不同针灸疗法干预关节炎炎症反应的机制研究进展

关节炎是一系列以关节及关节周围组织，因炎症、感染、创伤、退化或其他因素引起的炎性疾病。近年来关节炎的患病率显著增加，临床上代表性关节炎有类风湿关节炎、脊柱关节炎（以强直性脊柱炎为典型）、痛风、骨关节炎等。近年来的研究逐渐重视这些疾病中炎性细胞因子的研究，包括白介素（IL）家族系列中多种炎性因子及肿瘤坏死因子-α（TNF-α）。最新研究发现针灸在此类疾病的治疗中，可能参与相关炎性因子的致病途径，并通过调控此类细胞因子水平，从而改善炎症反应，为临床运用针灸治疗关节炎提供了理论及实验依据。     

超敏C反应蛋白、类风湿因子、抗环瓜氨酸肽抗体联合血清淀粉样蛋白A检测在类风湿性关节炎诊断中的应用价值

目的探讨超敏C反应蛋白(hs-CRP)、类风湿因子(RF)、抗环瓜氨酸肽抗体(抗CCP抗体)联合血清淀粉样蛋白A(SAA)检测诊断类风湿性关节炎的价值。方法以该院2018年1月至2018年12月收治的102例类风湿性关节炎患者作为实验组,同期82例健康体检者作为对照组,使用特种蛋白分析仪OTTMAN-1及配套试剂盒检测全血hs-CRP和SAA,使用日立7600生化分析仪及配套试剂检测抗CCP抗体及RF,比较四项指标水平。结果实验组患者的hs-CRP、RF、抗CCP抗体和SAA平均水平均明显高于对照组(P<0.05);实验组患者hs-CRP、RF、抗CCP抗体和SAA阳性检出率分别为88.24%、91.18%、81.37%和91.18%,高于对照组的1.22%、0.00%、57.32%和0.00%(P<0.05);实验组患者hs-CRP、RF、抗CCP抗体联合SAA检测阳性检出率为98.04%,高于单一指标检出率(P<0.05)。结论hs-CRP、RF、抗CCP抗体联合SAA检测有利于提高类风湿性关节炎诊断准确性。     

自我管理对类风湿性关节炎患者疼痛缓解的效果评价:Meta分析和系统评价

目的:分析自我管理对类风湿性关节炎患者疼痛缓解的效果。方法:通过检索PubMed、Embase、Web of Science、Cochrane Library、Clinical Trails 5个数据库1980年1月1日至2018年7月31日的文献,按照纳入标准筛选文献后,收集以自我管理对RA患者疼痛缓解研究的随机对照试验,提取所需数据用RevMan 5.3软件进行Meta分析。结果:共纳入8篇文献,采用Cochrane协作网的“偏倚风险评估”工具对文献质量进行评价,其中6篇文献为A级(低度偏倚),2篇文献为B级(中度偏倚)。Meta分析结果显示,VAS疼痛评分(SMD=-0.32,P=0.50);疼痛自评(SMD=0.10,P=0.65);生命质量评分QoL(SMD=-0.72,P=0.38);健康评估问卷HAQ(MD=-0.12,P=0.31);DAS-28(MD=-0.28,P=0.42。结论:自我管理对RA患者疼痛缓解差异没有统计学意义。其临床及家庭应用价值和意义还需要进一步的证实。     

