CT引导下骶髂关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗强直性脊柱炎的研究

目的 通过对骶髂关节局部注射重组人Ⅱ型肿瘤坏死因子(TNF)受体-抗体融合蛋白(rhTNFR:Fc)的病理及影像研究,初步评价局部生物制剂治疗的临床疗效和安全性.方法 16例强直性脊柱炎(AS)患者采用单侧骶髂关节腔内注射rhTNFR:Fc的局部治疗方法(每月1次,25 mg/次,共3次,总疗程8周),对比20例全身皮下注射用药组(每周2次,25 mg/次,共16次,总疗程8周),分析其疗效、安全性、耐受性.同时观察注药前后骶髂活检组织细胞因子TNF-α、转化生长因子(TGF)-β、白细胞介素(IL)-6 mRNA的表达和光镜、免疫组织化学的变化,以及单光子发射计算机断层(SPECT)和磁共振成像(MRI)在代谢和宏观形态学上的改变.采用t检验或t'检验及χ2 Fisher's 精确检验或秩和检验.结果 rhTNFR:Fc局部注射显示:①治疗组在12周后Bath强直性脊柱炎疾病活动指数(BASDAI)评分(32±13)mm、疲乏(40±16)mm、晨僵(35±16)min、骶髂关节局部压痛(34±22)mm、患者总体评价VAS评分(40±17)mm上有明显改善(P<0.01),不良反应减少,并能节省医疗费用.②治疗后活检组织TNF-α、TGF-βmRNA相对表达量(0.891±0.06,0.84±0.05)较治疗前(1.08±0.19,1.13±0.33)明显下降(P<0.05),IL-6 mRNA相对表达量无明显改变(P>0.05).光镜下表现的滑膜炎、附着点炎、软骨变性、软骨下骨板破坏、骨髓炎的阳性率有所下降,而炎症细胞指数明显下降(z=-2.71,P<0.05).③治疗后骶髂关节放射学核素(ROI)的平均值(1.38±0.16)较治疗前(1.45±0.14)明显减少(P<0.05),MRI上的骨髓水肿、脂肪沉积等改变明显减轻(P<0.05).结论 骶髂关节腔注射rhTNFR:Fc,具有良好的疗效、安全性、耐受性及疗效经济学价值,特别有益于病变早期或局限于骶髂关节病变、不能耐受全身使用生物制剂的AS患者,临床推广应用前景.     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白对类风湿关节炎患者血清IgM- IgG-和IgA-类风湿因子的影响

目的 观察重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白(rhTNFR:Fc,商品名益赛普)对类风湿关节炎(RA)患者IgM-类风湿因子(RF),IgG-RF,IgA-RF的影响,探讨rhTNFR:Fc治疗RA的免疫学机制.方法 选择华中科技大学同济医学院附属协和医院及武汉市中心医院2007-2008年110例RA患者,采用随机数字表法随机分为rhTNFR:Fc组和甲氨蝶呤组.rhTNFR:Fc组55例,每周2次皮下注射rhTNFR:Fc(25 mg/次),24周.甲氨蝶呤组55例,每周1次口服甲氨蝶呤片,7.5mg/次起,8周内逐步加到15 mg/次,24周.观察药物对IgM-RF、IgG-RF、IgA-RF的影响,临床疗效评价采用28个关节疾病活动度(DAS28)疗效评定标准.组内治疗前后的差异采用配对t检验分析,组间治疗前后的差异采用两样本t检验分析.结果 ①2组患者病情均明显改善,rhTNFR:Fc的IgM-RF降低时间早于甲氨蝶呤组(P＜0.05).②rhTNFR:Fc组血清IgM-RF (29±16) U/ml明显降低(P＜0.05),IgG-RF (145±20) U/ml和IgA-RF(153±34)U/ml明显升高(P＜0.05).③甲氨蝶呤组IgM-RF (44±14) U/ml,IgG-RF (62±14) U/ml和IgA-RF (66±19) U/ml均明显降低(P＜0.05).④对临床指标的分析表明rhTNFR:Fc治疗RA疗效确切.结论 rhTNFR:Fc与甲氨蝶呤均能有效缓解RA的病情.rhTNFR:Fc能显著降低RA患者血清中IgM-RF的水平,而对IgG-RF,IgA-RF水平有升高作用,可能与其治疗RA的免疫学机制有关.     

