超微血管成像技术评估类风湿关节炎手指关节 亚临床炎及分布特点

目的 采用超微血流成像（SMI）技术评估类风湿性关节炎（RA）患者掌指关节（MCP）及近端指间关节（PIP）亚临床活动性炎的分布特点。方法 对2015年11月~2018年9月在我院接受治疗的临床缓解的23例RA患者MCP及PIP各230个关节进行超声检查,利用灰阶超声观察滑膜增厚程度,并利用SMI技术观察血流分布,比较不同关节及同一关节掌侧及背侧关节面受累程度差异。结果 临床缓解的23例患者超声完全缓解率仅21.74%;230个受检关节中SMI对MCP和PIP滑膜区血流信号的显示率分别为17.83%、16.96%,差异无统计学意义（P＞0.05）;MCP主要以背侧滑膜血流信号显示为主,显示率63.41%较PIP背侧显示率33.33%高,PIP主要以掌侧滑膜血流信号显示为主,显示率53.85%较MCP掌侧显示率21.95%高,差异均具有统计学意义（P＜0.05）;MCP和PIP受累程度比较,差异无统计学意义（P＞0.05）。结论 SMI技术能够客观地评估RA患者MCP及PIP亚临床活动性炎,其中MCP亚临床活动性炎主要分布于背侧滑膜,PIP则主要分布于掌侧滑膜。     

尿酸、黄嘌呤氧化酶与类风湿关节炎疾病活动度的关系

目的 探究血清尿酸(UA)、黄嘌呤氧化酶(XOD)表达水平与类风湿关节炎(RA)患者疾病活动度的关系。方法分析本院2019年3月至2021年1月接收的180例RA患者(RA组)的临床资料，根据28个关节的疾病活动度评分(DAS28)将患者分为缓解期组(86例)(DAS28评分<2.6分)和活动期组(94例)(DAS28评分≥2.6分),同时依据X线检查将患者分为骨损伤组(60例)和无骨损伤组(120例);对照组(176例)为健康体检者。血清UA水平的检测采用全自动生化分析仪，血清XOD水平的检测采用双抗体夹心酶联免疫吸附(ELISA)法；采用Pearson进行RA患者血清UA、XOD与疾病活动度的相关性分析；采用Logistic回归法分析UA、XOD对RA患者疾病活动度的影响。结果 RA组血清UA、XOD表达水平明显高于对照组(P<0.05)。活动期组血清UA、XOD表达水平明显高于缓解期组(P<0.05)。活动期RA患者UA与XOD、UA与DAS28评分、XOD与DAS28评分均呈正相关(r=0.721、0.622、0.571,P均<0.05)。缓解期RA患者...     

类风湿关节炎患者外周血单个核细胞Sonic Hedgehog信号通路表达的初步研究

目的: 初步探讨类风湿关节炎(RA)患者外周血单个核细胞(PBMCs)和滑膜组织中Sonic Hedgehog(Shh)信号通路相关因子表达及意义。方法: 收集符合1987年美国风湿病学会(ACR)RA分类标准、28个关节疾病活动度评分(DAS28)≥3.2,病情活动RA患者(35例)及年龄、性别相匹配的健康志愿者(35例)外周血2 mL,分离PBMCs,提取总RNA,采用实时荧光定量PCR(real-time PCR)检测Shh信号通路中信号肽Shh、膜受体Ptch1和核转录因子Gli1 mRNA的表达。收集10例病情中度活动(DAS28≥3.2)RA患者的滑膜组织,同时收集5例外伤或半月板损伤(无关节炎)者滑膜组织作为对照组,免疫组化检测Shh、Ptch1和Gli1的蛋白表达情况。结果: RA患者PBMCs中Shh和Gli1 mRNA的相对表达量分别为1.36±1.48和1.15±0.68,对照组上述信号分子的mRNA表达量分别为0.47±0.25和0.49±0.05,2组差异有统计学意义(P<0.05),Ptch1 mRNA表达在2组间的差异无统计学意义(P>0.05);免疫组化示Shh和Gli1蛋白表达的阳性细胞百分率均高于对照组(P<0.05),Ptch1蛋白表达阳性细胞百分率2组无显著差异(P>0.05)。结论: RA患者PBMCs与滑膜组织中检测到Shh通路相关信号分子Shh和Gli1的表达上调,提示RA患者中可能存在Shh信号通路的激活,其在RA发病机制中的作用值得进一步研究。     

