沙利度胺联合柳氮磺胺吡啶治疗强直性脊柱炎

目的探讨沙利度胺联合柳氮磺胺吡啶治疗强直性脊柱炎的临床效果。方法将80例首诊强直性脊柱患者随机分为观察组和对照组,每组40例,观察组联合应用沙利度胺和柳氮磺胺吡啶,对照组单用沙利度胺。比较两组患者治疗后晨僵时间、扩胸度、强直脊柱炎病情活动指数、强直性脊柱炎功能指数、关节疼痛数、枕壁距、Schober试验以及ESR、CRP等指标,进行临床疗效评估。结果治疗后12周,两组患者各项指标均较用药前明显改善(P0.05),观察组各项指标改善效果明显优于对照组(P0.05),观察组总有效率高于对照组(P0.05)。两组不良反应比较差异无统计学意义(P0.05)。结论沙利度胺联合柳氮磺胺吡啶治疗强直性脊柱炎可以提高疗效,是一种较可靠的治疗方案。     

中西医结合治疗慢性溃汤性结肠炎39例临床观察

目的观察中药煎剂灌肠加西药柳氮磺胺吡啶口服与单纯口服柳氮磺胺吡啶的治疗效果比较。方法将79例病例分为观察组（39例）和对照组（40例）,观察组采用中药煎剂加柳氮磺胺吡啶口服,对照组单纯口服柳氮磺胺吡啶。两组治疗时间与评价标准相同。结果观察组近期治愈32例（82.1%）、总有效率为97.5%,较对照组的近期治愈18例（45.0%）、总有效率80.0%为优（P〈0.01）。结论治疗慢性溃疡性结肠炎使用中药煎剂灌肠加口服柳氮磺胺吡啶,比单纯口服柳氮磺胺吡啶效果好。     

强直性脊柱炎慢作用药治疗3年以上随访分析

目的：了解柳氮磺胺吡啶、甲氨蝶呤、雷公藤多甙以及三种药物联合治疗强直性脊柱炎的远期疗效。方法：４６例活动性ＡＳ分别给予柳氮磺胺吡啶、甲氨蝶呤、雷公藤多甙以及三种药物联合治疗３年以上，通过观察晨僵腰痛、实验室及放射学检查以及医师与２全面评价的变化来确定疗效。结果：总临床疗效分别为显效８２．６％，有效１５．２％。有５６．５％患者经单种慢作用药治疗可以控制病情发展，６．５％病例需应用两种以上慢作用药，尤     

马应龙麝香痔疮膏联合柳氮磺吡啶栓治疗轻中度溃疡性直肠炎的临床观察

目的探讨马应龙麝香痔疮膏联合柳氮磺吡啶栓治疗溃疡性直肠炎的临床疗效和安全性。方法选择213例符合轻、中度溃疡性直肠炎诊断的患者随机分为马应龙麝香痔疮膏联合柳氮磺吡啶栓组(治疗组)108例,柳氮磺吡啶栓组(对照组)105例,疗程均为4周。对两组治疗前后的症状、电子结肠镜检查及不良反应进行比较。结果治疗组症状改善有效率均高于对照组,两组无不良反应发生。结论马应龙麝香痔疮膏联合柳氮磺吡啶栓治疗轻、中度溃疡性直肠炎安全有效。     

补阳还五汤联合柳氮磺吡啶治疗强直性脊柱炎临床观察

目的:观察补阳还五汤联合柳氮磺吡啶治疗强直性脊柱炎的临床疗效及安全性。方法:将47例强直性脊柱炎患者随机分为治疗组23例和对照组24例。对照组口服柳氮磺吡啶,治疗组在对照组治疗基础上加用补阳还五汤。两组均治疗6个月,观察两组治疗前后临床评价指标的改善情况,并对不良反应进行评价。结果:治疗后,两组患者的各项临床指标均有明显改善(P0.05),且治疗组改善优于对照组(P0.05),也未出现不良反应。结论:补阳还五汤联合柳氮磺吡啶治疗强直性脊柱炎安全有效,值得推广应用。     

