系统性红斑狼疮分类标准的再评价

为了进一步修订美国风湿病学会(ACR)制定的系统性红斑狼疮(SLE)分类标准,2003年,国际协作组在瑞典兰德举行会议,对现有的SLE分类标准进行了分析和讨论。美国约翰斯·霍普金斯大学医学院的Petri和Magder将会议内容整理成文并发表在Lupus杂志(2004,13:829)上,供临床医师及研究人员参考。ACR制定的1971年,1982年和1997年SLE分类标准见表1。表1ACR制定的1971年、1982年和1997年SLE分类标准比较1971年分类标准1982年分类标准1997年分类标准蝶形红斑蝶形红斑蝶形红斑盘状红斑盘状红斑盘状红斑光敏感光敏感光敏感口腔溃疡口腔溃疡口腔溃…     

第十三届亚太风湿病联盟年会热点荟萃

第十三届亚太风湿病联盟（APLAR）年会于2008年9月23日至9月27日在日本横滨召开。本次会议除邀请众多来自欧洲抗风湿病联盟（EULAR）和美国风湿病学会的著名学者作专题报道外，还首次将其和电子壁报形式相结合进行学术交流，因此本届年会是有史以来规模最大、形式最新的亚太地区风湿病学术大会，同时也是全球风湿病学者的盛会。现将本次会议中有关系统性红斑狼疮（SLE）、类风湿关节炎（RA）和生物制剂的应用等热点内容作一简要介绍。     

ACR／EULAR 2009年类风湿性关节炎新分类标准解读

类风湿性关节炎（RA）是一种慢性自身免疫性疾病,以关节滑膜炎症为特征,随着病情的进展,可导致骨侵蚀和关节破坏,从而出现功能障碍甚至残疾。据国外流行病学资料统计,RA患病率约为1％,10年致残率可达30％。2009年11月,美国风湿病学会（ACR）联合欧洲抗风湿病联盟（EULAR）推出了RA新的分类标准,是继1987年ACR修订的RA分类标准后首次更新,因此引起了风湿病学界的广泛关注和讨论。本文对此新标准的相关内容作一解读,以供同道参考。     

《系统性红斑狼疮诊治指南》解读（节选）

系统性红斑狼疮（SLE）是一种病因未明、自身免疫介导、炎症性结缔组织病。由于病人体内产生多种自身抗体,可损害各个系统、各个脏器和组织。为了帮助临床医生认识和提高SLE的诊治水平,以改善SLE的预后,中华风湿病学会于2003年制订了《系统性红斑狼疮诊治指南》（以下简称《指南》）。     

神经精神狼疮的自身抗体及影像学检查

系统性红斑狼疮(SLE)累及神经精神系统称之为神经精神狼疮(NPSLE),1999年美国风湿病学会(ACR)对19类NPSLE作了分类定义,提出了诊断标准、辅助检查及排除方法[1].     

小儿系统性红斑狼疮20例临床分析

小儿系统性红斑狼疮（SLE）是一种多系统受累的自身免疫性疾病。临床表现多样化，极易误诊或漏诊。按1982年我国风湿病学会拟定SLE诊断标准，现将我科1995-2005年住院的20例分析如下。     

上海系统性红斑狼疮诊断标准对早期诊断系统性红斑狼疮的价值

中华医学会上海分会风湿病学会系统性红斑狼疮(SLE)诊断标准制订组于1988年9月报道了“系统性红斑狼疮诊断标准(简称上海标准)”。本文比较上海标准与美国风湿病协会 SLE 诊断标准(简称 ARA 标准,     

