类风湿性关节炎患者健康相关生命质量评价及其影响因素

目的 探讨类风湿性关节炎（RA）住院患者健康相关生命质量（HRQoL）评分及其影响因素。 方法 采用欧洲五维度五水平健康量表（EQ-5D-5L）及自编问卷对 2023 年 4~9 月安徽中医药大学第一附属医院风湿免疫科收治的 200 例 RA 住院患者进行HRQoL 调查,EQ-5D-5L 量表中健康描述系统及视觉模拟标尺（EQ-VAS）分别用于测量 RA 患者健康效用值及整体健康状态,采用单因素分析、Tobit 多因素回归分析影响 RA 患者 HRQoL 的因素。 结果 共收集 190 份有效问卷,有效回收率 95%。RA 患者健康效用值为（0.77±0.25）,EQ-VAS 评分为（76.44±43.65）分,其健康问题多集中于“行动能力”和“疼痛或不适”两个维度。Tobit 多因素回归分析显示,文化程度低（P=0.042,95%CI：0.032~0.143）与吸烟（P=0.013,95%CI：-0.154~-0.019）是 RA 患者 HRQoL 的危险因素。 结论 RA患者 HRQoL 与 EQ-VAS 较一般人群相比情况尚可,但仍存在健康效用值较低的问题,其中文化程度低与吸烟的患者 HRQoL 较差。     

Surgical Management for Chronic Destructive Septic Hip Arthritis: Debridement,Antibiotics, and Single‐Stage Replacement is as Effective as Two‐Stage Arthroplasty

ObjectiveTo compare the surgical outcomes of debridement, antibiotics, and single‐stage total hip replacement (DASR) vs two‐stage arthroplasty (two‐stage arthroplasty) for chronic destructive septic hip arthritis (SHA).MethodsCases of chronic destructive SHA treated by DASR or two‐stage arthroplasty in our department from January 2008 to October 2021 were retrospectively reviewed. Patient demographic information, perioperative inflammation markers, intraoperative blood loss, microbial culture, and metagenomic new generation sequencing results were recorded. The perioperative complications, hospital stay, hospitalization cost, infection recurrence rate, and Harris Hip Score (HHS) at the last follow‐up were compared between the two groups.ResultsA total of 28 patients were included in the study, including 11 patients who received DASR and 17 patients who received two‐stage arthroplasty. There was no significant difference in demographic information, preoperative serum inflammatory markers, synovial fluid white blood cell count, or percentage of polymorphonuclear leukocytes between the two groups. The DASR group demonstrated significantly lower intraoperative blood loss [(368.2 ± 253.3) mL vs (638.2 ± 170.0) mL, p = 0.002], hospital stay [(22.6 ± 8.1) days vs (43.5 ± 13.2) days, p < 0.0001], and hospitalization expenses [(81,269 ± 11,496) RMB vs (137,524 ± 25,516) RMB, p < 0.0001] than the two‐stage arthroplasty group. In the DASR group, one patient had dislocation as a complication. There were no cases with recurrence of infection. In the two‐stage arthroplasty group, there was one case complicated with spacer fracture, one case with spacer dislocation, and one case with deep vein thrombosis of the lower limbs. There were no cases with recurrence of infection. There were no significant differences in the readmission rate, complication rate, or HHS at the last follow‐up between the two groups.ConclusionsBoth DASR and two‐stage arthroplasty achieved a satisfactory infection cure rate and functional recovery for chronic destructive SHA, and DASR demonstrated significantly lower intraoperative blood loss, hospital stay, and hospitalization costs than two‐stage arthroplasty. For appropriately indicated patients, if microbial data are available and a standardized debridement protocol is strictly followed, DASR can be a treatment option.     

激光穴位点射疗法对痛风急性期的疗效观察

目的:观察500MW激光风湿治疗机穴位点射治疗痛风急性期的疗效,探讨其作用原理。方法:痛风急性期患者48例,随机分为激光组和对照组,每组24例。激光组用输出波长为810 NM,功率为500 MW激光风湿治疗机,通过穴位点射方法治疗。对照组口服非甾体类消炎药。疗程均为3~7 d,观察患者关节疼痛肿胀情况及不良反应表现。结果:激光组疗效优于对照组,且毒副作用明显小于对照组。结论:激光穴位点射治疗对痛风急性期有良好的治疗作用,且无明显不良反应,患者依从性好。     

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??Toward New Classification Criteria for Juvenile Idiopathic Arthritis??First Steps??Pediatric Rheumatology International Trials Organization International Consensus was published onJournal of Rheumatologyin October??2018??and then at the2018Annual Meeting of AmericanColleage of Rheumatology??ACR????the relevant experts introduced the samecontent. Although the new JIA classification criteria in the process of improvement in western countries is still??PRINTO has designed a two-step’sprospective study??which will form a mature new JIA classification criteria after itscompletion. The new trend and progress of this subject is of great significance to the diagnosis??treatment and research of JIAin the world. CCIHA has organized a group of relevant Chinese experts to interpret the international consensus??aiming at putting forward suggestions and opinions of Chinese experts on the new classification of JIA??providing a basis for future research on the real world researchof JIA in China??and putting forward the opinions of Chinese experts to be in line with the new international criteria. This paper only interprets faithfully the original English text. The formation and application of JIA’s new classification criteria in China still need further study and discussion.     