柳氮磺吡啶口服联合锡类散保留灌肠治疗溃疡性结肠炎的疗效探讨

为探讨柳氮磺吡啶口服联合锡类散保留灌肠治疗溃疡性结肠炎的临床疗效,将60例溃疡性结肠炎患者随机分为两组,各30例,一组采用柳氮磺吡啶口服联合锡类散保留灌肠治疗（治疗组）,一组单纯口服柳氮磺吡啶治疗（对照组）,比较两组疗效及治疗前后疾病活动指数（DAI）。结果显示,治疗组治愈27例,好转2例,无效1例,治愈率为90．0％;对照组治愈20例,好转6例,无效4例,治愈率为66．7％。治疗组治愈率明显高于对照组,P〈0．05。治疗后两组DAI均较治疗前显著降低,P〈0．05;治疗组降低更明显,P〈0．05。结果表明,柳氮磺吡啶口服联合锡类散保留灌肠能提高溃疡性结肠炎的临床治愈率。     

甲氨喋呤联合米非司酮治疗异位妊娠效果观察

目的总结甲氨喋呤联合米非司酮治疗异位妊娠的方法和效果。方法随机将68例异位妊娠患者分为2组,各34例。观察组采用甲氨喋呤联合米非司酮治疗,对照组单用氨甲喋呤治疗。观察2组患者的治疗效果和不良反应。结果观察组血β-HCG恢复正常时间、住院时间和治愈率均显著优于对照组,2组差异有统计学意义(P0.05)。治疗过程中2组药物不良反应发生率差异无统计学意义(P0.05)。结论甲氨喋呤联合米非司酮治疗异位妊娠,效果显著且无严重不良反应。但须严格掌握适应证和把握好中转手术的时机。     

雷公藤多甙预防克罗恩病术后复发

目的观察雷公藤多甙预防克罗恩病（CD）术后复发的疗效。方法将2005年1月至2006年12月间接受病灶切除的静止期CD病患者随机分为两组,术后2周内分别接受雷公藤多甙（60mg／d,雷公藤组,21例）和柳氮磺胺吡啶（4g／d,柳氮磺胺吡啶组,18例）治疗。于服药后0、13、26、52周或出现临床症状时,测CDAI评分和红细胞沉降率（ESR）及C反应蛋白（CRP）;52周或出现临床症状时行肠镜检查,同时行Rutgeeert术后内镜复发评分。结果雷公藤组1例失访,2例因不规律服药而剔除,随访成功率为85．7％。柳氮磺胺吡啶组2例失访,随访成功率为88．9％。1年内出现临床症状复发者雷公藤组1例（5．6％）,柳氮磺胺吡啶组4例（25．0％）;内镜复发者雷公藤组4例（22．2％）,柳氮磺胺吡啶组9例（56．2％）;差异有统计学意义（P〈0．05）。结论雷公藤多甙预防CD术后复发的疗效较好,可以用来维持静止性CD缓解及预防术后复发。     

消痹汤联合西药治疗瘀血痹阻型类风湿关节炎30例的临床观察

目的探讨消痹汤联合西药治疗瘀血痹阻型类风湿关节炎的临床疗效及安全性。方法将60例类风湿关炎患者根据随机数字表法分为治疗组和对照组各30例。对照组服用甲氨喋呤5 mg每周一次,来氟米特20 mg一日一次,必要时服用依托考昔,并如实记录。治疗组在对照组基础上予消痹汤加减,必要时服用依托考昔,并如实记录。连续治疗12 w后分析两组患者的临床疗效差异,并观察两组患者晨僵时间、休息痛、关节压痛数、关节肿胀数、双手握力、20 m步行时间、健康评价问卷评分以及实验室指标水平变化的情况。结果两组均有较好的治疗作用,治疗组总有效率为93.3%,对照组总有效率为83.3%。差异有统计学意义(P0.05);治疗组在疾病活动度、晨僵时间、休息痛、关节肿胀个数、关节压痛个数、20 m步行时间、双手握力和健康评价问卷方面的改善优于对照组,差异有统计学意义(P0.05);治疗组治疗后C-反应蛋白、红细胞沉降率、类风湿因子、肿瘤坏死因子-α、白细胞介素-1水平变化与对照组相比更为明显(P0.05)。结论消痹汤联合西药治疗瘀血痹阻型类风湿关节炎在提高疗效、控制症状、改善实验室指标等均有较强的优势,值得临床推广应用。     

