艾拉莫德或来氟米特联合甲氨蝶呤治疗活动性类风湿关节炎的疗效和安全性比较:一项多中心 随机 双盲 双模拟对照的临床研究

目的旨在评价艾拉莫德联合甲氨蝶呤治疗活动性RA的疗效与安全性.方法本研究是一项多中心、随机、双盲、双模拟、对照临床试验.研究纳入中重度活动期RA患者,按照1∶1比例随机分配到艾拉莫德联合甲氨蝶呤治疗组(A组)与来氟米特联合甲氨蝶呤治疗组(B组).分别在用药后12、24、52周对2组的疗效和安全性进行评价.主要疗效终点为治疗后52周ACR20达标率.分别采用Pearson χ^2检验及两因素方差分析比较2组52周时ACR20达标率以及DAS28改善幅度,采用Pearson χ^2检验或Fisher确切概率检验比较2组治疗后ACR50和ACR70达标率之间差异.2组中计量资料采用独立样本t检验或非参数检验进行比较.结果共有240例符合入排标准的患者纳入研究.基线2组人口统计学资料与疾病活动性比较差异无统计学意义.A组和B组治疗后52周ACR20达标率分别为84.1%与81.0%(χ^2=0.35,P=0.56).2组在用药后12、24、52周ACR50/70达标率、DAS28、简明疾病活动指数以及同基线比DAS28下降绝对值比较差异均无统计学意义.A组不良事件更少(60.0%和79.0%,P<0.01).A组较B组出现AST/ALT升高和白细胞降低者更少,且更少使用护肝药物(P<0.05).结论艾拉莫德联合甲氨蝶呤是一种安全、有效的治疗活动性RA的方案,其疗效与来氟米特联合甲氨蝶呤相当,但安全性更好.     

临床内科学研究性教学方法实践探索报告

国内外现阶段正热烈地讨论研究性教学方法，但有关探索和实践多集中在综合性大学的理工科，临床医学专业实施研究性教学方法较少。华中科技大学作为综合性、研究型、创新性大学，师资力量雄厚，科研实力强，综合办学条件优厚，为积极探索研究性教学方法奠定了坚实的基础。     

全国多中心类风湿关节炎患者门诊用药费用的调查

目的 了解我国类风湿关节炎(RA)患者的门诊药费情况,分析药费的影响因素和不同人群药费的差别.方法 面对面调查646例RA患者的回顾性用药情况,同时记录患者的一般资料、临床特点及关节功能状态评分.将其中病程1年以上并且药费资料完整的435例纳入分析,根据用药情况估计过去1年的药费,分析了药费与人口学特征、临床特点的关系,并评估不同药物的性价比.结果 ①RA患者过去1年内的人均门诊药费为人民币(8018±17 238)元,其中改善病情药的费用人均(1610±2138)元,占总药费的20%;生物制剂人均(3975±17 071)元,占总药费的49%;非甾体抗炎药的人均费用为(353±829)元,占总药费的4%;植物药人均费用为(1769±3528)元,占总药费的22%;人均激素费用为(48±160)元,外用药(74±386)元,各占药费的1%.②门诊药费相关因素分析显示,伴有关节外表现(OR:2.180,95%CI:1.335～3.558,P=0.002)、患者功能状态差(OR:1.373,95%CI:1.012～1.863,P=0.04.1)为导致药费增高的相关因素.③不同人群的药费分析提示大学以上学历、脑力劳动、月收入>3000元、享受公费医疗的人群的改善病情抗风湿药(DMARDs)的费用高,门诊患者及功能状态好的患者的DMARDs的费用高.④不同药物的性价比分析显示DMARDs药物的性价比更高.结论 RA患者每年药费高,其中生物制剂、改善病情药及植物药占药费的主要部分,伴有关节外表现和患者功能状态差是高药费的相关因素.人群的学历、收入、付费方式均影响各项药费的分布.DMARDs药物的性价比更高.     

原发性干燥综合征肾损害的临床特征及治疗进展

干燥综合征(Sj(o)gren syndrome,SS)是一种常见的弥漫性结缔组织病,好发于女性,以外分泌腺体上皮细胞高度淋巴细胞浸润为特征.临床上主要表现为干燥性角、结膜炎,口腔干燥症,同时还可累及其他重要脏器系统,如肺脏、肾脏、神经系统等.在不伴发其他相关的系统性自身免疫病时,称为原发性干燥综合征(primary Sj(o)gren syndrome,pSS).     

系统性红斑狼疮合并猪霍乱沙门菌败血症一例

系统性红斑狼疮（SLE）特别是用免疫抑制剂治疗的患者易患机会菌感染并影响生存率。猪霍乱沙门菌是一种条件致病菌．成人感染该菌比较少见。迄今为止，我国报道的人类感染猪霍乱沙门菌者不足100例，引起败血症者罕见。本文报告1例成人SLE合并猪霍乱沙门菌败血症。[第一段]     