CT引导下骶髂关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗强直性脊柱炎的研究

Objective To evaluated intra-articular injection of TNF-α inhibitors into the sacroiliac joint as an effective and viable alternative. Methods Sixteen patients with documented ankylosing spondylitis (AS), without steroids or disease modifying anti-rheumatic drugs (DMARDs) were performed CT-guided intra-articular injections of etanercept (TNF-α antagonist) at week 0, 4 and 8 (25 mg per dose). Similarly, 20 patients with AS in the control group received systemic etanercept therapy at a dose of 50 mg per week for 8 weeks. All patients were followed up clinically and evaluated periodically. Pathological features of sacroiliitis were observed with light microscopy and immunohistochemistry. Expression of cytokines in joint biopsy samples was estimated by RT-PCR. Image changes of sacroiliitis were observed by SPECT/CT and MRI. Ttest, t'tesr and χ2 Fisher's test were selected. Results All the 16 patients who received intra-articular etanercept, the mean value of radiological nuclide decrease of the SIJ ROI (region of interest) in the SPECT improved significantly after 8 weeks treatment [(1.38±0.16 vs 1.45±0.14) P<0.05] . Bone marrow edema and fat deposition in MRI were relieved significantly after 8 weeks (P<0.05). In 8 patients the expression of TNF-α and TGF-β mRNA in joint tissue decreased significantly after 8 weeks [(0.89±0.06, 0.84±0.05) vs (l.08± 0.19, 1.13±0.33) (P<0.05)]. The occurrence of gynonitis, enthesitis, chondritis, subehondral bony plate destruction, bone marrow inflammation and inflammatory cell index also decreased significantly (P<0.05). Participants given intra-articular injection showed significant clinical improvement after 8 weeks and 12 weeks treatment(P<0.01 ) in BASDAI score [(32±13) mm]. Conclusion This study has shown that intra-articular injection of etanercept in SIJ can improve joint function and quality of life. It has a satisfactory safety profile and is cost effective. This mode of treatment is most beneficial in local arthropathy of recent onset and in those patients who do not tolerate systemic etanercept therapy.     

CT引导下骶髂关节腔内注射重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗强直性脊柱炎的研究

Objective To evaluated intra-articular injection of TNF-α inhibitors into the sacroiliac joint as an effective and viable alternative. Methods Sixteen patients with documented ankylosing spondylitis (AS), without steroids or disease modifying anti-rheumatic drugs (DMARDs) were performed CT-guided intra-articular injections of etanercept (TNF-α antagonist) at week 0, 4 and 8 (25 mg per dose). Similarly, 20 patients with AS in the control group received systemic etanercept therapy at a dose of 50 mg per week for 8 weeks. All patients were followed up clinically and evaluated periodically. Pathological features of sacroiliitis were observed with light microscopy and immunohistochemistry. Expression of cytokines in joint biopsy samples was estimated by RT-PCR. Image changes of sacroiliitis were observed by SPECT/CT and MRI. Ttest, t'tesr and χ2 Fisher's test were selected. Results All the 16 patients who received intra-articular etanercept, the mean value of radiological nuclide decrease of the SIJ ROI (region of interest) in the SPECT improved significantly after 8 weeks treatment [(1.38±0.16 vs 1.45±0.14) P<0.05] . Bone marrow edema and fat deposition in MRI were relieved significantly after 8 weeks (P<0.05). In 8 patients the expression of TNF-α and TGF-β mRNA in joint tissue decreased significantly after 8 weeks [(0.89±0.06, 0.84±0.05) vs (l.08± 0.19, 1.13±0.33) (P<0.05)]. The occurrence of gynonitis, enthesitis, chondritis, subehondral bony plate destruction, bone marrow inflammation and inflammatory cell index also decreased significantly (P<0.05). Participants given intra-articular injection showed significant clinical improvement after 8 weeks and 12 weeks treatment(P<0.01 ) in BASDAI score [(32±13) mm]. Conclusion This study has shown that intra-articular injection of etanercept in SIJ can improve joint function and quality of life. It has a satisfactory safety profile and is cost effective. This mode of treatment is most beneficial in local arthropathy of recent onset and in those patients who do not tolerate systemic etanercept therapy.     