髋关节软组织液体松解术缓解强直性脊柱炎疼痛疗效观察

目的改善强直性脊柱炎(AS)患者的临床症状.方法将232例AS患者按入院顺序单日分为观察组(118例),双日分为对照组(114例),两组均予口服柳氮磺吡啶,连续治疗3个月;观察组同时采用髋关节软组织液体松解术(注射点为股骨头最高点上1.0～2.0 cm处),每周注射1次,连续6周.3个月后评价效果.结果两组患者除扩胸度外,疼痛评分、Schober试验、枕壁试验、15米步行时间、晨僵时间、髋关节活动度等6项指标均较治疗前显著好转(P<0.05、P<0.01);观察组治疗后疗效显著优于对照组(P<0.05).结论髋关节软组织松解术可有效缓解(AS)患者的临床症状.     

强直性脊柱炎早期诊断和系统治疗

目的：探讨强直性脊柱炎（AS）早期诊断的可能性和系统治疗的有效性。方法：将32例强直性脊柱炎患者随机分为2组，一组单独应用NSAIDs药物，另一组除应用NSAIDs外，加用柳氮磺胺吡啶和甲氨喋呤，进行疗效观察。结果：两组患者用药后自觉症状均有缓解，前屈，旋转和骶髂关节Gaenslen征与治疗前差异无显著性，而且组间差异也无显著性。结论：原有的AS诊断标准不利早期确诊，应作适当修改，骶髂关节炎是诊断AS的基础上，HLA－B27与AS呈强相关性，但非特异性；慎用慢作用或细胞毒药物治疗AS。     

腰腿痛宁胶囊联合八段锦治疗早期类风湿关节炎42例临床观察

目的:观察腰腿痛宁胶囊联合八段锦治疗早期寒湿痹阻型类风湿关节炎的临床疗效及对血清炎性因子的影响,为临床治疗类风湿关节炎提供新思路.方法:将84例类风湿关节炎患者分为治疗组和对照组,每组42例.治疗组给予腰腿痛宁胶囊联合八段锦治疗,对照组给予甲氨蝶呤片治疗,根据病情临时使用对乙酰氨基酚.2组均以8周为1个疗程.观察2组临...     

三黄散外敷治疗合并上消化道出血的急性痛风性关节炎28例临床观察

目的:观察三黄散外敷治疗合并上消化道出血的急性痛风性关节炎的临床疗效。方法:将56例合并上消化道出血的急性痛风性关节炎患者按照随机数字表法分为治疗组和对照组,每组28例。对照组给予氟比洛芬凝胶贴膏贴敷治疗,治疗组予三黄散外敷治疗。2组均以1周为1个疗程。观察2组临床疗效,以及治疗前后关节疼痛数字评分法(NRS)评分、C反应蛋白和患者对疗效的整体评价。结果:治疗组有效25例,无效3例,总有效率为89.29%;对照组有效21例,无效7例,总有效率为75.00%。2组比较,差异有统计学意义(P < 0.05)。治疗后,2组关节疼痛NRS评分和C反应蛋白较治疗前均有改善(P < 0.05),且治疗组优于对照组(P < 0.05)。结论:中药三黄散外敷治疗急性痛风性关节炎安全有效。     