依那西普抑制类风湿性关节炎滑膜炎症并降低黏附相关分子表达

目的观察肿瘤坏死因子(TNF)拮抗剂依那西普治疗的类风湿性关节炎(RA)患者滑膜组织炎症评分及相关分子标志物表达的改变。方法行膝关节镜下滑膜切除术治疗的RA患者16例,其中8例既往接受依那西普治疗,8例未接受依那西普或其他生物制剂治疗。滑膜组织HE染色比较2组患者Rooney炎症评分,免疫组织化学染色检测滑膜组织中增殖细胞核抗原(PCNA)及血管黏附分子1(VCAM-1)、细胞间黏附分子1(ICAM-1)和钙黏素11(cadherin-11)的表达。结果依那西普组Rooney评分明显低于非生物制剂组,滑膜衬里层PCNA与cadherin-11表达明显降低,衬里下层PCNA及cadherin-11表达也显著降低。两组间滑膜衬里层及衬里下层VCAM-1与ICAM-1表达无显著性差异。临床炎性指标[红细胞沉降率(ESR)、C反应蛋白(CRP)、血小板计数(PLT)]及28个关节疾病活动指数(DAS28)与Rooney评分之间无统计学相关性。结论依那西普可抑制RA滑膜细胞增生和淋巴细胞浸润,并降低与增生及黏附相关分子的表达,缓解RA滑膜组织炎性病变;临床炎性指标不能完全反映局部关节滑膜组织学改变。     

依那西普抑制类风湿性关节炎滑膜炎症并降低黏附相关分子表达北大核心CSCD

目的观察肿瘤坏死因子(TNF)拮抗剂依那西普治疗的类风湿性关节炎(RA)患者滑膜组织炎症评分及相关分子标志物表达的改变。方法行膝关节镜下滑膜切除术治疗的RA患者16例,其中8例既往接受依那西普治疗,8例未接受依那西普或其他生物制剂治疗。滑膜组织HE染色比较2组患者Rooney炎症评分,免疫组织化学染色检测滑膜组织中增殖细胞核抗原(PCNA)及血管黏附分子1(VCAM-1)、细胞间黏附分子1(ICAM-1)和钙黏素11(cadherin-11)的表达。结果依那西普组Rooney评分明显低于非生物制剂组,滑膜衬里层PCNA与cadherin-11表达明显降低,衬里下层PCNA及cadherin-11表达也显著降低。两组间滑膜衬里层及衬里下层VCAM-1与ICAM-1表达无显著性差异。临床炎性指标[红细胞沉降率(ESR)、C反应蛋白(CRP)、血小板计数(PLT)]及28个关节疾病活动指数(DAS28)与Rooney评分之间无统计学相关性。结论依那西普可抑制RA滑膜细胞增生和淋巴细胞浸润,并降低与增生及黏附相关分子的表达,缓解RA滑膜组织炎性病变;临床炎性指标不能完全反映局部关节滑膜组织学改变。     