退变性腰椎侧凸合并类风湿性关节炎患者侧凸程度的影响因素分析

目的 :分析退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)合并类风湿性关节炎(rheumatoid arthritis,RA)患者的发病特征和侧凸程度的影响因素。方法 :单中心纳入2013年1月～2018年4月61例合并RA拟行腰椎手术的患者,分为患有DLS者27例(DLS组)和无脊柱畸形患者34例(NDLS组)。提取信息包括人口统计学信息[如性别、年龄和体重指数(body mass index,BMI)等]、RA相关信息[如Steinbrocker分级、是否服用改变病情抗风湿药(disease-modifying anti-rheumatic drugs,DMARDs)等]、手术相关信息和DLS信息[如Cobb角、顶椎旋转角度、冠状位顶椎偏移距离、髂嵴连线高度、骨质疏松、全膝关节置换(total knee arthroplasty,TKA)史和膝关节功能评分(knee society score,KSS)],Steinbrocker分级用来评价RA活动性,Cobb角反映腰椎侧凸程度,KSS用以评价膝关节功能。结果:患者平均RA病程为16.8±12.7年,Steinbrocker分级Ⅰ～Ⅲ级分别为14例、34例和13例。两组患者以女性为主,DLS组(男∶女=1∶26)和NDLS组(男∶女=8∶26)在性别上存在统计学差异(P=0.031),而在年龄、BMI上无统计学差异(P0.05);两组在Steinbrocker分级、服用DMARDs比例和骨质疏松患者比例上无统计学差异(P0.05)。两组共11例实施TKA手术,两组间TKA分布比较无统计学差异(P=0.153)。DLS组平均侧凸程度(Cobb角)为18.4°±9.0°(10.4°～39.2°),实施TKA患者其Cobb角(11.8°±1.5°)小于无TKA者(20.6°±9.5°)(P=0.001)。DLS组顶椎旋转角度为8.4°±6.8°,冠状位偏移距离为47.3±7.8mm,髂嵴连线均位于L4/5椎间隙。Cobb角与顶椎旋转角度、冠状位偏移距离和TKA存在相关性(P0.05),与其余参数均无显著相关性。针对DLS患者侧凸程度回归分析,显示既往行TKA为其影响因素(P=0.029),但TKA发生时间、TKA患者DLS病程与侧凸程度无明确相关性。行TKA患者KSS评分(88.7±5.3分)高于未行TKA者(80.4±10.0分)(P=0.034),KSS和Cobb角之间存在负相关性(r=-0.717,P0.001),以Cobb为因变量的两者之间的拟合曲线为Cobb角=70.38-0.64×KSS。结论:合并RA的DLS患者在中老年女性更易出现;在既往行TKA的RA患者中,DLS侧凸程度较小;KSS与DLS侧凸程度存在高度相关性。     

外周血miR-150-5p、SOCS1 mRNA对类风湿关节炎“病”“证”诊断意义的初步探讨＊

目的 探讨类风湿关节炎患者外周血miR-150-5p、细胞因子信号抑制因子1（suppressor of cytokine signaling 1，SOCS1）mRNA的表达及对类风湿关节炎（Rheumatoid Arthritis，RA）疾病诊断、中医证型判断的意义。方法 纳入符合诊断标准的RA患者57例及健康对照组19例，根据《22个专业95个病种中医诊疗方案》有关RA的中医证候诊断标准，判断RA的中医证型。qPCR检测RA患者及健康对照组miR-150-5p、SOCS1mRNA的相对表达水平，同时检测血常规、肝功能、肾功能等常规指标。双荧光素酶分析方法判断两者是否存在靶向关系。统计分析miR-150-5p、SOCS1 mRNA对RA疾病的诊断意义及其与中医证型的相关性。结果 RA患者外周血miR-150-5p的相对表达水平下调，低于正常人群（t = -19.019，P < 0.05）；其表达水平随疾病活动度升高，有下降趋势；患者外周血SOCS1 mRNA的相对表达水平上调，低于正常人群（t = 5.333，P < 0.05）；其表达水平随疾病活动度升高，有上升趋势。MiR-150-5p与SOCS1 mRNA有靶向结合关系（P < 0.05）。通过AUC曲线比较，miR-150-5p的相对表达水平区分RA的敏感性及特异性分别为98.1%、92.1%（AUC = 0.972，P < 0.05）；SOCS1 mRNA的相对表达水平无法区分RA（AUC = 0.472，P > 0.05）。RA患者中miR-150-5p的相对表达水平低于3.06，RA患者风湿痹阻证、寒湿痹阻证的相对风险分别为8.33、250.00（P < 0.05）。结论 miR-150-5p、SOCS1 mRNA在RA患者中有差异性表达，且有靶向结合关系。miR-150-5p可能是RA的疾病诊断及中医风湿痹阻证、寒湿痹阻证证型诊断的潜在生物标志物。     

Does the stabilization of the calcaneocuboid joint with Steinmann pin in Evans osteotomy affect its incidence of arthritis?

PurposeThis study aims to determine the effect of retaining a Steinmann pin in the calcaneocuboid joint on its rates of arthritis following Evans calcaneal osteotomy lengthening procedure. The study hypothesized that leaving the pin across the calcaneocuboid joint post-operatively would lead to higher rates of arthritis.MethodsThis is a retrospective review of patients under 18 years of age who underwent Evans osteotomy at our hospital from January 2015 to May 2020. The Patients were stratified into 2 groups: Group 1 (pin was left post-operatively across the joint and removed on follow-up) and Group 2 (pin was removed during surgery). Demographic data were recorded, including age, sex, and body mass index. Calcaneocuboid arthritis was determined by radiographic imaging at least one-year follow-up. Time to pin removal, size of the pin and graft, and subluxation were analyzed as possible risk factors for arthritis. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were estimated.Results39 patients were included in the study: 24 patients had the pin removed post-operatively, and 15 had the pin removed intra-operatively. There were no significant differences between the 2 groups regarding body mass index, age, sex, or laterality. Calcaneocuboid arthritis rates were significantly higher in the Group 1 than Group 2 (12(50%) vs. 2(13.3%), respectively; p = 0.02). On multivariate regression, both age (OR, 1.305 [95%CI: 1.009−1.696]; p = 0.044) and leaving the pin in the joint postoperatively (OR, 7.661 [95%CI: 1.208−48.570]; p = 0.031) were found as risk factors for arthritis at follow-up. The mean time to pin removal, the size of the pin, and the size of the graft were not found to be significant predictors of arthritis (p > 0.05).ConclusionsThis study shows that leaving the Steinmann pin in the calcaneocuboid joint in children post-operatively is associated with an increased risk of developing early radiographic signs of calcaneocuboid joint arthritis.     