Improvement of the clinical outcome in Ankylosing spondylitis by balneotherapy

AIMS: This study is designed to show the efficacy of balneotherapy and balneotherapy (BT) + nonsteroid antiinflammatory drug (NSAID) use in Ankylosing spondylitis (AS) patients. METHODS: In this prospective study, BT, BT+ NSAID and NSAID therapy in 61 patients with AS were evaluated by ASAS core set. BT group (21 patients) was treated only with BT for 20 min, once a day, 5 days a week, over a period of 3 weeks. BT+NSAID group (20 patients) was treated with 1000 mg naproxen as well as BT. NSAID group (20 patients) was treated with 1000 mg naproxen. All of the participants did respiratory and postural exercises for 20 min a day and for the whole study period. Each patient was evaluated on admission (before treatment), at the end of the therapy and 6 months after the treatment. RESULTS: At the end of the study, statistically significant improvement was observed in all the clinical parameters of the patients in BT (G1), BT+NSAID (G2) and NSAID (G3) groups. This significant symptomatic and clinical improvement was maintained even 6 months after the treatment. The changes from baseline to follow up were similar in G1 and G2 except duration of morning stiffness (DMS) and chest expansion (CE). Improvements in CE and DMS were better in G1 and G2, respectively. Improvements observed in G1 and G2 were superior to the improvements observed in G3 for the variables of morning pain, nocturnal pain, DMS, global well being of the patient, occiput-wall distance, CE, finger to floor distance and functional index. In Schober test, improvement observed in G1 was statistically superior to G3. CONCLUSION: We concluded that BT can be suggested as an effective symptomatic treatment modality in patients with AS. Furthermore, sufficient improvement in clinical parameters can be obtained by BT alone.     

Increased efficacy of infliximab associated with methotrexate in ankylosing spondylitis

ObjectivesThe aims of this study were to assess the efficacy of infliximab (IFX) combined with methotrexate (MTX) versus IFX alone in the treatment of ankylosing spondylitis (AS).MethodsThe study was a 30 weeks open label and prospective study of parallel groups in 19 patients with active AS. These patients had shown incomplete therapeutic response to standard therapy (full dose of non-steroidal anti-inflammatory drugs: NSAIDs) and disease modifying antirheumatic drugs: DMARDs (MTX or sulfasalazine: SLZ) for a period of at least 12 weeks and were treated with IFX (5 mg/kg). Patients were divided into two treatment groups according to the previous treatment: in Group A, 9 patients previously treated with 7.5 mg/week of MTX were treated with IFX in addition to MTX (IFX + MTX); in Group B, 10 patients previously treated only with NSAIDs were treated with IFX (5 mg/kg) as monotherapy (IFX). The primary outcome was improvement in disease activity shown by the BASDAI50 at week 30; the secondary outcome included comparison of the proportions of subjects in each group achieving response criteria proposed by the ASAS group. BASDAI, BASFI, ESR, CRP, pain, inflammation and Patient Global Assessment were also recorded.ResultsBoth groups were similar in sex ratio, clinical forms and B27. Differences between groups occurred only in the disease duration and age of the patient. At 14 and 30 weeks only 50% and 10% respectively of the patients from the IFX group achieved BASDAI50 response compared to 89% of patients from the IFX + MTX group. The difference between groups at 30 weeks was statistically significant (p = 0.001; percentage of difference: 79%; 95% confidence interval (CI): 26–93%:). ASAS50 was reached in 67% and 55.6% of patients from the IFX + MTX group at 14 and 30 weeks respectively, compared with 30% and 0% of patients from the IFX group The difference between groups at 30 weeks was statistically significant (p = 0.011; percentage of difference: 57%; 95% CI: 8–84.7%).ConclusionInfliximab in combination with MTX seems to increase the efficacy of the therapeutic response in active AS patients, but more wide-ranging studies are necessary, mainly long-term studies.     