超声评分构建在手类风湿性关节炎患者中的应用价值

目的探讨超声评分构建分析手类风湿性关节炎病情程度。方法选择2015年1月至2016年12月解放军第一医院收治的手类风湿性关节炎患者187例,其中男性84例,女性103例,年龄22~65岁。参照Hartung W超声评分标准,分为低分(0~1)组89例和高分(2~3)组98例。低分组男性41例,女性48例;年龄23~63岁,平均年龄43.29岁。高分组男性43例,女性55例;年龄22~65岁,平均年龄43.72岁。行超声手关节检查,观察滑膜厚度、关节腔积液、血流分级情况、骨髓水肿、骨与软骨侵蚀、肌腱炎情况,计算类风湿性关节炎疾病活动度评分、健康相关的生存质量(SF-36)评分;实验室检测C反应蛋白、红细胞沉降率、血管内皮生长因子水平。结果低分组滑膜厚度、关节腔积液比例、血流信号分级为Ⅱ或Ⅲ级比例、骨髓水肿发生率、骨与软骨侵蚀比例、肌腱炎发生率明显低于高分组[(1.28±0.41)mm vs(3.19±0.67)mm,25.84%vs 77.55%,15.73%vs 87.76%,0.00%vs 12.24%,0.00%vs 43.88%,0.00%vs 16.33%];两组比较,差异有显著统计学意义(P=0.0000.01)。低分组类风湿性关节炎疾病活动度评分显著低于高分组[(3.28±1.48)分vs(4.78±2.06)分],差异有显著统计学意义(P=0.000)。低分组C反应蛋白水平、红细胞沉降率、血管内皮生长因子水平明显低于高分组[(5.29±2.54)mg/L vs(8.95±3.29)mg/L,(21.95±8.95)mm/h vs(35.29±11.72)mm/h,(45.37±9.92)pg/m L vs(77.85±12.77)pg/m L];两组差异有显著统计学意义(P=0.000)。低分组健康相关的生存质量(SF-36)评分显著高于高分组[(83.81±4.99)分vs(78.93±6.49)分];两组差异有显著统计学意义(P=0.000)。结论超声评分可以较好地反映手类风湿性关节炎患者病情严重度,值得进一步推广。     

调节性固有淋巴细胞在类风湿性关节炎中的可能作用和临床意义

目的探讨调节性固有淋巴细胞(ILCregs)在类风湿关节炎(RA)病理过程的作用。方法采用流式细胞术检测RA患者外周血、滑膜液中ILCregs频率,并与患者的临床指标进行相关性分析;运用免疫荧光染色技术检测ILCregs是否存在于RA病变滑膜组织。结果相比于健康对照组,RA外周血总ILCs频率没有明显变化,但ILCregs频率在RA患者外周血中显著增高。外周血ILCregs频率与RA患者DAS28-CRP评分、CRP和ACPA均呈显著负相关。同一患者ILCregs在滑膜液中频率显著高于外周血。免疫荧光染色证实了ILCregs在RA患者病变滑膜组织中存在。结论本研究证实了ILCregs在RA患者外周血、滑膜液和滑膜组织中均显著高于正常人,且其频率与RA患者相关临床指标负相关,提示其在RA中可能具有保护性作用且可能是RA治疗潜在新靶标。     

超微血管成像联合CMR-FT在ACS患者微血管功能障碍评估中的应用

目的研究超微血管成像(SMI)联合心血管MRI特征追踪技术(CMR-FT)在急性冠状动脉综合征(ACS)患者微血管功能障碍评估中的应用。方法采用前瞻性分析,选择2017年8月至2020年11月在陕西中医药大学第二附属医院诊治的120例ACS患者(观察组),其中男性57例,女性63例;年龄51～84岁,平均年龄66.57岁;体质量指数24.11～25.09 kg/m2,平均体质量指数24.59 kg/m2;稳定心绞痛(SAP)49例,不稳定心绞痛(UAP)43例,急性心肌梗死(AMI)28例。另选取同期进行体检的健康人群120例(对照组),其中男性55例,女性65例;年龄50～82岁,平均年龄66.14岁;体质量指数24.11～25.09 kg/m2,平均体质量指数24.19 kg/m2。比较两组患者的左心室的心肌应变力、心功能、冠状动脉斑块的影像学特征并进行分析;分析SMI联合CMR-FT诊断效能。结果观察组左心室整体峰值径向应变值(GPRS)[(24.89±8.24)%vs (44.26±9.19)%](t=17.191,P=0.000)、整体峰值周向应变值(GPCS)[(18.59...     