Treat-to-target strategy in patients with rheumatoid arthritis: Audit of adherence from real world clinical data

IntroductionThe current paradigm of the management of rheumatoid arthritis (RA) recommends achieving a state of remission or low disease activity through the treat-to-target strategy. Our study assesses adherence to this strategy.MethodPatients with RA (ACR-EULAR 2010 criteria) were included. From each centre, 19 patients were randomly selected. Clinical histories (CH) were assessed by independent auditors, checking compliance with predefined quality criteria. The study was approved by ethics committees.ResultsWe included 856 patients (mean age 54 years; 71% women). The use of a combined index (CI) was recorded in 61% of cases. Visits were recorded every 4 weeks using a CI in 4% of CH while attempts were made to achieve remission. Monitoring of disease activity every 6–8 months after reaching the target was recorded in 73% of cases.ConclusionsThe implementation of the treat-to-target strategy is barely recorded in patients with RA in routine clinical practice.     

雷公藤多苷联合泼尼松治疗类风湿关节炎肺间质病变的临床疗效

目的:探讨雷公藤多苷治疗类风湿关节炎(RA)肺间质病变(ILD)的临床疗效分析。方法:选取2013年12月至2016年12月右江民族医学院附属医院收治的RA-ILD患者100例作为研究对象,按照随机数字表法分为对照组和观察组,每组50例,对照组给予泼尼松治疗,观察组在此基础上给予雷公藤多苷治疗。比较2组患者临床治疗有效率、治疗前后症状评分、红细胞沉降率(ESR)、C反应蛋白(CRP)、类风湿因子(RF)水平、肺高分辨CT(HRCT)积分、用力肺活量(FVC)、第一秒钟用力呼气容积(FEV1)、FEV1/FVC、外周血基质金属蛋白酶1(MMP-1)、基质金属蛋白酶-9(MMP-9)水平变化以及不良反应的差异。结果:雷公藤多苷可明显减少RA-ILD患者的症状评分,提高临床治疗有效率,下降ESR、CRP、RF、HRCT、MMP-9水平,上调FVC、FEV1、FEV1/FVC、MMP-1。观察组和对照组不良反应发生率差异无统计学意义(P>0.05)。结论:雷公藤多苷可有效治疗RA-ILD,其作用机制可能通过MMPs介导。     

穿山龙提取物抗急性痛风性关节炎的尿液代谢组学分析

目的:对急性痛风性关节炎大鼠给予穿山龙提取物后的尿液代谢组学进行研究,寻找相关的潜在生物标志物及相关代谢通路。方法:采用尿酸钠(MSU)诱导的急性痛风性关节炎大鼠模型,将SD大鼠40只随机分为空白组、穿山龙提取物组、模型组、穿山龙提取物干预组,每组10只。给药组灌胃给予穿山龙提取物,给药剂量0. 48 g·kg~(-1),每天1次,连续5 d,于末次给药后,收集大鼠尿液,运用UPLC-Q-TOF/MS结合模式识别方法分析,采用正、负离子扫描模式下电喷雾离子源,数据采集范围m/z 100～1 500,采用全扫描方式。结果:鉴别出了12个共同的潜在生物标志物,分别为肌氨酸,二甲基甘氨酸,脱氧胞苷,尿酸,5-HT,L-胱硫醚,4-吡哆酸,脱氧尿苷,褪黑激素,5-甲氧基色胺,富马酸和胞苷。与空白组比较,穿山龙提取物组中这12个潜在生物标志物均明显下调;与模型组比较,在穿山龙提取物干预组的潜在生物标志物中,有10个上调,2个下调,穿山龙提取物对肌氨酸,尿酸,L-胱硫醚,4-吡哆酸,脱氧尿苷,5-甲氧基色胺,胞苷,二甲基甘氨酸,褪黑激素,富马酸这10个标志物均表现出了纠正异常表达的趋势;与急性痛风性关节炎相关性最强的代谢通路为半胱氨酸和甲硫氨酸代谢、色氨酸代谢。结论:穿山龙提取物可能是通过促进半胱氨酸和甲硫氨酸代谢中胱硫醚向半胱氨酸的转化水平,上调色氨酸代谢中褪黑激素,实现对痛风性关节炎的防治作用。