类风湿关节炎患者氧化应激与抑郁情绪的关系

目的:探讨类风湿关节炎患者氧化应激状态与抑郁情绪之间的关系。方法:用Hamilton抑郁量表、Zung自测抑郁量表、Zung自测焦虑量表、SCL-90(symptom checklist 90)症状量表及多项目问卷对129名类风湿关节炎患者进行调查评估,20例正常人作为对照组,在进行治疗前检测血浆氧化应激指标。根据Hamilton抑郁量表将类风湿关节炎患者分为抑郁组(≥20分,A组)和非抑郁组(<20分,B组),正常人作为对照组(C组)。结果:研究发现类风湿关节炎患者抗氧化酶防御能力下降。A组SDS(self-rating depression scale)评分为(59.12±10.18)分,B组SDS评分为(39.24±5.02)分,两组间比较差异有统计学意义(t=0.42,P<0.01)。A组SAS(self-rating anxietyscale)评分为(52.85±6.35),B组SAS评分为(39.24±5.02)分,两组间比较差异有统计学意义(t=1.48,P<0.01)。A组患者抗超氧阴离子自由基(antisuperoxide anion capacity,A-ASC)水平(393.76±43.35)明显低于B组(456.98±93.86)及C组(483.51±30.64)(F=3.95,P=0.03);A组患者丙二醛(malondialdehyde,MDA)水平(13.84±3.35)明显高于B组(9.42±3.52)及C组(7.86±3.21)(F=12.01,P=0.01)。Pearson相关分析示MDA与抑郁呈明显正相关(r=0.58,P<0.05),A-ASC与抑郁呈明显负相关(r=-0.30,P<0.05)。结论:类风湿关节炎患者存在氧化损伤,伴抑郁症状的患者抗氧化酶防御能力进一步减弱,提示氧化应激可能与类风湿关节炎抑郁症状的发生和发展密切相关。     

风湿病教学中应用多种教学方法的体会

传统的以授课为基础的教学模式(lecture-based learning,LBL)难以适应培养现代新型医学人才的需求,以问题为导向的教学方法(problem-based learning,PBL)以其独特的优越性在国内外教学改革中取得了重要成效,文章探讨风湿病学教学中根据不同的教学内容,结合临床病例(case-based learning,CBL)的广义的PBL教学,从而丰富了教学形式,激发了学生学习兴趣,增强了学生创新能力达到了更好的教学效果.     

类风湿性关节炎合并弥漫大B细胞淋巴瘤5例并文献复习

目的 探讨类风湿性关节炎(RA)合并弥漫大B细胞淋巴瘤(DLBCL)的临床特点,提高对此类疾病的认识.方法 回顾性分析首都医科大学附属北京世纪坛医院2011年1月-2018年1月住院治疗的RA合并DLBCL患者的临床资料.结果 RA合并DLBCL患者5例,占同期RA住院病例的0.32％(5/1561),其中男1例,女4...     