肌骨超声对类风湿性指关节炎的病理特征及疾病严重程度的诊断价值分析

目的:探讨肌骨超声评价类风湿性关节炎(Rheumatoid arthritis,RA)的病理特征及疾病严重程度的临床意义.方法:回顾性分析2020年1月至2022年6月我院收治的90例RA患者(113个受累膝关节)的临床资料,所有患者均于入院后接受肌骨超声(Musculoskeletal ultrasound,MSUS)和核磁共振成像(Magnetic Resonance Imaging,MRI)检查,以关节镜检查结果为"金标准".根据28关节活动性评分评估患者病情,将患者分为重度活动组、中度活动组、轻度活动组及缓解组.比较两种检查方式对RA的检出率和诊断价值.分析MSUS征象、血流信号与疾病严重程度的相关性.结果:MSUS共检出受累膝关节101个,准确度为89.38％;MRI共检出受累膝关节100个,准确度为88.50％.MSUS对关节积液的检出率高于MRI(P<0.05).MSUS和MRI诊断RA的敏感度、特异度、准确率、Kappa值均较高.不同活动性滑膜厚度、关节腔积液深度、骨侵蚀程度评分及血流信号分级比较,重度活动组>中度活动期>轻度活动组>缓解组(P<0.05).结论:MSUS和MRI对RA均具有较高的诊断价值,但MSUS应用价值更高,MSUS征象和血流信号与RA疾病严重程度联系密切.     

类风湿关节炎患者外周血单核细胞miR-24、miR-132 表达及临床意义

目的:miR-24、miR-132在类风湿关节炎(RA)患者外周血单个核细胞(PBMC)中的表达及临床意义。方法:收集160例RA患者、65例骨关节炎(OA)患者和65名健康对照者作为研究对象。RA患者按照DAS28评分分为低活动组(n=64)和中高活动组(n=96),Sharp评分分为非骨侵蚀组(n=73)和骨侵蚀组(n=87)。采用实时定量PCR(RT-PCR)法检测各组PBMC中miR-24、miR-132表达水平。应用ROC曲线分析miR-24、miR-132对RA的诊断价值,Pearson相关分析RA患者miR-24、miR-132与DAS28评分、Sharp评分的相关性。结果:RA组PBMC中miR-24(3.62±0.75 vs 0.91±0.18,0.86±0.13)及miR-132(2.48±0.23 vs 1.07±0.14,0.96±0.11)表达水平均明显高于OA组和对照组(P0.01)。中高活动组PBMC中miR-24(5.86±1.15 vs 1.20±0.41)及miR-132(3.25±0.42 vs 1.14±0.19)表达水平明显高于低活动组(P0.01)。骨侵蚀组PBMC中miR-24(6.12±1.24 vs 1.14±0.39)及miR-132(3.48±0.46 vs 1.06±0.17)表达水平均明显高于非骨侵蚀组(P0.01)。ROC曲线分析显示miR-24、miR-132诊断RA的临界值分别为1.93、1.65,两项联合诊断RA的AUC(0.925,95%CI:0.863～0.972)最大,其敏感度和特异度为90.2%和85.8%。相关分析显示,RA患者miR-24、miR-132与Sharp评分、DAS28评分均呈正相关(P0.05)。结论:RA患者PBMC中miR-24、miR-132高表达,与疾病活动度和骨侵蚀程度相关,两项联合检测有助于提高RA诊断的价值。     

Efficacy and safety of combination therapy with mizoribine and methotrexate for rheumatoid arthritis resistant with methotrexate

Background. MZB is a purine analog, and is used as a disease modifying anti-rheumatic drug (DMARD). We conducted an open label uncontrolled clinical trial to evaluate the efficacy and safety of combination therapy with methotrexate (MTX) and mizoribine (MZB). Methods. Thirty one RA patients (9 males, 22 females, 68±12 year-old) who fulfilled ACR criteria of RA and did not show sufficient clinical response to MTX were included. MZB (150 mg/day, once a day) were added to MTX. DAS28-CRP was measured at day 0 and 1, 3, 6, and 12 months after the treatment. Adverse events were recorded. Results. Overall DAS28-CRP was significantly decreased from 4.4±1.0 to 3.1±1.3 at 3 months (p<0.01), 2.7±0.68 at 6 months (p<0.01), 2.4±1.4 at 12 months (p<0.01). Seventeen patients (55%) achieved significant improvement of DAS28-CRP. Number of swollen joints of responders before the treatment was significantly fewer than that of non-responders. Improvement of DAS28-CRP was significantly different between the responders (0.91±0.74) and non-responders (0.18±0.66) at 1 month (p<0.01). Nine patients (29%) could achieve remission Four patients experienced adverse events. Conclusions. MTX and MZB combination therapy was effective and relatively safety.     

