Th17/Treg细胞失衡参与类风湿关节炎发病机制的研究进展

类风湿关节炎（rheumatoid arthritis,RA）是一种以滑膜炎和血管炎为特征的自身免疫性疾病,T淋巴细胞浸润是其发病的关键,Th17和Treg细胞具有同源性,皆由初始CD4+ T细胞分化而来。其中Th17 细胞促进炎症反应,而Treg细胞抑制炎症反应,维持自身免疫耐受。RA的发生与免功能疫紊乱、免疫细胞过渡活化以及免疫细胞亚群比例失衡密切相关。Th17/Treg失衡存在整个RA疾病过程中,最终导致滑膜炎症、关节破坏、骨侵蚀等,加重RA病程的发展。调节Th17/Treg之间的平衡是治疗RA的一个靶点。笔者将对Th17/Treg失衡在RA发生发展中的调节作用进行综述。     

挛缩性瘢痕成纤维细胞内钙离子浓度的测定

钙离子在细胞的生命活动中起着重要的作用，参与了细胞运动、肌肉收缩等过程。为了探讨钙离子浓度与瘢痕挛缩的关系，应用近年来发展起来的Ｆｕｒａ２／ＡＭ技术，采用图像分析处理系统，检测了培养的增生性瘢痕、瘢痕疙瘩及正常皮肤的成纤维细胞内的钙离子浓度。结果表明，增生性瘢痕中钙离子浓度明显高于瘢痕疙瘩和正常皮肤，有显著性差异（Ｐ＜０．０１），而后二者则无显著性差异（Ｐ＞０．０５）。认为，钙离子浓度的升高与瘢痕挛缩有着密切的关系     

迷迭香酸对血小板源生长因子BB诱导大鼠肾小球系膜细胞增殖及分泌的影响

肾小球系膜细胞（GMC）分泌的细胞因子如转化生长因子B1（TGF-β1）及单核细胞趋化蛋白1（MCP-1）等在引起肾小球疾病进展中起重要作用。迷迭香酸（rosmarinic acid．RA）是从紫苏等唇形科中草药中提取的一种多酚类化合物，具有抗炎、抗氧化及免疫调节等多种活性。有研究报道，RA对体外培养的GMC增殖具有抑制作用，但其作用机制尚不清楚。本实验通过体外培养大鼠GMC．观察RA对血小板源生长因子BB（PDGF-BB）刺激的GMC增殖及分泌MCP-1与TGF-β1的影响。     

P53基因在类风湿关节炎骨代谢中的作用

类风湿关节炎(rheumatoid arthritis,RA)作为一种自身免疫性疾病,其病理表现为血管翳侵袭性增生破坏滑膜及骨质,与肿瘤的异常增生类似,引起人们对RA发病过程是否有癌基因参与的设想。而骨代谢异常贯穿于RA的整个病程,可以表现为局部骨侵蚀、骨质疏松症(osteoporosis,OP)甚至病理性骨折。p53基因作为发现较早,分布最广的抑癌基因之一,在自身免疫性疾病中的作用也日益受到重视。本文就p53在RA病程及RA骨代谢中可能的作用及机制进行阐述,并提出目前可能存在的一些问题,希望对进一步的研究起到一定的提示作用。     

Th17细胞在肾脏病发病机制中的作用

Th17细胞是新的CD＋4T辅助细胞亚群,是独立于Th1和Th2细胞之外的第三类效应T细胞亚群,其产生的多种相关细胞因子（如IL-17和IL-17F）在炎症和自身免疫反应起着关键性作用[1].     

