强直性脊柱炎患者外周血不同类型单核细胞极化与病情严重程度的关系

目的 探讨强直性脊柱炎（AS）患者外周血不同类型单核细胞极化与病情严重程度的关系。方法 选取2020年1月—2021年12月广州中医药大学附属深圳平乐骨伤科医院收治的AS患者71例（AS组），以及年龄、性别基本匹配的体检志愿者80例作为对照组。采用流式细胞术检测CD36^＋、CD206^＋、CD68^＋，分析不同类型单核细胞与脊柱结构破坏指数的相关性，并对比患者治疗前后不同类型单核细胞的变化。结果 AS组C反应蛋白（CRP）、血沉（ESR）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、免疫球蛋白A（IgA）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平高于对照组（P <0.05）。AS组外周血CD36^＋、CD206^＋细胞比例低于对照组（P <0.05），CD68^＋细胞比例高于对照组（P <0.05）。CD36^＋、CD206^＋与强直性脊柱炎疾病活动指数（BASDAI）评分、Bath强直性脊柱炎功能指数（BASFI）评分均呈负相关（P <0.05），CD68^＋与BASDAI评分、BASFI评分均呈正相关（P <0.05）。AS患者治疗后CRP、ESR、IgG、IgM、IgA、TNF-α、IL-6水平较治疗前均降低（P <0.05）。AS患者治疗后CD36^＋、CD206^＋细胞比例较治疗前升高，CD68^＋细胞比例及BASDAI评分、BASFI评分较治疗前降低。结论 AS患者外周血CD36^＋、CD206^＋细胞比例降低、CD68^＋细胞比例升高与疾病严重程度有一定的关系。     

The effect of in-out-in axis pedicle screws on the vertebral artery in the posterior occipitocervical surgery北大核心CSCD

Objective To observe the effect of insertion of in-out-in axis pedicle screws on the vertebral artery in the posterior occipitocervical surgery for atlantoaxial subluxation or instability. Methods The data of 52 patients with atlantoaxial dislocation or instability were analyzed who had been treated by internal fixation with in-out-in pedicle screws in the posterior occipitocervical surgery from January 2015 to February 2021 at Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital. There were 30 males and 22 females, aged from 17 to 65 years (mean, 41.2 years). There were 26 cases of unilateral vertebral artery high-riding, 3 cases of bilateral high-riding, 19 cases of unilateral narrow pedicle due to C2 and C3 fusion, and 4 cases of bilateral narrow pedicles. X-ray, CTA and MRI were performed before and 3 days after surgery. The patients' clinical symptoms were recorded. CTA was used to measure the diameter of the vertebral artery at the transverse foramina of C2 and C3 and to observe the effect of in-out-in screws on the morphology of the vertebral artery. X-ray and CT examinations were performed at 6 months after surgery to observe the bone fusion. Results The surgery went on uneventfully in all the patients. In the 9 cases undergoing anterior and posterior surgery, the operation time averaged 271.2 min (from 213 to 352 min) and the bleeding volume 471.5 mL (from 230 to 830 mL). In the 43 cases undergoing posterior surgery, the operation time averaged 171.6 min (from 131 to 226 min) and the bleeding volume 395.9 mL (from 170 to 660 mL). There was no such complication as spinal or vascular injury. The CTA reexamination 3 days after surgery showed that the diameter of the vertebral artery was (2.92±0.55) mm and (3.04±0.54) mm, respectively at the cervical 2 and 3 transverse foramina, showing no significant change compared with the preoperative values [(2.91±0.68) mm and (3.11±0.50) mm] (P>0.05) and that the vertebral artery was displaced externally and inferiorly in 21 cases. Follow-ups for all patients ranged from 7 to 24 months (mean, 11 months). At 6 months after surgery, bone fusion was observed by imaging and no breakage or displacement of the internal fixation was observed. Conclusion The in-out-in pedicle screws in the posterior occipitocervical surgery may have little impact on the vertebral artery, leading to reliable clinical outcomes. © 2022 Chinese Journal of Orthopaedic Trauma. All rights reserved.     

慢性肾脏病“肾阳虚”证候与生物学指标相关性研究

慢性肾脏病发病率呈逐年递增趋势，不仅给众多患者增加了精神和经济负担，也给我国社会公共卫生事业带来重大问题，而结合传统中医药与现代医学手段对其进行干预、治疗，已经成为当前我国全民大健康事业的重要组成部分。历代中医大家都曾对“肾阳虚”证候进行了大量的阐述，并提出了相应的治法方药，现代中医药工作者依据中医典籍理论，对这一证候进行了深入研究，并认为其与慢性肾脏病有着密不可分的联系，并通过运用一系列的现代科学实验技术对二者的相关内涵进行探索且取得了一定的成果。本文从慢性肾脏病临床常用相关生物学指标和“肾阳虚”证候的相关研究入手，并将一系列临床、实验研究进行阐述分析，进而对二者相关性论述，针对当前关于“肾阳虚”证候与慢性肾脏病生物学指标相关研究较为片面、欠缺的现状，系统总结慢性肾脏病“肾阳虚”证候相关生物指标的研究方法，为慢性肾脏病“肾阳虚”证辩证标准规范化研究提供科学思路，进而为中医学证候本质研究奠定基础。     

122例腹膜透析患者中医证型及其与腹膜炎及心血管事件相关性研究

目的:明确腹膜透析患者的中医证型、腹透相关腹膜炎及心血管事件与中医证型的相关性,为腹膜透析患者的长期中医干预管理提供临床证据。方法:采用回顾性分析的方法,分析总结122例腹膜透析2年患者的一般临床资料、中医证型分布、腹膜炎和心血管事件发生情况,并做统计分析。结果:患者腹膜透析前本证以脾肾气虚为主(P0.05),标证以湿浊、湿热为主(P0.05),透析2年后本证、标证分布变化不明显(P0.05),总体标证减少。危险因素方面,湿热证是腹透相关腹膜炎发生的高危中医证型,湿热证和水气证是发生急性左心衰、慢性心衰急性加重、急性冠脉综合征、高血压危象等心血管事件的高危中医证型(P0.05)。结论:湿热、水气证是腹膜透析患者发生腹膜炎和心血管事件的高危中医危险因素。腹膜透析中医管理应结合患者的体质、证候,维护腹透患者脾肾之气,避免湿热、水湿之邪产生,以制定相应的中医诊疗和调护方案。