High‐temporospatial‐resolution dynamic contrast‐enhanced (DCE) wrist MRI with variable‐density pseudo‐random circular Cartesian undersampling (CIRCUS) acquisition: evaluation of perfusion in rheumatoid arthritis patients

This study is to evaluate highly accelerated three‐dimensional (3D) dynamic contrast‐enhanced (DCE) wrist MRI for assessment of perfusion in rheumatoid arthritis (RA) patients. A pseudo‐random variable‐density undersampling strategy, circular Cartesian undersampling (CIRCUS), was combined with k–t SPARSE‐SENSE reconstruction to achieve a highly accelerated 3D DCE wrist MRI. Two healthy volunteers and 10 RA patients were studied. Two patients were on methotrexate (MTX) only (Group I) and the other eight were treated with a combination therapy of MTX and anti‐tumor necrosis factor (TNF) therapy (Group II). Patients were scanned at baseline and 3 month follow‐up. DCE MR images were used to evaluate perfusion in synovitis and bone marrow edema pattern in the RA wrist joints. A series of perfusion parameters was derived and compared with clinical disease activity scores of 28 joints (DAS28). 3D DCE wrist MR images were obtained with a spatial resolution of 0.3 × 0.3 × 1.5 mm³ and temporal resolution of 5 s (with an acceleration factor of 20). The derived perfusion parameters, most notably transition time (dT) of synovitis, showed significant negative correlations with DAS28‐ESR (r = ?0.80, p < 0.05) and DAS28‐CRP (r = ?0.87, p < 0.05) at baseline and also correlated significantly with treatment responses evaluated by clinical score changes between baseline and 3 month follow‐up (with DAS28‐ESR r = ?0.79, p < 0.05, and DAS28‐CRP r = ?0.82, p < 0.05). Highly accelerated 3D DCE wrist MRI with improved temporospatial resolution has been achieved in RA patients and provides accurate assessment of neovascularization and perfusion in RA joints, showing promise as a potential tool for evaluating treatment responses. Copyright © 2015 John Wiley & Sons, Ltd.     

类风湿患者DD和AT-Ⅲ检测的临床意义

目的检测类风湿关节炎（RA）患者血浆D-二聚体（DD）及抗凝血酶Ⅲ（AT-Ⅲ）表达水平,探讨其在RA中的临床意义。方法选择RA患者36例为RA组,正常对照组30例,测定其血浆DD、AT-III及血浆C反应蛋白（CRP）水平。结果 RA组患者血浆DD水平为（289.36±71.75）μg/L,显著高于正常对照组的（132.25±38.63）μg/L;血浆AT-III水平为（56.2±12.70）%,明显低于对照组的（92.40±3.80）%,差异均有统计学意义（P〈0.05）。相关性分析显示,RA组患者血浆DD、AT-III水平与DAS28评分具有相关性（r=0.32,P〈0.01;r=-0.72,P〈0.01）。RA组患者经治疗病情缓解后（DAS28〈2.6）血浆DD水平为（141.38±32.75）μg/L,显著低于治疗前的（289.36±71.75）μg/L,差异有统计学意义（P〈0.01）,与正常对照组比较差异无统计学意义（P〉0.05）;RA组患者经治疗病情缓解后血浆AT-III水平为（96.20±4.20）%,显著高于治疗前的（56.2±12.7）%,差异有统计学意义（P〈0.01）,与正常对照组比较差异无统计学意义（P〉0.05）。结论血浆DD及AT-III水平与RA患者的病情活动有关,可反映心血管病变危险性,对RA患者的病情判断及预后估计有重要的评判价值。     

Older age of rheumatoid arthritis onset is associated with higher activation status of peripheral blood CD4(+) T cells and disease activity