系统性红斑狼疮合并自发性肾上腺出血1例

A 58-year-old female was referred to our department with intermittent suffocation for 1.5 years, aggravated for a month. 1.5 years before she developed oral ulcer, raynaud phenomenon, proteinuria, bilateral pleural effusion, ANA and anti-dsDNA positive. This patient was diagnosed with systemic lupus erythematosus (SLE). After given hormones, hydroxychloroquine sulfate (HCQ), her symptom relieved soon. The patient stopped her pills 1 year ago. One month ago, she had chest tightness, increased urine foam, and suffered from oliguria. Her admission medical examination: blood pressure (BP) 130/80 mmHg, conjunctiva pale, and lower lung breath sounds reduced. There was no tenderness, rebound pain and abdominal muscle tension in the abdomen. Liver and spleen rib inferior, mobile dullness negative, and lower extremity edema. Blood routine tests were performed with hemoglobin (HGB) 57 g/L. Urine routine: BLD (3+). 24-hour urinary protein 3.2 g. serum albumin 20.5 g/L, C-reactive protein (CRP) 12.85 mg/L, erythrocyte sedimentation rate (ESR) 140 mm/h. Antinuclear antibody (ANA) (H)1 ∶10 000;, anti-dsDNA antibody 1 ∶3 200;, anti-Smith antibody, anti-U1-snRNP / Sm antibody were positive, blood complement 3(C₃) 0.43 g/L, complement 4(C₄) 0.07 g /L. Anticardiolipin antibody (ACL), anti-β2-GP1;, lupus anticoagulant (LA) were negative, HRCT suggested bilateral medial pleural cavity product liquid. Admission diagnosis: SLE lupus nephritis, anemia, pleural effusion, and hypoproteinemia. We treated her with methylprednisolone 1 000 mg×3 d;, late to 48 mg/d and cyclophosphamide 1.0 g, HCQ 0.2 g bid, gamma globulin 10 g×5 d. Day 2 of treatment;, this patient developed acute right upper quadrant pain, not accompanied by nausea, vomiting, blood stool and diarrhea. Antipyretic antispasmodic treatment was invalid, after the morning to ease their own abdominal pain. Day 4 of treatment, daytime blood HGB 77 g/L. Bilateral renal vascular ultrasound: bilateral renal artery blood flow velocity was reduced. The abdominal pain of the above symptoms recurred at night, BP was 120/80 mmHg, and no positive signs were found on abdominal examination. No abnormality was found in the vertical abdominal plain film. Blood routine examination: HGB 53 g/L, Plasma D dimer 2 515 μg/L;, amylase in hematuria was normal, the stool occult blood was negative. Abdominal computed tomography (CT): normal structure of right adrenal gland disappeared, irregular mass shadow could be seen in adrenal region, CT value was about 50 HU. Morphological density of left adrenal gland was not abnormal. The retroperitoneum descended along the inferior vena cava to the right iliac blood vessel and showed a bolus shadow. The density of some segments increased. The lesion involved the right renal periphery and reached the left side of abdominal aorta. Most lesions surrounded the inferior vena cava, the right renal vein and part of the small intestine. The boundary between the upper lesion and the vena cava was unclear. Iodine-containing contrast agent was taken orally. No sign of contrast agent overflowing was found in the abdominal cavity. Hematoma and exudative changes were considered in retroperitoneum. Conclusion of contrast-enhanced ultrasound of blood vessels: The retroperitoneal inferior vena cava (volume 3.5 cm×3.5 cm×1.5 cm) was hypoechoic and had no blood flow lesion. The adrenal gland had a high possibility of origin. Left renal vein thrombosis extended to inferior vena cava. According to the above data;, it was analyzed that the cause of retroperitoneal hematoma of the patient was left adrenal vein thrombosis caused by hypercoagulable state, which led to vascular rupture and hemorrhage caused by increased vascular pressure in adrenal gland. Therefore, on the basis of continuing to actively treat the primary disease, and on the basis of dynamic observation of no active hemorrhage for 3 days, the anticoagulant therapy was continued with 10 mg/d of apixaban. Clinical symptoms were gradually eased, HGB did not decrease. Two weeks later, the ultrasonic examination showed that the irregular cluster hypoechoic range behind the inferior vena cava was significantly smaller than that before (1.8 cm×1.2 cm×0.7 cm). Abdominal CT examination after 1 month showed that there was no abnormal morphological density of bilateral adrenal glands and basic absorption of retroperitoneal exudation. Adrenal hemorrhage is uncommon. SLE with adrenal hemorrhage is rarer. In SLE patients;, especially those complicated with APS, if abdominal pain accompanied by HGB decrease occurs, except after gastrointestinal hemorrhage, the possibility of adrenal hemorrhage should be warned.     

骨关节炎与类风湿关节炎患者膝关节滑膜中血管内皮生长因子及血管形态的特征

目的：比较骨关节炎（osteoarthritis,OA）患者与类风湿关节炎（rheumatoid arthritis,RA）患者膝关节滑膜组织血管内皮生长因子（vascular endothelial growth factor,VEGF）及滑膜血管形态的特征,分析VEGF与部分炎症指标的相关性。方法：将滑膜组织分为滑膜衬里层、血管周围及衬里下基质组织进行研究,采用原位杂交及免疫组织化学方法检测OA与RA患者膝关节滑膜组织各层VEGF mRNA及蛋白表达。将滑膜组织VEGF蛋白表达的平均光密度比值分别与患者外周血的部分实验室炎性指标进行相关性分析,并将VEGF表达结果进一步与关节镜下滑膜形态学所见进行相关性分析。应用视觉模拟表（visual analog scale,VAS）对关节镜下滑膜形态（血管密度、血管形态、扭曲或直行血管走行方式）进行评分;滑膜增生程度也采取VAS半定量分析方法,分为几乎无滑膜增生、少有、有及滑膜肥厚。结果：在滑膜衬里层、血管周围及衬里下层基质组织, VEGF mRNA及蛋白表达在OA与RA患者之间差异均有统计学意义（P<0.05）。OA衬里下层基质组织VEGF蛋白表达与红细胞沉降率呈正相关（r=0.58,P<0.05）;RA滑膜衬里层VEGF蛋白表达与血小板计数呈正相关（r=0.87,P<0.05）,RA衬里下层基质组织VEGF蛋白表达与C反应蛋白呈正相关（r=0.56,P<0.05）。此外,OA滑膜衬里层VEGF蛋白表达与直行血管走行方式呈正相关（P＜0.05）,OA衬里下层基质组织VEGF蛋白表达与滑膜纤维素增生程度呈正相关（P＜0.05）;RA滑膜衬里层VEGF蛋白表达与血管形态、弯曲血管走行方式及血管密度均呈正相关（P＜0.05）。结论：滑膜组织各层VEGF mRNA及蛋白表达在OA及RA患者之间均存在差异,VEGF表达与部分炎症指标及关节镜下滑膜血管形态呈正相关。     

