类风湿关节炎蛋白质组学研究进展

蛋白质组学技术通过在蛋白质水平上对机体进行研究以阐述疾病的发生、发展及转归。将蛋白质组学技术应用于类风湿关节炎(RA)的研究,多项研究均证实钙连蛋白A(MRP-8)等蛋白质与RA滑膜局部炎性反应有关,可能参与RA发病。应用表面增强激光解析电离飞行时间质谱技术结合决策树统计方法可建立RA的疾病诊断预测模型。     

氟骨症与强直性脊柱炎临床特点对照分析

目的探讨氟骨症与强直性脊柱炎(ankylosing spondylitis,AS)的鉴别诊断要点。方法回顾分析我省某氟骨症专科医院提供的62例氟骨症与同期就诊我院54例AS的临床资料。结果氟骨症患者发病平均年龄(42.9±6.66)岁,明显大于AS患者[(18±7.57)岁],差异有统计学意义(P<0.01);外周关节疼痛数目≥3者所占比例明显大于AS组(74.2%vs 3.7%,P<0.01),活动后加重所占比例明显高于AS组(83.9%vs 5.56%,P<0.01),HLA-B27阳性所占比例明显低于AS组(3.2%vs 90.7%,P<0.01),四肢骨病变、外周关节病变及骨间膜钙化比例均明显高于AS组(P<0.01),脊柱竹节样变比例高于AS组(61.3%vs 22.2%,P<0.05),骨质破坏比例明显低于AS组(P<0.01)。结论氟骨症与强直性脊柱炎的鉴别,应从流行病学、临床表现、HLA-B27检测及影像学检查等综合考虑,以减少误诊。     

负荷剂量英夫利昔单抗治疗强直性脊柱炎的临床疗效及疗效预测因素分析

目的 探讨负荷剂量的抗肿瘤坏死因子(TNF)-α单克隆抗体英夫利昔单抗治疗强直性脊柱炎(AS)的临床疗效和达到临床疗效的预测因素.方法 本研究以一项2个中心的开放性Ⅱ期临床试验为基础,纳入确诊的AS患者,并且处于疾病活动期,即Bath AS疾病活动指数(BASDAI)和脊柱痛评分均≥4.患者分别在试验的第0、2、6周静脉滴注英夫利昔单抗5 mg/kg,在10周时对其临床疗效进行评估,以10周时是否达到ASAS 20,ASAS 40和BASDAI 50为疗效标准,对人口学参数[性别、年龄、病程、人类白细胞抗原(HLA)-B27阳性与否]和基线时疾病活动指标[BASDAI、脊柱炎症、脊柱痛VAS、夜间痛VAS、患者总体评估指数、BASFI、BASMI、肌腱端指数、整体关节肿胀指数、扩胸度、红细胞沉降率(ESR)和C反应蛋白(CRP)和BASRI]17个指标进行Logistic单因素和多因素疗效预测分析.结果 63例患者(男性占79%,平均年龄32岁,平均病程10年,HLA-B27阳性占90%)纳入并完成研究,第10周试验结束时,84%的患者达到ASAS 20改善;.75%的患者达到ASAS 40改善;70%的患者达到BASDAI评分改善＞50%.Logistic单因素和多因素分析显示:人口学参数和基线时疾病活动指标均未显示能预测患者的疗效.结论 英夫利昔单抗治疗AS疗效明显,基线时的人口学参数、疾病活动性的临床和实验室指标不能预测疗效.     

多发性骨髓瘤误诊1例报道

报道多发性骨髓瘤误诊为类风湿性关节炎1例，分析误诊原因主要为两种疾病早期临床表现有些类似，本例报道提示临床医生一定要详细询问病史，全面分析病情，仔细辨别有相似临床表现的疾病，争取早期诊断，避免误诊。     

小剂量甲氨喋呤鞘内注射治疗系统性红斑狼疮中枢神经系统病变临床观察

系统性红斑狼疮(SLE)是一种累及全身多个系统的自身免疫性疾病,中枢神经系统(CNS)较易受累,在SLE中,其发病率、病死率仅次于肾脏病变和继发感染而位居第三.传统的CNS-SLE治疗为甲基强的松龙和环磷酰胺静脉冲击.本研究采用小剂量甲氨喋呤鞘(MTX)和地塞米松(DEX)鞘内注射治疗CNS-SLE 24例,取得良好疗效.报告如下:     