Leukocytapheresis (LCAP) for the treatment of rheumatoid arthritis on a maintenance hemodialysis patient

A 57-year-old-woman, who was treated with regular maintenance hemodialysis (HD), newly contracted rheumatoid arthritis (RA). Oral predonisolone was effective for alleviating her arthralgia but the RA activity became steroid-dependent. For treatment of poorly controlled synovitis leukocytapheresis (LCAP) showed excellent efficacy in the treatment of her joint pain. No serious adverse effects were observed. Serological markers such as CRP, serum amyloid A, matrix metalloproteinase 3 and peripheral blood lymphocyte count fluctuated with her clinical symptoms. We recommend LCAP as candidate therapy for steroid-dependent patients with RA who are on maintenance HD.     

塞来昔布联合督脉灸、揿针治疗活动期强直性脊柱炎25例临床观察

目的:观察塞来昔布联合督脉灸、揿针治疗活动期强直性脊柱炎患者的临床疗效.方法:将50例强直性脊柱炎患者随机分为治疗组和对照组,每组25例.对照组给予塞来昔布口服联合督脉灸(每次30 min,每日1次)治疗;治疗组在对照组治疗基础上联合揿针(每次6 h,每日1次)治疗.2组均以2周为1个疗程.观察2组临床疗效,以及治疗前...     

强直性脊柱炎的早期临床特征研究

目的探讨强直性脊柱炎的早期临床特征,为其早期初步诊断提供依据。方法对51例确诊为强直性脊柱炎早期患者的临床症状和体征按性别分别进行统计学分析。结果本组资料中有52％男性有休息痛和晨僵,女性为53．84％和46．15％;活动后疼痛缓解男女分别为80％和96．15％。骶髂关节检查的阳性率为80％,指地距离大于10cm者,男女分别为64％和42％,Schober试验阳性者男女分别为20％和3．84％;胸廓活动度小于5cm者,男性8％,女性3．84％。血沉和C反应蛋白的阳性率分别为21．57％和47．06％。结论晨僵和休息后疼痛加重以及活动后缓解是强直性脊柱炎早期重要的临床症状。骶髂关节检查和指地距离具有较高的阳性率。血沉和C反应蛋白有辅助诊断意义。     

病证结合中药组方治疗类风湿性关节炎活动期临床对照试验

目的:探讨在中医辨证的基础上,采用现代药理研究证实具有消炎镇痛或免疫抑制作用的中药进行组方,治疗类风湿性关节炎活动期患者,并与西药甲氨喋呤加尼美舒利作对照,观察其疗效和安全性。方法:选择类风湿性关节炎活动期患者60例,分为试验组30例和对照组30例。试验组采用病证结合方法给予中药煎剂口服,每日1剂;对照组口服甲氨喋呤7.5~10 mg(1次/周) 尼美舒利分散片100 mg(2次/日),分别在治疗后第8周随访,评价两组临床疗效和不良反应。结果:治疗8周后2组疾病疗效比较:试验组有效率为81.5%(22/27),对照组有效率为76.0%(19/25),两组比较差异无统计学意义(P=0.629>0.05)。两组证候疗效比较:试验组有效率为97.0%(26/27),对照组有效率为76.0%(19/25),两组比较差异有统计学意义(P=0.046<0.05)。两组临床观察指标比较,试验组在改善关节肿胀数、双手握力、晨僵时间等方面,疗效优于对照组(P<0.05);在关节疼痛VAS评分、关节压痛数、关节功能分级等方面与对照组比较差异无统计学意义(P>0.05)。两组实验室指标比较,试验组在降低C反应蛋白方面明显优于对照组(P<0.05);在降低血沉和类风湿因子方面与对照组比较差异无统计学意义(P>0.05)。两组不良反应比较,其不良事件发生率差异有统计学意义(P<0.05)。结论:病证结合中药组方治疗类风湿性关节炎与对照组疗效相当;但在改善证候积分、消肿、降低晨僵时间、提高双手握力、降低C反应蛋白等方面明显优于对照组,不良反应明显低于对照组,是值得提倡的治疗类风湿性关节炎活动期的有效方法。