重组人肿瘤坏死因子受体-抗体融合蛋白治疗老年类风湿关节炎26例疗效

注射用重组人肿瘤坏死因子受体-抗体融合蛋白[商品名：益赛普(Etanercept,ETA)]是人Ⅱ型肿瘤坏死因子(TNF)受体p75的膜外区与IgG的Fc段构建的融合蛋白,可特异性地阻断TNF-α与其细胞表面受体的相互作用[1].本文对照观察ETA治疗活动性老年类风湿关节炎(RA)疗效,以探讨老年RA的最佳治疗方案.     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗类风湿关节炎双盲随机多中心对照临床研究

目的研究注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白[rhTNFR：Fc,益赛普,（etanercept）]对活动性类风湿关节炎（RA）患者的疗效及安全性.方法238例患者随机分为试验组和对照组.试验组每周1次口服空白模拟甲氨蝶呤（MTX）,同时接受rhTNFR：Fc皮下注射治疗,每周2次,每次25 mg;对照组每周1次口服定量MTX（每周7.5 mg起,8周内增至15 mg）,同时每周2次皮下注射空白模拟rhTNFR：Fc.疗程24周.疗效评价采用美国风湿病学会（ACR）疗效评定标准.结果治疗2周后,rhTNFR：Fc组ACR20有效率为35.59%,MTX组为22.50%,组间比较差异有统计学意义（P＜0.05）.治疗8周后,rhTNFR：Fc组和MTX组的ACR20、ACR50和ACR70组间比较差异均有统计学意义（（P＜0.05）.治疗12周后,rhTNFR：Fc组ACR20有效率为66.10%,MTX组是51.67%,两组间比较差异有统计学意义（（P＜0.05）.治疗24周后,rhTNFR：Fc组ACR20有效率为75.42%,且ACR70有效率优于MTX组（（P＜0.05）,显示rhTNFR：Fc疗效强于MTX.两组药物之间总的不良反应发生率差异无统计学意义.结论rhTNFR：Fc用于治疗中、重度RA具有良好的安全性和显著的疗效;在前12周治疗期间,rhTNFR：Fc较MTX起效快、效果更明显.     

重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合改善病情抗风湿药治疗中国人群风湿性疾病的安全性研究

目的 评价注射用重组人Ⅱ型肿瘤坏死因子α受体-抗体融合蛋白(rhTNFR:Fc)治疗大样本量风湿性疾病患者的安全性.方法 观察从2006年5月至2009年3月间使用rhTNFR:Fc治疗的类风湿关节炎(RA)、强直性脊柱炎(AS)、幼年特发性关节炎(JIA)和银屑病关节炎(PsA)患者治疗期间内所发生的不良事件.结果 共对2041病例患者进行观察,其中RA 1388例,AS 421例,其他232例.其中RA中不良事件发生率为13.47％,最常见的为注射部位反应(2.67％)、皮疹(1.87％)和转氨酶升高(1.80％).AS总的不良事件发生率为10.45％,常见的是注射部位反应(5.23％)、转氨酶升高(2.38％)和皮疹(0.71％).全部感染的发生率为2.40％,最常见的感染为上呼吸道感染.本次研究中未观察到严重不良事件、死亡、结核病和恶性肿瘤的发生.结论 rhTNFR:Fc治疗RA、AS等风湿性疾病具有良好的安全性.     