40例腹膜后纤维化临床资料回顾

 目的 回顾两所紧密型医疗联合体医院腹膜后纤维化的患者人口特征、临床特征、放射学特征、治疗及部分随访结果,为该病的诊治提供更多循证依据。方法 预先统一制定好采集电子病历信息表,通过检索两所医院的电子病历系统,收集2008-01至2019-06被诊断腹膜后纤维化的患者40例,通过统一的病例回顾表格,进行病例数据采集,包括人口学、临床特征、实验室检查数据、治疗方式、治疗结果及部分患者随访结果。采用scheel影像学评估方法,分为Ⅰ型腹主动脉和(或)髂血管受累,Ⅱ型下腔静脉受累,Ⅲ型单侧或双侧输尿管受累,Ⅳ型肾门或肾动脉或肾静脉受累。结果 40例中,年龄24～83岁,平均(59.13±14.7)岁,其中男31例,女9例,男女比例3.5∶1,男性29例有不同程度吸烟史,女性均不吸烟。首发症状腰背痛、腹痛及腰背痛腹痛同时存在占65%,其次是下肢肿胀发病,无症状体检发现占5%。部分患者炎性反应指标增高,影像学结果显示Ⅰ+Ⅲ型比例最高,其次为Ⅰ型。10例进行了IgG4水平检测,5例提示IgG4水平增高,其中1例IgG4增高达正常水平的10倍以上。IgG4增高的4例患者都有高吸烟指数。治疗方式中手术联合药物比例最高,药物治疗中,激素为基石治疗。结论 老年男性患者居多,腹部CT及MRI为最普通和实用的影像学检查工具。PET-CT有助于疾病诊断,病理诊断进一步明确疾病病因,激素免疫抑制药为主要的治疗策略,配合泌尿外科D-J管治疗是改善急性症状的治疗策略。     

红细胞1型补体受体在系统性红斑狼疮患者中的表达及意义

目的通过检测红细胞1型补体受体(CR1)在系统性红斑狼疮(SLE)患者中的表达,探讨其临床意义。方法采用流式细胞术检测50例SLE患者和30例健康对照者红细胞CR1表达的水平,并对SLE患者病情活动程度行SLE疾病活动指数(SLEDAI)积分,分为活动期组与稳定期组,同时将活动期组红细胞CR1表达与稳定期组相比较;并分析SLE活动度指标与CR1表达的相关性。结果①SLE患者组红细胞CR1表达明显低于健康对照组,差异具有统计学意义(P<0.01)。②SLE患者活动期组红细胞CR1表达明显低于稳定期组,两组间CR1表达有显著性差异(P<0.01)。③SLE患者SLEDAI积分与CR1表达呈显著负相关(r=-0.971,P<0.01)。结论 SLE患者红细胞CR1表达的变化与疾病活动有明显的相关性,可以作为评判SLE病情活动的指标之一。     

临床病例评析——淋巴水肿腹膜后纤维化

目的提高对淋巴水肿和腹膜后纤维化(RPF)之间关系的认识。方法报道首都医科大学附属北京世纪坛医院4例以淋巴水肿起病并发现腹膜后纤维化的患者, 对其诊治经过进行分析讨论。结果 4例患者均以淋巴水肿起病, 影像学提示可疑的腹膜后纤维化。1例经淋巴结活检证实为非霍奇金淋巴瘤。2例经病理或正电子发射计算机断层扫描(PET)/CT除外恶性病变, 且经糖皮质激素联合免疫抑制剂治疗有效, 证实为特发性腹膜后纤维化。另1例为系统性淀粉样变模拟腹膜后纤维化。结论 RPF的淋巴管受累比较少见, 当患者以淋巴水肿起病时需考虑RPF的可能。即使初诊为RPF也要警惕肿瘤或其他疾病, 需要完善影像学检查, 必要时组织活检, 以便及早诊断和治疗, 改善患者预后。