结缔组织病合并感染的病原学特征分析

目的探讨结缔组织病合并感染的病原学特征,以期为临床诊治提供依据。方法回顾性分析我科体液培养阳性的102例结缔组织病合并感染患者的病原学资料。结果本组疾病感染的病原体中,G杆菌感染已占绝对优势达62．75％,G^＋球菌感染率仅为37．25％。在菌种构成方面,大肠埃希氏菌占16．67％,铜绿假单胞菌占14．72％,肺炎克雷伯杆菌占9．80％,金黄色葡萄球菌占9．80％,凝吲阴性葡萄球菌占6．86％,表皮葡萄球菌占5．88％。感染的部位以呼吸道和泌尿道居多,分别为57．84％、16．66％,全身感染引起的败血症也占有较高的比率,为17．64％。对27株大肠埃希菌及肺炎克雷伯菌属进行ESBLs检测,阳性率为59．26％。结论G^-杆菌是结缔组织病合并感染的主要致病菌,感染菌株中ESBLs阳性率较高,全身感染引起的败血症的比率较高。     

全国多中心类风湿关节炎患者门诊用药费用的调查

Objective To describe the distribution of medication costs of rheumatoid arthritis patients, and to analyze the factors that may affect the costs. Methods Data were obtained from a 12-month retrospective investigation of patients with rheumatoid arthritis (RA) across China. Department of Rheuma-tology of 18 hospitals were randomly selected. The data about their social conditions, clinical conditions, medications associated with RA such as disease-modifying antirheumatic drugs (DMARDs), non -steroidal anti -inflammtory drugs (NSAIDs), steroids, biologic agents were collected, and the costs of drugs were calculated. A non-parameter test and multivariate logistic regression analysis were performed. Results Six hundred and forty six patients were enrolled into the study, 435 completed data were chosen for analysis. The results demonstrated that the average costs per patient for medications in the past year was 8018 . The total medication costs were further subdivided into the following parts: DMARDs, (represented 20% of the total costs), biologic drugs (49%), NSAIDs (4%), herbal drugs (22%), steroids (1%). Data analysis showed that patients with higher education and higher incomes, with medical insurance,better health function status and outpatients paid more on DMARDs. Extra-articular manifestations increased the odds of the high-cost group (OR: 2.180, 95%CI: 1.335～3.558, P=0.002), while poor health function status increased the probability of paying high costs (OR: 1.373, 95%CI: 1.012～1.863, P=0.041). Conclusion High medication costs in RA do exist in RA patients. The costs of medication is associated with health function status and the presence of extra-articular manifestations.     

类风湿关节炎患者外周血CD4+T细胞TIM-3 mRNA的表达

目的观察类风湿关节炎(RA)患者外周血CD4 T细胞TIM-3mRNA的表达,探讨TIM-3在RA发病中的作用。方法应用实时定量反转录-聚合酶链反应(RT-PCR)技术检测25例RA患者和18名健康对照组外周血CD4 T细胞TIM-3mRNA的表达,并分析TIM-3mRNA的表达与类风湿因子(RF)、C反应蛋白(CRP)的相关性。结果RA患者外周血CD4 T细胞TIM-3mRNA的相对表达较健康对照组明显增多(0.84±0.09vs0.55±0.07,t=11.73,P<0.01),且与RF水平呈正相关(r=0.84,P<0.01);高度活动组RA患者TIM-3mRNA的表达高于低中度活动组(0.89±0.06vs0.81±0.09,t=2.49,P<0.05)。结论RA患者CD4 T细胞TIM-3mRNA的表达异常增多并与RF水平呈正相关,高度活动组TIM-3mRNA的表达高于轻中度活动组,提示TIM-3mRNA的表达与RA的病情活动有关,TIM-3可能在RA的发病中起重要作用。     

全国多中心类风湿关节炎患者门诊用药费用的调查

Objective To describe the distribution of medication costs of rheumatoid arthritis patients, and to analyze the factors that may affect the costs. Methods Data were obtained from a 12-month retrospective investigation of patients with rheumatoid arthritis (RA) across China. Department of Rheuma-tology of 18 hospitals were randomly selected. The data about their social conditions, clinical conditions, medications associated with RA such as disease-modifying antirheumatic drugs (DMARDs), non -steroidal anti -inflammtory drugs (NSAIDs), steroids, biologic agents were collected, and the costs of drugs were calculated. A non-parameter test and multivariate logistic regression analysis were performed. Results Six hundred and forty six patients were enrolled into the study, 435 completed data were chosen for analysis. The results demonstrated that the average costs per patient for medications in the past year was 8018 . The total medication costs were further subdivided into the following parts: DMARDs, (represented 20% of the total costs), biologic drugs (49%), NSAIDs (4%), herbal drugs (22%), steroids (1%). Data analysis showed that patients with higher education and higher incomes, with medical insurance,better health function status and outpatients paid more on DMARDs. Extra-articular manifestations increased the odds of the high-cost group (OR: 2.180, 95%CI: 1.335～3.558, P=0.002), while poor health function status increased the probability of paying high costs (OR: 1.373, 95%CI: 1.012～1.863, P=0.041). Conclusion High medication costs in RA do exist in RA patients. The costs of medication is associated with health function status and the presence of extra-articular manifestations.     

贵州省24134名高校考生近视统计分析

本文统计贵州省1986年普通高等学校24134名考生的近视眼发病率,其中16～18岁的占97.5%。结果表明:近视眼的发病率为44.84%;—6D 以下的中低度近视占96.86%;近视眼的发病有显著的性别差异、民族差异和地区差异(P<0.01)。