肿瘤坏死因子受体-Fc融合蛋白治疗类风湿关节炎与强直性脊柱炎短期疗效及不良反应的差异

目的 观察重组人Ⅱ型肿瘤坏死因子受体-抗体Fc融合蛋白[rhTNFR:Fc,益赛普(etanercept)]治疗类风湿关节炎(RA)及强直性脊柱炎(AS)的疗效及不良反应,评估其在不同关节病中的作用.方法 对18例难治性RA和22例难治性AS患者,使用ATNFR:Fc 25 mg/次,每周2次皮下注射,持续3个月.在治疗前和治疗后2、4、12周进行疗效及不良反应评估.RA组和AS组疗效评价分别采用美国风湿病学会(ACR20)H和ASAS20疗效评价标准.结果 ①rhTNFR:Fc治疗后As组达到ASAS20的总体有效率为95.5%,而RA组达到ACR20为50%,组间比较差异有统计学意义(P＜0.01);②AS组在rhTNFR:Fc治疗第2、4、12周时达到ASAS20疗效的患者分别为12例、21例和21例,而RA组达到ACR20疗效的为3例、5例和9例,各时段组间比较差异有统计学意义(P＜0.01);③RA组发生不良反应的患者占50%,显著高于AS组的9%(P＜0.01).RA组因无效及不良反应停药的患者5例,而AS组仅1例,脱漏率差异有统计学意义(P＜0.05),AS组的依从性好于RA组;④两组治疗前与治疗后12周X线比较均无明显改变.结论 相对RA患者总体反应而言,AS组患者对rhTNFR:Fc治疗起效快,有效率高,不良反应少,依从性好:但两组治疗前后关节X线均无明显改变.     

重组人Ⅱ型肿瘤坏死因子受体—抗体融合蛋白联合甲氨蝶呤治疗活动性类风湿关节炎的疗效和安全性的开放多中心临床研究

目的 评估重组人Ⅱ型肿瘤坏死因子受体—抗体融合蛋白(rhTNRF:Fc)联合甲氨蝶呤治疗活动性类风湿关节炎(RA) 52周的临床疗效、放射学改变和安全性。方法 30例中重度活动性RA患者应用rhTNRF：Fc(25 mg皮下注射,每周2次)联合甲氨蝶呤（每周15 mg口服）治疗。应用美国风湿病学会(ACR)20、50、70疗效标准和28个关节的疾病活动度评分(DAS28)评估临床疗效,应用改良的Sharp评分标准评价放射学疗效。计数资料应用x2检验或Fisher精确检验,计量资料采用配对t检验。结果 治疗52周时达到ACR20、50、70标准的有效率分别为90％、87％和67％。DAS28由6.4±0.6降至3.4±1.1(P＜0.01),23％患者达到疾病缓解,17％达到低度活动状态。健康状况问卷由1.18±0.56降至0.25±0.34（P＜0.01）。基线期和52周时,双手和双腕X线片关节间隙狭窄（8±10与8±11）和关节侵蚀(10±15与10±15)的改良Sharp评分差异无统计学意义;73％患者无放射学进展。未见严重不良反应,无新发结核菌感染和恶性肿瘤。结论 rhTNRF:Fc联合甲氨蝶呤治疗RA 52周能够显著减低疾病活动度、改善关节功能以及延缓放射学进展,达到临床缓解和阻止放射学进展的治疗目标：且耐受性良好。     

中药联合注射用人Ⅱ型肿瘤坏死因子受体抗体融合蛋白治疗老年类风湿关节炎的临床疗效分析

类风湿关节炎(RA)多发于老年人,是一种以对称性多关节炎为主要表现的慢性、进行性、侵蚀性疾病,多为感染后引起的自身免疫反应,造成以滑膜炎症为基础的关节病变.由于RA病因未明,至今尚无特异疗法.目前临床多采用免疫抑制剂、糖皮质激素等治疗,但疗效并不理想,造成病情迁延反复,最终导致关节畸形及功能障碍,严重影响老年人的生活质量.近来我院采用中药联合注射用人Ⅱ型肿瘤坏死因子受体抗体融合蛋白(益赛普)治疗老年RA,取得良好效果.     