类风湿关节炎不同分类标准的多中心临床比较

目的:验证并比较早期类风湿关节炎(early rheumatoid arthritis, ERA) 分类标准与1987年美国风湿病学会(American College of Rheumatology, ACR)和2010年ACR/欧洲抗风湿联盟(European League Against Rheumatism, EULAR)制定的分类标准在ERA患者诊断中的敏感性和特异性。方法:在4所医院中入选年龄≥16岁、病程≤1年、存在≥1个关节肿痛的关节炎患者,观察指标包括临床表现、实验室检查及影像学检查。ERA的诊断经2名风湿病专科医师根据临床症状、用药情况、影像学检查进行临床诊断。结果: (1)共纳入关节炎患者325例,男性98例(30.15%), 女性227例(69.85%),平均年龄(47.53±14.44)岁,中位病程5(2, 8)个月。最终诊断为ERA 236例,非ERA 89例 (Non-ERA,包括骨关节炎、反应性关节炎、未分化关节炎、脊柱关节炎等)。(2) ERA标准的敏感性为87.29%,特异性为84.37%,敏感性高于1987年ACR标准 (χ²=43.641,P<0.001), 与2010年ACR/EULAR标准相比差异无统计学意义 (χ²=0.446,P=0.593);特异性低于1987年 ACR年标准 (χ²=4.891, P=0.027),与2010年ACR/EULAR标准比较差异无统计学意义 (χ²=0.044,P=1.000)。(3)在病程≤3个月和病程≤6个月关节炎患者中,ERA分类标准敏感性分别为81.71%、86.79%,均高于1987年ACR标准 (χ²=7.131,P=0.008和χ²=22.015,P<0.001), 与2010年ACR/EULAR标准比较差异无统计学意义 (χ²=0.220,P=0.755和χ²=0.473,P=0.491), 3个标准的特异性比较差异均无统计学意义。(4) 3种分类标准与临床诊断存在一致性,其中ERA标准、2010年ACR/EULAR标准与临床诊断一致性较好(Kappa>0.6)。3种分类标准间一致性比较结果提示,ERA标准与2010年ACR/EULAR标准间一致性较好(Kappa=0.836)。结论:ERA分类标准在ERA诊断中的敏感性高于1987年ACR分类标准,与2010年ACR/EULAR年标准相当,3种标准间特异性比较差异无统计学意义;ERA标准在病程≤3个月的极早期关节炎中仍可识别出RA患者。     

类风湿关节炎不同分类标准的多中心临床比较

目的:验证并比较早期类风湿关节炎(early rheumatoid arthritis, ERA) 分类标准与1987年美国风湿病学会(American College of Rheumatology, ACR)和2010年ACR/欧洲抗风湿联盟(European League Against Rheumatism, EULAR)制定的分类标准在ERA患者诊断中的敏感性和特异性。方法:在4所医院中入选年龄≥16岁、病程≤1年、存在≥1个关节肿痛的关节炎患者,观察指标包括临床表现、实验室检查及影像学检查。ERA的诊断经2名风湿病专科医师根据临床症状、用药情况、影像学检查进行临床诊断。结果: (1)共纳入关节炎患者325例,男性98例(30.15%), 女性227例(69.85%),平均年龄(47.53±14.44)岁,中位病程5(2, 8)个月。最终诊断为ERA 236例,非ERA 89例 (Non-ERA,包括骨关节炎、反应性关节炎、未分化关节炎、脊柱关节炎等)。(2) ERA标准的敏感性为87.29%,特异性为84.37%,敏感性高于1987年ACR标准 (χ²=43.641,P<0.001), 与2010年ACR/EULAR标准相比差异无统计学意义 (χ²=0.446,P=0.593);特异性低于1987年 ACR年标准 (χ²=4.891, P=0.027),与2010年ACR/EULAR标准比较差异无统计学意义 (χ²=0.044,P=1.000)。(3)在病程≤3个月和病程≤6个月关节炎患者中,ERA分类标准敏感性分别为81.71%、86.79%,均高于1987年ACR标准 (χ²=7.131,P=0.008和χ²=22.015,P<0.001), 与2010年ACR/EULAR标准比较差异无统计学意义 (χ²=0.220,P=0.755和χ²=0.473,P=0.491), 3个标准的特异性比较差异均无统计学意义。(4) 3种分类标准与临床诊断存在一致性,其中ERA标准、2010年ACR/EULAR标准与临床诊断一致性较好(Kappa>0.6)。3种分类标准间一致性比较结果提示,ERA标准与2010年ACR/EULAR标准间一致性较好(Kappa=0.836)。结论:ERA分类标准在ERA诊断中的敏感性高于1987年ACR分类标准,与2010年ACR/EULAR年标准相当,3种标准间特异性比较差异无统计学意义;ERA标准在病程≤3个月的极早期关节炎中仍可识别出RA患者。     

雷公藤多甙在风湿性疾病中的应用

雷公藤的抗炎、抗免疫等药理作用已经得到医学界的公认,并在多种疾病的治疗中显示了独到的效果。笔者使用该药治疗类风湿关节炎（RA）、系统性红斑狼疮（SLE）和系统性硬化症（SSC）,经临床观察。疗效满意,现报道如下。lits床资料RA患者30例,男5例,女25例,年龄最小16岁,最大64岁,平均年龄35．6岁;病程为6个月一15年,平均4．9年Z均符合美国风湿病协会（ARA）1987年修订的RA诊断标准。SDe患者34例,均为女性,年龄］5－56岁,平均32．5岁;病程为2个月一5年,均符合ARA1982年修订的SLE诊断标准。SSC患者8例,男性1例,女…     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.