白细胞介素-18与狼疮性肾炎

狼疮性肾炎（lupus nephritis，LN）是一种自身免疫介导性炎症性疾病，是系统性红斑狼疮（SLE）在各种因子介导下导致的肾脏的病理性改变。LN的发病机制不甚明了，近年来认为促炎性细胞因子在LN的发病中发挥重要作用，对其研究也越来越多，这些因子或激活T淋巴细胞和单核一巨噬细胞、诱导下游细胞因子生成，或激活B淋巴细胞、促进自身抗体的产生而引起自身免疫紊乱。白细胞介素18（interleukin-18，IL-18）是一种主要由单核一巨噬细胞分泌的细胞因子，     

RANKL/RANK信号途径与类风湿关节炎骨量丢失的相关性

类风湿关节炎（rheumatoid arthritis,RA）是一种慢性全身性自身免疫性疾病,临床上抑制RA患者关节周围及全身的骨量丢失是治疗的关键。研究表明炎症细胞因子（TNF-α、IL-1、IL-7、IL-17等)是刺激导致RA患者骨量丢失的重要介质,破骨细胞是参与骨吸收的主要细胞,RANKL/RANK信号途径是RA炎症导致骨量丢失的主要通路。RANKL/RANK信号途径为以RA为代表的自身免疫性疾病与骨代谢疾病之间建起了一座桥梁,其在免疫系统和破骨细胞发育中的关键作用已经形成了“骨免疫”理论,以更准确的揭示在RA继发骨量丢失的过程中免疫系统与骨代谢系统间复杂的交互作用。本文综述了RA继发骨量丢失与RANKL/RANK信号途径间的相关性。     

17-β雌二醇对人胚肾成纤维细胞生物特性的影响

雌激素作为一种多功能的自分泌和旁分泌激素具有生殖功能以外的重要生理作用［１］。雌激素可抑制肾小球系膜细胞合成和分泌胶原,减少系膜基质的聚集,限制肾小球硬化的发展［２］。在间质纤维化的发展过程中,肾成纤维细胞（ｋｉｄｎｅｙ ｆｉｂｒｏｂｌａｓｔ,ＫＦＢ）的增殖起着决定性作用［３］。１７－β雌二醇（１７－β ｅｓｔｒａｄｉｏｌ,Ｅ２）对肾脏病的进展可能具有良性作用,其对ＫＦＢ的影响尚未见报道。本试验拟在细胞水平,观察Ｅ２对ＫＦＢ增生、凋亡及细胞外基质成分（ＥＣＭ）之一的纤连蛋白（Ｆｎ）表达的影响。 一…     

自身免疫性睾丸炎中间质巨噬细胞的研究进展

睾丸间质巨噬细胞（Macrophage，Mφ）在机体非特异性免疫中起十分重要的作用，是睾丸发生免疫紊乱性炎症的重要参与者，其分泌的大量炎症介质在男性不育中起着关键作用。近年，有关间质巨噬细胞与睾丸炎的报道日益增多，本文对自身免疫性睾丸炎中间质Mφ的变化及其对生精细胞、非生精细胞的影响进行归纳总结，现综述如下。     

类风湿关节炎骨破坏作用机制及中医药治疗研究进展

类风湿关节炎(RA)是一种累及多个关节的全身性自身免疫性疾病,常累及小关节,病变呈对称性、侵袭性和致残性,发病后期常易造成不可逆转的软骨、骨和其他邻近组织的破坏,最终导致严重的关节畸形甚至残疾,给患者及其家庭造成严重的身体和心理损害,严重影响生活质量。迄今为止,虽然治疗RA的药物很多,但RA仍然无法完全得到彻底根治,究其原因在于RA及其骨破坏的发病机制仍未完全明确。因此,对于RA骨破坏的发病机制及如何治疗显得格外重要。RA骨破坏的发病机制总的来说是成骨细胞与破骨细胞之间的失衡导致的,本文通过整理近年来参与RA关节软骨破坏及骨侵蚀病程的相关研究文献进行综述和讨论,分别从细胞因子/趋化因子、非编码RNA、信号通路等三个不同方面阐述了对成骨细胞与破骨细胞之间的作用造成RA骨破坏的发病机制,以期为RA骨破坏发病机制研究提供新的思路。中医药在预防RA骨破坏的发病过程中起着重要的作用,在保证疗效的前提下还能保证其安全性。因此,对于RA骨破坏的发病机制进行深入地研究及研究中医药在其治疗中的作用,为其治疗能够提供新的研究思路。     

