are similar, the infectious organisms or strains may be different.