Rheumatoid arthritis (RA) is a chronic inflammatory disease, with a clinical manifestation both systemic and in joints. It has been suggested that age at disease onset and/or patients' age have influence on disease activity and clinical outcome. The reasons for the different course of RA in older people are not known; however, the activation status of peripheral blood lymphocytes could be responsible. Our aim was to relate expression of activation markers in peripheral blood CD4(+) T cells of RA patients with patients' age and/or onset age and disease activity measured by DAS28. Seventy RA patients were included into the immunological study. Two separation criteria were performed: based on age of RA onset and on the biological age of patients. We examined different activation markers, CD69, CD25, CD95 and human leucocyte antigen D-related (HLA-DR), on the CD4(+) T cell surface. Division of RA patients in 10-year intervals at 40, 50 and 60 years revealed that RA patients with later disease onset were characterized by higher DAS28. This phenomenon was not limited to the division at 60 years of age but, surprisingly, the major differences were found for the 40-year onset division. Analysis of all four components of DAS28 revealed that disease activity in older disease onset was dependent on all components. Older-onset RA patients had a higher percentage of CD4(+) CD25(+) and CD4(+) CD95(+) T cells. Summarizing the major differences in DAS28 and activation status of CD4(+) T cells observed for onset of disease at 40 years seems to be the most informative about the immunological status of RA patients.     

Roles of claudin-5 and von Willebrand factor in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disorder that affects approximately 1% of the world’s population. The pathogenesis of RA is not understood fully. It is assumed that endothelial function is associated with the proinflammatory state of RA. Endothelial dysfunction/activation reflects the increased level of von Willebrand factor (vWF) and a shift toward prothrombotic activity of the endothelium. The present study was performed to investigate the possible relationships between vWF and claudin-5 and the level of disease activity in patients with RA. The study population was divided into four groups according to the disease activity score in 28 joints (DAS28): remission group (RG), 18 patients (DAS28 < 2.6); low disease activity group (LDAG), 23 patients (DAS28 > 2.6-3.2); moderate disease activity (MDAG), 23 patients (DAS28 > 3.2-5.1); high disease activity group (HDAG), 14 patients (DAS28 > 5.1); and control group (CG), 10 healthy subjects. Claudin-5 and vWF assessment were derived from serum samples gathered from the patients known to have RF and anti-CCP titers in the normal ranges. A high positive association of claudin-5 and vWF with the MDAG was observed (P < 0.001). The results of our study indicated that the relationship between vWF and claudin-5, which are indicators of endothelial cell dysfunction and tight junction activity, may be a predictor of disease activity. Further studies are required to investigate these pathways to shed light on the roles of claudin-5 and vWF in the progression of inflammation and other vascular conditions.     

Neutrophils of rheumatoid arthritis patients on anti-TNF-α therapy and in disease remission present reduced adhesive functions in association with decreased circulating neutrophil-attractant chemokine levels

Neutrophils participate in the initiation and progression of rheumatoid arthritis (RA) although the exact mechanisms responsible for neutrophil accumulation in rheumatoid joints are not understood. This study compared the adhesive and chemotactic functions of neutrophils from RA patients in activity (DAS28 > 3.2) and not in activity (DAS28 < 2.6) and observed the effects of different treatment approaches on these functions. Neutrophils were isolated from healthy controls (CON), and patients with active or inactive RA in use of therapy not specific for RA (NSAIDs), in use of DMARDs and in use of anti-TNF-α therapy. Adhesive and chemotactic properties were evaluated using in vitro assays; adhesion molecule expression was assessed by flow cytometry and real-time PCR and circulating chemokines were determined by ELISA. No significant alterations in the adhesive and chemotactic properties of neutrophils from active RA were observed when compared to CON neutrophils, independently of treatment regimen. In contrast, neutrophils from RA patients in disease remission presented reduced adhesive properties and a lower spontaneous chemotactic capacity, in association with decreased adhesion molecule expression, although profiles of alterations differed for those patients on DMARDs and those on anti-TNF-α therapy. Circulating levels of the major neutrophilic chemokines, IL-8 and epithelial neutrophil activating peptide-78, were also significantly decreased in those patients demonstrating a clinical response. Remission of RA appears to be associated with ameliorations in aspects important for neutrophil adhesion and chemotaxis; whether these alterations contribute to decrease neutrophil migration to the synovial fluid, with consequent improvements in the clinical manifestations of RA, remains to be determined.     