Elderly-onset rheumatoid arthritis

The treatment of elderly-onset rheumatoid arthritis pursues the same objectives as in younger patients: to control the clinical manifestations, to prevent structural damage, to preserve function, and to decrease excess mortality. In the elderly, the presence of co-morbidities and increased rate of drug-related adverse effects raise specific therapeutic challenges. Nonsteroidal anti-inflammatory drugs are associated with cardiovascular, gastrointestinal, and renal adverse events. The role for corticosteroid therapy remains controversial. Although glucocorticoids provide a short-term decrease in clinical activity and probably a medium-term decrease in structural damage, these benefits are offset by numerous adverse effects. Methotrexate was effective in clinical trials and observational studies and did not produce a higher adverse event rate compared to younger patients, provided renal function was normal. Data on the efficacy of TNFα antagonists in therapeutic trials are available only for etanercept. Disease activity decreased and function improved. The adverse event rate was higher in older patients, but this was also true of the conventional drugs used as comparators. Registry data confirm that TNFα antagonist therapy is effective in RA. An increased rate of infections was found only in some registries. To combat the 2-fold cardiovascular risk increase associated with RA, disease activity should be stringently controlled and all cardiovascular risk factors managed aggressively.     

Early rheumatoid arthritis

The diagnosis and treatment of early rheumatoid arthritis are presented.     

Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis affects approximately 60,000 to 250,000 children in the United States and is the most common connective tissue disease occurring during childhood. This article discusses the signs, symptoms, and general management of the disease, including surgical techniques.     

Juvenile rheumatoid arthritis

The early diagnosis of JRA rests on the recognition of three distinct modes of onset that are important in preventing deformity, blindness, and even death. Systemic onset is characterized by typical systemic manifestations, particularly high spiking fever and the rheumatoid rash, polyarticular onset is noted by arthritis of more than four joints, and pauciarticular onset is distinguished by involvement of four joints or less, most often a knee initially. In JRA, fundamental to the heart of successful management is patient and parental education regarding both the nature of the disease and goals of therapy. Whereas the NSAIDs are adequate for the control of active disease in most patients, two key issues must be resolved. First, it is important to recognize that the choice of drug for the individual patient is frequently a matter of trial and error. Second, it is critical to prescribe antiinflammatory quantities of a given drug. The slow-acting (remittive) agents, such as intramuscular or oral gold, are reserved for patients with prolonged active polyarthritis, which affects 15 per cent of all patients with JRA. There are several drawbacks to the use of remittive agents. They must be tried for several months, often in the presence of rapidly developing joint limitation and erosions on radiograph, before their effectiveness can be determined. Also, when using these drugs, one must often follow a meticulously graduated dosage regimen, while carefully monitoring the patient for toxic and potentially lethal side effects. It follows, therefore, to never use these agents unless you are familiar with their administration and potential toxicity and to seek help from a specialist.     

Spontaneous septic arthritis complicating rheumatoid arthritis

Thirteen cases (in twelve patients) of septic arthritis complicating rheumatoid arthritis are reported. One ankle, one metacarpopophalangeal joint, one shoulder, and ten knees were involved. Staphylococcus aureus was cultured from twelve joints and Escherichia coli, from one. Treatment consisted of repeated needle aspirations in two patients, arthrotomy with Penrose drainage in six, and arthrotomy with through-and-through irrigation in four. Needle aspiration was the least effective therapy. The authors recommend as the treatment of choice: systemic antibiotic therapy and immediate arthrotomy followed by through-and-through irrigation with fluid containing the appropriate antibiotics.     

Mortality in rheumatoid arthritis

Rheumatoid arthritis reduces not only quality but also length of life. In the 14 main studies conducted since 1980, in a total of 13,424 patients, the mean standardized mortality ratio was 1.82 (range, 0.87-3) as compared to the population at large. Life expectancy was shortened by 5 to 10 years in most studies. The diversity of the methods used explains the discrepancies among results. Excess mortality may occur in only some subsets of patients. Both rheumatoid complications and an increase in nonspecific causes of death (e.g., infections) contribute to the excess mortality. Factors predictive of premature death are the same as those predictive of functional impairment. Many unknowns remain about the condition of rheumatoid arthritis patients at the end of their life.