类风湿关节炎滑膜组织人糖皮质激素诱导型肿瘤坏死因子受体表达的免疫组织化学研究

目的 观察研究人糖皮质激素诱导型肿瘤坏死因子受体(hGITR)在类风湿关节炎(RA)滑膜组织和软骨组织中的表达及其与滑膜炎性病变程度的相关性.方法 用免疫组织化学的方法对16例RA患者、9例骨关节炎(OA)患者及4例无关节病变的截肢患者滑膜组织和软骨组织中hGITR的表达进行描述分析,并对hGITR表达情况与RA患者滑膜炎性病变程度相关性进行分析.结果 hGITR在RA滑膜组织主要分布于血管翳周围,如血管内皮细胞和炎性细胞等,hGITR阳性细胞数约为69%.而该受体在RA患者软骨组织细胞中的表达率与对照组比较差异无统计学意义.OA滑膜组织和软骨组织细胞中hGITR也呈现不同程度的阳性表达,但与RA比较阳性程度较弱,阳性细胞数量较少;对hGITR表达与RA滑膜炎性程度的相关性分析发现,hGITR与RA滑膜炎性程度呈正相关(r=0.895,P<0.01).结论 hGITR在RA滑膜组织炎性细胞及血管内皮细胞上的异常表达可能是其参与RA血管翳的形成及滑膜组织的侵袭等病理过程导致RA患者滑膜损伤的一个重要机制.     

肿瘤坏死因子拮抗剂治疗类风湿关节炎和强直性脊柱炎发生结核的风险

目的了解类风湿关节炎(RA)和强直性脊柱炎(AS)患者在应用肿瘤坏死因子(TNF)拮抗剂治疗前后结核病的发病风险。方法随访2003年7月至2006年2月期间进行英利昔单抗和依那西普临床试验的RA和AS患者,筛选时对所有患者均进行结核菌素纯蛋白衍生物(PPD)皮试及拍摄胸部正侧位X线片．随访过程中密切观察结核的发生情况。结果筛选的67例RA患者中1例PPD阳生,英利昔单抗治疗结束后发生右锁骨上淋巴结结核1例；203例AS筛选患者中27例PPD阳性,2例胸部X线片发现肺部结核钙化灶．2例为肺部结核,入选AS患者试验期间及随访过程中均无结核病发生。临床试验筛选的RA和AS患者的PPD阳性及胸片显示结核活动或有钙化灶的统计数据显示均低于我国全人口的结核感染率和活动性肺结核患病率。其差异有统计学意义(P＜0．01)。结论本研究未发现RA和AS患者接受抗TNF治疗前后结核发病的风险的增高,但在应用TNF拮抗剂治疗前,建议应严格掌握适应证,避免严重不良反应的发生。     

Risk factors and clinical characteristics of deep knee infection in patients with intra-articular injections: A matched retrospective cohort analysis

BackgroundDeep knee infection (DKI), consisting of sepsis arthritis (SA) and chronic low-grade infection (CLGI), is a rare but catastrophic adverse event that can result from intra-articular (IA) injections. The purpose of this study was to assess the risk factors for DKI and describe the clinical characteristics of DKI in patients who received IA injections.MethodsFifty patients with IA injection-induced DKI who underwent surgical treatment between January 2010 and May 2016 served as cases and were matched with non-infected controls who received IA injections in a proportion of 1:5 based on age, gender, and date of admission. All IA injections (both cases and controls) were performed within 6 months of admission at our institution or at a referring institution. Risk factors for injection-induced DKI were analyzed, and the clinical characteristics between SA and CLGI were compared.ResultsThe final multivariate logistic regression analysis demonstrated that body mass index ≥25 kg/m² [odds ratio (OR) = 2.3; 95% confidence interval (CI): 1.1–4.7], corticosteroid injections (OR = 3.21; 95% CI: 1.63–6.31), rheumatoid arthritis (OR = 2.61; 95% CI: 1.20–5.68) and injections performed by general practitioners (OR = 5.23; 95% CI: 2.00–13.67) increased the risk of DKI following IA injections. Of 50 cases, there were 21 SA cases and 29 CLGI cases. SA cases had significantly higher metrics in the categories of fever, local warmth, swelling, rest pain, night pain, limited motion, serum WBC, and CRP levels than CLGI cases.ConclusionsWe identified risk factors and clinical characteristics of injection-induced DKI, which may offer improved guidance on IA injections and knowledge of DKI in patients with IA injections, especially in CLGI patients.     