红细胞压积变化对急性ST段抬高型心肌梗死患者临床预后的影响

目的 探讨红细胞压积的变化对急性ST段抬高型心肌梗死（STEMI）接受急诊经皮冠状动脉支架植入术患者的临床预后的影响。方法 连续性纳入我院心肌梗死绿色通道收治行急诊支架植入患者603例,根据住院期间红细胞压积的变化分为A组（红细胞压积降低组,255例）和B组（红细胞压积升高组,348例）。收集两组患者资本资料、手术相关信息、化验室资料、住院期间临床事件、1个月内临床事件以及1年内临床事件并予以统计分析。结果 A组年龄大于B组[（60.33±11.06）岁 vs（58.44±10.88）岁,P＜0.05],B组脑血管病史发生率高与A组（13.50% vs 8.24%,P＜0.05）,A组梗死相关动脉中血栓病变发发生率高于B组（97.25% vs 88.51%,P＜0.05）。支架植入后最终TIMI血流:3级血流A组较B组高（85.88% vs 79.02%,P＜0.05）。A组较B组住院期间心源性死亡发生率低（0 vs 2.01%,P＜0.05）;出院1年内LVEF低于B组[（55.53±6.42）% vs （57.19±6.82）%,P＜0.05];出院1年室壁运动异常发生率高于B组（92.88% vs 87.69%,P＜0.05）。结论 住院期间红细胞压积升高增加STEMI患者在院期间心源性死亡的发生,红细胞压积降低预示着心功能的下降及室壁运动功能受损。     

Ultrasonographic evaluation of enthesitis in patients with ankylosing spondylitis

The aim of this study was to assess sensitivity and responsiveness of power Doppler ultrasound (PDUS) in detecting enthesitis for ankylosing spondylitis (AS) patients compared to clinical examinations. Twenty AS patients initiating etanerceptunderwent clinical and PDUS examinations of six bilateral entheseal sites at baseline and after 1, 2 and 3 months of treatment. Clinical and PDUS examinations identified at least one entheseal lesion in nine (45%) and 19 (95%) patients, respectively. Furthermore, of 240 entheseal sites examined in these 20 patients, PDUS detected 123 entheseal lesions (51.3% of sites), compared with only 47 entheseal lesions (19.6%) detected by clinical examination (P < 0.05). The entheseal lesions found on PDUS were most commonly identified by calcification (33.3%), tendon edema (29.2%), abnormal blood flow (25.8%), a thickened tendon (22.1%), cortical irregularity (12.9%), bony erosions (9.6%) and bursitis at the tendon insertion to the bone cortex (7.1%). Improvements in clinical symptoms and laboratory parameters, and significant decreases in PDUS scores were observed following treatment with etanercept. Improvements in PDUS scores continued during follow-up in patients who entered remission following treatment. In conclusion, PDUS improve detection of structural and inflammatory abnormalities of the enthesis in AS compared to physical examination. In addition, PDUS may be useful inascertaining medications.     

基于浮筏撬拨技术的桡骨远端骨折切开复位内固定的术式设计及运用

目的对于移位的不稳定桡骨远端骨折患者,设计规范程式化的掌侧接骨板内固定术式,探索新术式的临床疗效。方法选择桡骨远端骨折患者共48例,其中男性21例,女性27例;年龄18~65岁,平均年龄63.5岁。随机分为两组,即治疗组和对照组。治疗组患者23例,其中男性10例,女性13例;年龄58~80岁,平均年龄63.2岁。对照组患者25例,男性11例,女性14例;年龄57~81岁,平均年龄63.8岁。治疗组借助浮筏撬拨技术复位、围旋前方肌双窗口技术暴露和"鱼簖"技术定位实现接骨板掌侧内固定术;对照组使用传统切开复位内固定术治疗。观察两组患者的手术时间和腕关节功能。结果治疗组手术时间较对照组缩短[(39.12±3.04) min vs(46.52±3.53) min;t=1.762,P <0.05]。术后3个月,治疗组腕关节功能减损值为8.9°,对照组腕关节功能减损值为12.7°;治疗组优于对照组,差异有统计学意义(χ^2=42.12,P <0.05)。结论基于浮筏撬拨技术的桡骨远端骨折切开复位内固定的术式可以实现程式化,缩短手术时间,维护腕部和前臂旋转功能,值得进一步推广。