Ciccia Francesco, Rizzo Aroldo, Triolo Giovanni
aDipartimento Biomedico di Medicina Interna e Specialistica, Sezione di Reumatologia, Università degli Studi di Palermo bDipartimento di Oncoematologia, Azienda Ospedaliera Ospedali riuniti Villa Sofia-Cervello, Palermo, Italy.
Curr Opin Rheumatol. 2016 Jan;28(1):89-96. doi: 10.1097/BOR.0000000000000239.
Subclinical gut inflammation has been described in a significant proportion of patients with ankylosing spondylitis (AS), up to 10% of them developing it during the time of clinically overt inflammatory bowel disease. Histologic, immunologic, and intestinal microbiota alterations characterize the AS gut.
Microbial dysbiosis as well as alterations of innate immune responses have been demonstrated in the gut of AS. Furthermore, a growing body of evidence suggests that the gut of AS patients may be actively involved in the pathogenesis of AS through the production of proinflammatory cytokines, such as IL-23p19, and the differentiation of potentially pathogenic innate lymphoid cells producing IL-22 and IL-17. Finally, a strong correlation between the presence of subclinical gut inflammation and the degree of spine inflammation have been also proved in AS.
Subclinical gut inflammation and innate immune responses in AS may be considered a possible consequence of microbial dysbiosis. Relationships between cause and effect remain, however, to be answered.
在相当比例的强直性脊柱炎（AS）患者中已发现存在亚临床肠道炎症，其中高达10%的患者在临床明显的炎症性肠病发作时出现这种情况。组织学、免疫学和肠道微生物群改变是AS肠道的特征。
在AS患者的肠道中已证实存在微生物失调以及固有免疫反应的改变。此外，越来越多的证据表明，AS患者的肠道可能通过产生促炎细胞因子（如IL-23p19）以及分化产生IL-22和IL-17的潜在致病性固有淋巴细胞，积极参与AS的发病机制。最后，在AS中也已证实亚临床肠道炎症的存在与脊柱炎症程度之间存在密切相关性。
AS中的亚临床肠道炎症和固有免疫反应可能被认为是微生物失调的一个可能后果。然而，因果关系仍有待解答。