强直性脊柱炎和类风湿关节炎患者低相对分子质量IgM水平的研究

目的 研究强直性脊柱炎(AS)和类风湿关节炎(RA)患者体内低相对分子质量IgM水平的变化.方法 取AS、RA患者和健康对照人群血清,超滤法分离低相对分子质量IgM,酶联免疫吸附试验测定低相对分子质量IgM比例.采用Mann-Whitney U检验方法进行统计分析.结果 AS和RA患者血清低相对分子质量IgM比例较健康对照明显升高(分别为0.194±0123,0.061±0.026,0.028±0.165);低相对分子质量IgM比例与患者病情活动度无明显相关.结论 低相对分子质量IgM升高可能是AS和RA患者体内体液免疫功能紊乱的表现,但其具体的病理意义尚需进一步研究.

Abstract：

Objective To study the serum levels of low molecule weight IgM (LMW IgM) in ankylosing spondylitis (AS) patients and rheumatoid arthritis (RA) patients and to evaluate the relationship of LMW IgM levels with the disease activities. Methods The levels of LMW IgM and pentameric IgM in AS patients, RA patients and healthy controls were measured with ELISA after separated using ultrafiltration assay. Differences in the percentage of LMW IgM between subject groups were analysed using Mann-Whitney U test. Results The percentages of LMW IgM increased dramatically in AS patients and RA patients compared with healthy controls (0.194 ± 0123, 0.061 ±0.026, 0.028 ±0.165 separately). The LMW IgM percentages were not correlated with the disease activities. Conclusion The increase of LMW IgM indicates humoral immune function abnormality in AS patients and RA. However, the mechanism needs further study.     

重组人细胞毒T淋巴细胞相关抗原4抗体融合蛋白对类风湿关节炎患者外周血T淋巴细胞的影响

目的 探讨应用重组人细胞毒T淋巴细胞相关抗原(CTLA)-4抗体融合蛋白(rhCTLA-41g)治疗类风湿关节炎(RA)患者的临床疗效及对患者外周血辅助性T细胞17(Th17)和调节性T细胞的影响.方法 48例处于活动期的RA患者按1:1的比例随机分为治疗组和对照组,治疗组接受12周的rhCTLA-4Ig(10mg/kg)治疗;对照组接受12周的安慰剂治疗.以美国风湿病学会RA20％改善标准(ACR20)及疾病活动指数(DAS)28观察临床疗效;同时用流式细胞术检测受试者外周血Th17的变化,反转录聚合酶链反应(RT-PCR)检测外周血单个核细胞中FoxP3表达水平的变化.采用t检验和x2检验进行统计学分析.结果 ①治疗后12周治疗组24例中18例达ACR20改善,达ACR20改善的患者比例为75％,对照组中有1例(4％)达ACR20改善,2组差异有统计学意义(x2=25.176,P＜0.01);治疗后12周DAS28评分治疗组与对照组比较差异有统计学意义(分别为3.0±0.7,6.9±0.7,t=-12.39,P＜0.01).②治疗后治疗组RA患者外周血表达IL17A的单个核细胞为(0.22±0.20)％,对照组为(1.63±0.47)％,治疗组较对照组显著下降,差异有统计学意义(t=5.61,P＜0.05).③治疗组FoxP3 mRNA的表达(0.88±0.18)较对照组(0.24±0.05)明显增高,差异有统计学意义(t=7.56,P＜0.01).结论 rhCTLA-4Ig治疗RA临床表现和实验室指标明显改善,且外周血中TH17细胞及调节性T细胞的失衡程度有明显恢复.     