Infliximab治疗强直性脊柱炎发生皮肤不良反应七例临床分析

目的探讨抗肿瘤坏死因子单克隆抗体infliximab的皮肤不良反应。方法在一项2个中心的开放性研究中．对infliximab治疗活动性强直性脊柱炎的安全性进行评估，所有患者在0、2、6周静脉输注infliximab5mg/kg，并随诊观察至10周，对出现皮肤不良反应的患者进行治疗，直至病情缓解。结果63例患者纳入研究，7例(11％)出现皮肤病变，包括毛囊炎、皮下脂肪瘤感染、足癣各1例，荨麻疹、迟发过敏性反应性皮炎伴严重脱发各2例．其中1例发生荨麻疹时伴有呼吸困难，未完成第3次液体的输注．另外2例迟发过敏性反应性皮炎病例为严重不良事件。结论Infliximab的皮肤不良反应常见，临床表现多样，多为轻度至中度，少数为重度。随着该药在临床的推广应用，应对其皮肤不良反应引起足够重视。     

类脂质渐进性坏死1例

A 61-year-old woman was referred to our department with a 11-year-erythra. In the anterior tibia of both lower extremities, we could see large dark red infiltrating erythema, waxy luster, clear boundary, slight central atrophy, depression and capillary dilatation. He was diagnosed with “dermatitis contusiformis” in local hospitals;, but the treatment of traditional Chinese medicine and external drugs was not effective. She had normal laboratory findings for blood routine test, biochemical indexes, C reactive protein(CRP) and erythrocyte sedimentation rate(ESR).Furthermore, autoimmune antibodies were all negative. The skin pathology showed degeneration and necrosis of collagen fibers, chronic granulomatous inflammation in the dermis, and there were more acute and chronic inflammatory cell infiltration around the small vessels and in the wall of the tube. We eventually diagnosed it as necrobiosis lipoidica (NL) according to the history, erythra morphology and skin pathology. After treatment of low dose hormone and thalidomide for 1 year, the color and range of skin lesions gradually alleviated. NL was a rare chronic granulomatous inflammatory disease. There appeared to be a predominance in females. The incidence of NL was higher in patients with diabetes mellitus, although this asscoiation was currently questioned. NL might also be connected with autoimmune diseases, such as rheumatoid arthritis, sarcoidosis, ulcerative colitis and Crohn’s disease. The pathological changes of the tissue were mainly in the dermis;, including necrotic type, granulomatous type or mixed type. NL typically presented on the pretibial surface of lower extremities. Less typical locations included the face, scalp, vulva and upper limbs. Leisions usually began with small papules and nodules that gradually infiltrated into brown-yellow patches and developed central wax-like atrophy. The diagnosis is often based on clinical examination and skin biopsy. NL is rare and easy to be misdiagnosed. For rheumatologists, we should carefully compare with the nodular erythema, the microscopic polyangitis and allergic purpura. It is significant for differential diagnosis to perform skin biopsy. Lacking of randomized controlled trials, no specific treatment has proven to be the gold standard. First-line therapy mainly consists of intralesional and systemic corticosteriods. Additionally, other reported treatment options include immunomodulator, biological agent, antiplatelet aggregation drug and platelet-rich plasma. These patients need long term follow up continuously for progression of the disease, ulcerations, and possibility of malignant tranformation.     

银屑病关节炎患者抗核周因子的检测

目的　评价抗核周因子 (antiperinuclear factor,APF)在诊断、鉴别诊断银屑病关节炎与类风湿关节炎的作用。方法　以人颊黏膜上皮细胞为底物用间接免疫荧光法对 4 0例银屑病关节炎、6 4例寻常型银屑病、15 1例非炎症性风湿病、2 2 0例类风湿关节炎 (15 7例类风湿因子阳性 ,6 3例类风湿因子阴性 )的患者以及 176名健康对照者进行了血清 APF的检测。结果　银屑病关节炎患者 APF阳性率 7.5 % ,比健康对照者增高 (1.1% ,P<0 .0 5 ) ,与寻常型银屑病 (3.1% )和非炎症性风湿病 (3.3% )患者阳性率相似 ,差异无统计学意义 ,但低于类风湿因子阴性的类风湿关节炎患者 (5 4 .0 % ,P<0 .0 0 1)和类风湿因子阳性的类风湿关节炎患者 (83.4 % ,P<0 .0 0 1) ,3例 APF阳性的银屑病关节炎均为多关节炎累及 ,其类风湿因子阳性。结论　 APF检测有助于银屑病关节炎和类风湿关节炎的鉴别和银屑病关节炎的分型。