Clinical And Pathological Study Of The Relationship Of Virus Infection With Ankylosing Spondylitis Clinical Observation Of Clarithromycin In Treatment Of Relapsed Ankylosing Spondylitis After Stopping TNF-α

[Objective]To study the relationship of Herpes Simplex virus and Cytomegalovirus infectedwith ankylosing spondylitis.Clinical observation of clarithromycin in treatment of relapsed ankylosingspondylitis after stopping TNF-α inhibitor.[Methods]Chemiluminescent immunoassay(CLIA) was used to detect serum anti theHerpes Simplex virus titer antibody and anti Cytomegalovirus antibodies in46ASPatients’Peripheral blood serumand and30normalcontrols.Immunohistochemistry(IHC) was used to detect the synovial Herpes Simplexvirus’s and Cytomegalovirus infected antigen in synovial tissue from patients andnormal control. Selected14relapsed ankylosing spondylitis patients were enrolled inthis study. All patients were give traditional oral medication in combination with theclarithromycin. Inflammatory index including erythrocyte sedimentation rate andC-reactive protein, and adverse effect were recorded every four weeks for20weeks.[Results]1.The positive rate of anti herpes simplex virus IgG antibodies was93.5%among46cases of AS patients and96.7%in normal controls.The two group was nosignificance.however, The anti herpes simplex virus IgG titer was found to beassociated with elevated ESR(r=0.304, p=0.04) and CRP level (r=0.439, p=0.002).2.The inflammatory index were higher in patients with anti Herpes simplex virusIgG titer>17than those with antibody titer <17. When Herpes simplex virus IgGtiter>17the mean of ESR was (33.63±22.71),the mean of CRP was（20.84±16.09）. When Herpes simplex virus IgG titer <17the mean of ESR was（17.27±12.30）,themean of CRP was（7.53±6.83）.3.The positive rate of anti herpes simplex virus IgM antibodies was4%among46cases of AS patients and3%in normal controls. The two group was nosignificance.4.The positive rate of anti cytomegalovirus virus IgG antibodies was97.8%among46cases of AS patients and100%in normal controls.The two group was nosignificance. ESR and CMV IgG titer was not correlated (r=0.217, p=0.148), CRPand the CMV IgG titer was not correlated (r=0.162, p=0.282). The positive rate ofanti cytomegalovirus virus IgM antibodies was0%among46cases of AS patientsand0%in normal controls. The two group was no significance.5.In synovial tissues, Herpes simplex virus antigen was observed in54.5%ASpatients compaird with50%in normal control,p=0.579.cytomegalovirus was observedin54.5%AS patients,compaird with41.7%in normal control,p=0.684.6.Fourteen patients were disease-relapsing after discontinuing tumor necrosisfactor antagonists for average (3.71±1.9) months and had a high inflammatoryindex.All patients were given an initial two weeks course of clarithromycin and oraltraditional drugs during the study period. Inflammatory index in86%(12cases)decreased in fourth week and maintained at a low level for20weeks86%(12cases).[Conclution]1.The level of herpes simplex virus titer associated with AS patients diseaseactivity2.AS disease activity and cytomegalovirus titers there is no correlation.3.In synovial tissues,used Immunohistochemical detection of herpes simplexvirus there was not statistical significant.4.In synovial tissues,used Immunohistochemical detection of cytomegalovirusthere was not statistical significant.5.The macrolides antibiotic is effective for relapsed ankylosing spondylitis afterdiscontinued TNF inhibitor.