类风湿关节炎诊疗规范

类风湿关节炎(RA)是一种以关节滑膜炎症为主要病理基础的自身免疫病, 致残率高。近年来, RA的诊治取得了突飞猛进的发展, 国际上有关RA的指南亦不断更新。我国RA患者人数多, 规范化诊疗的普及依然欠缺。中华医学会风湿病学分会在借鉴国内外诊治经验和指南的基础上制定了本规范, 对RA的诊断、治疗及管理给予建议, 以更好地控制关节炎症, 改善患者生活质量, 减少残疾及疾病负担。     

类风湿关节炎患者程序化死亡基因5与肿瘤坏死因子-α的表达及其相关性分析

目的 检测类风湿关节炎(RA)及骨关节炎患者血清、滑液中程序化死亡基因(PDCD)5及肿瘤坏死因子(TNF)-α的表达水平,并分析PDCD5与TNF-α表达的相关性,初步探讨PDCD5在RA发病机制中的作用.方法 选取2009年12月至2010年8月50例患者(其中RA 26例,骨关节炎24例),采用酶联免疫吸附试验(ELISA)法检测血清、滑液中PDCD5及TNF-α的含量,统计学分析采用t检验及Pearson直线相关分析.结果 血清中,RA患者的PDCD5含量显著高于骨关节炎患者[(37±33)与(13±14) pg/ml,P＝0.02];滑液中,RA患者的PDCD5含量也显著高于骨关节炎患者[(37±26)与(11±7)pg/ml,P＜0.01].TNF-α在RA患者血清中的含量与骨关节炎患者比较差异无统计学意义(P=0.122),但其在RA患者滑液中的含量显著高于骨关节炎患者(P=0.037).PDCD5与TNF-α在RA及骨关节炎患者的血清中均呈负相关(r=-0.55,P=0.004;r=-0.51,P=0.012),PDCD5与TNF-α在RA患者的滑液中也呈负相关(r=-0.49,P=0.012),但在骨关节炎患者的滑液中无相关(r=-0.353,P=0.09).结论 PDCD5与TNF-α是RA重要的凋亡调控因子,在RA的发生发展过程中发挥重要作用.     

类风湿关节炎310膝次膝关节镜镜下分析

目的 探讨类风湿关节炎(RA)膝关节病变的关节镜下表现.方法 回顾分析2005年12月至2008年2月佛山市第一人民医院223例RA住院患者310膝次膝关节镜术中镜下所见,分析RA膝关节病变的特征.结果 310膝次中的305膝次(98.4%)有不同程度的滑膜增生,探查膝关节各区域以内侧间隙、髁间窝、外侧间隙滑膜增生明显增多,分别为274(88.4%)、267(86.1%)和258(83.2%)膝次,髌上囊滑膜增生最少见,为152膝次(49.0%);296膝次增生滑膜的镜下表现为珊瑚或棉絮样,9膝次表现为苔藓样增生.301膝软骨可见不同程度软骨变性或缺损,股骨内、外髁软骨变性合并软骨破坏或缺损分别为124、163膝.单纯软骨变性63膝.51膝的前交义韧带部分断裂,5膝次完全断裂,后交叉韧带部分断裂23膝,1膝次完伞断裂.内侧半月板撕裂、基本或完全消失的膝次分别为234、38膝次,外侧分别为214、45膝次.结论 RA膝关节多有滑膜增生,髁间窝及内、外侧问隙最多见,髌上囊相对较少;增生滑膜形态以珊瑚或棉絮样为主.RA膝关节软骨破坏常见,股骨内、外髁处最为明显;部分膝关节可见前、后交义韧带部分或完伞断裂;大部分RA膝关节有半月板病变.