13例类风湿关节炎患者合并肺疾病的临床特点

目的:探讨类风湿关节炎(RA)患者合并肺疾病的临床特点。方法:回顾性分析13例RA患者合并肺疾病的临床特点及影像学资料。结果:RA合并肺疾病患者发病年龄偏大,起病急,病情重,病程短,呼吸道症状较轻;疾病活动性,在RA合并肺疾病患者中血小板计数高,血沉(ESR)快,C反应蛋白(CRP)高,并且类风湿因子(RF)呈高滴度阳性;影像学检查,在发现肺部病变时,肺高分辨率CT(HRCT)明显优于普通X线胸片。结论:RA患者合并肺疾病的临床表现多种多样,它的发生与原发病的活动及某些免疫学指标有关,早期行肺HRCT对早期诊断及时治疗非常重要。     

薯蓣皂苷片对类风湿性关节炎大鼠血清OPG/RANKL水平表达的干预作用

目的观察薯蓣皂苷片对类风湿性关节炎模型大鼠血清骨保护素(OPG)、核因子-κB受体活化因子配体(RANKL)表达水平的影响。方法 SD大鼠,随机分为6组,每组10只,其中选取10只作为正常组,其余大鼠采用弗氏完全佐剂复制类风湿性关节炎动物模型,并将造模成功的类风湿性关节炎大鼠随机分为模型组、阳性组(甲氨蝶呤组,3.8mg·kg~(-1))、薯蓣皂苷片高、中、低剂量组(10 mg·mL~(-1)、20 mg·mL~(-1)、30mg·mL~(-1)),连续灌胃给药治疗24 d后处死,采用ELISA法检测血清OPG、RANKL水平。结果薯蓣皂苷片各剂量组大鼠血清OPG、RANKL水平分别为(95.27±4.24)、(76.44±4.09)、(69.26±5.63)pmol·L~(-1)和(96.07±4.94)、(85.41±3.75)、(67.53±2.23)pmol·L~(-1),与模型组((53.92±2.83)pmol·L~(-1)和(116.18±3.02)pmol·L~(-1))相比均有显著性差异(P0.05);OPG/RANKL比值显著高于模型组。结论薯蓣皂苷片可能通过调整OPG/RANKL动态平衡而对破骨细胞功能产生影响,从而防止骨破坏。     

老年类风湿关节炎患者心功能变化及其相关性研究

目的:研究老年类风湿关节炎(RA)患者心功能变化及与他指标的相关性。方法:将68例类风湿关节炎(RA)患者按年龄分为中青年类风湿关节炎(YMRA)、老年类风湿关节炎(ERA)两组,采用超声心动图(UCG)检测两组RA患者的心功能,并与20例健康对照(NC)组比较;观察两组RA患者的疾病活动度评分(DAS-28)及临床症状、体征及实验室指标的变化。结果:①与NC组相比,两组RA患者舒张早期血流峰值(E峰)、短轴缩短率(FS,%)、E/A比值均显著降低(P<0.05或P<0.01);与YMRA组相比,ERA组患者E峰、E/A比值显著降低(P<0.05或P<0.01),舒张晚期血流峰值(A峰)显著升高(P<0.05)。②与YMRA组相比,ERA组病程、收缩压、DAS-28积分、关节肿胀积分、关节压痛积分、PLT、PCT、UA、α-AGP、hs-CRP、ESR显著升高(P<0.05或P<0.01);双手握力、CD4+CD25+Treg、CD4+CD25+CD127-Treg显著降低(P<0.05)。③Spearman相关分析显示,ERA组心功能参数E峰与年龄、DAS-28、α-AGP、CRP,E/A比值与收缩压,(EF,%)与类风湿因子,ST段压低数与年龄均呈呈显著负相关(P<0.05)。E峰与CD4+CD25+Treg,A峰与舒张压、15m步行时间,E/A比值与CD4+CD25+Treg均呈显著正相关(P<0.05)。结论:RA患者存在心功能下降,ERA患者心功能水平下降更为显著;UCG下表现为E峰、E/A、(EF,%)、(FS,%)的显著降低,A峰显著升高;ERA患者心功能参数与年龄、血压、实验室指标等相关。     

以肺痹论治类风湿关节炎肺间质纤维化

类风湿关节炎肺间质纤维化中医目前没有系统的认识,临床多将其归为中医肺痹一证进行论治,从前人经验中总结出其病因病机,认为本病是由痹证日久,肺气损伤,外邪侵袭造成的,以风寒湿等外邪痹阻日久,肺肾两虚,痰瘀毒阻于肺络为基本病机,在治疗上主张以补肺纳肾,祛痰化瘀解毒通络为总原则,临床疗效较好。     

人内质网分子伴侣BiP的克隆、表达及其在RA患者血清抗体检测中的作用

以类风湿关节炎(rheumatoid arthritis,RA)患者滑膜组织文库cDNA为模板,用PCR方法扩增得到1965 bp人内质网分子伴侣BiP的全长cDNA,将其克隆入OmicsLinkTM表达载体pReceiver-B01a,构建重组表达质粒pReceiver-B01a-BiP。重组表达质粒导入大肠杆菌BL-21(DE3)菌株中诱导表达目的蛋白,表达产物以Ni+-NTA agarose层析柱纯化。SDS-PAGE和免疫印迹法(Western blot)分析发现,表达产物以可溶性蛋白和包涵体形式共同存在,表达量约占菌体蛋白总量的20%~30%。相对分子质量约为80000,纯度达到电泳级。经免疫印迹法鉴定,获得的BiP重组蛋白可以与RA患者血清反应,检测的抗BiP抗体在RA患者血清中的阳性率为75.4%(49/65),明显高于系统性红斑狼疮(systemic lupus erythe-matosus,SLE)患者14.6%(7/48)、原发性干燥综合征(primary Sj gren’s syndrome,pSS)患者7.3%(4/55)及正常人0%(0/71)(P<0.01)。表明,经原核表达获得的BiP全长蛋白,RA患者血清抗体可以很好结合,有望应用于临床血清学诊断。