【摘要】 目的 研究活动期RA患者血清中细胞因子IL-18的表达，并探讨它们与疾病活动程度的关系。 方法 2008年12月-2010年1月将63例RA患者，根据DAS28将患者分为高度活动组和低度活动组，应用酶联免疫吸附法（ELISA）法检测63例RA患者和27例对照组的白细胞介素-18（IL-18）表达水平。分析IL-18的水平与临床指标的相关性。 结果 IL-18在活动期RA中表达水平高于低度活动组、对照组，分别为（238.88±41.75）、（189.11±40.62）、（185.42±44.93） pg/mL，有统计学意义（Plt;0.01）。RA活动组患者IL-18与外周血白细胞计数呈负相关（r=-0.628，Plt;0.05）。 结论 IL-18水平在RA活动期患者高表达，在RA发病和发展中起重要作用。【Abstract】 Objective To observe the expression of interleukin-18 (IL-18) in patients with active rheumatoid arthritis (RA). Methods A total of 63 patients with RA in our hospital from December 2008 to January 2010 were selected. The patients were divided into high activity group and low activity group according to the disease activity score 28 (DAS28). Levels of IL-18 in the serum in 63 patients and 27 control individuals were detected by ELISA technique. The relationship between IL-18 expression and the clinical indexes was analyzed. Results IL-18 serum levels were (238.88±41.75), (189.11±40.62), and (185.42±44.93) pg/mL In high activity group, low activity group and the control group respectively with a significant difference (Plt;0.01). The IL-18 level in high activity group was negative correlated with WBC counts. Conclusion Apparent expression of IL-18 is found in RA patients at the active phase, which plays an important role in the occurrence and development of RA.
目的 探讨“5.12”地震后北川羌族人群中类风湿关节炎（RA）患者外周血 T细胞亚群的表达情况并分析创伤后应激障碍（PTSD）对RA患者细胞免疫之间的影响。 方法 2009年3月－2010年3月，对98例北川羌族RA患者、112例健康对照，以及同期绵阳郊区84例RA患者、120例健康对照进行分析。用流式细胞仪分别检测CD3+、CD3+CD4+、CD3+ CD8+ T淋巴细胞数及CD4/+CD8+比值， RA疾病活动性采用DAS28测定，应用美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）诊断标准调查RA人群中的PTSD患者，应用PTSD检查表平时版（PCL-C）检查对PTSD患者进行分析。 结果 北川羌族与绵阳郊区RA活动组患者（分别为58例、39例）与健康对照组比较，CD8+ T淋巴细胞数降低，CD+4/CD8+比值增高，差异有统计学意义（P＜0.05）；北川羌族RA活动组与绵阳郊区RA活动组比较，CD3+ T淋巴细胞数降低，差异有统计学意义（P＜0.05）。北川RA患者中PTSD者（38例）与非PTSD者（60例）比较，PTSD组CD3+ T淋巴细胞数和CD4+/CD+8比值均明显低于PTSD组，差异有统计学意义（P＜0.05）；PCL-C对北川RA患者中PTSD的测定发现，PCL高分组CD3+ T淋巴细胞数显著低于PCL低分组（P＜0.05）。 结论 “5.12”地震后一部分RA患者出现T细胞免疫功能异常，且免疫功能异常与PTSD有关，对合并有PTSD的进行RA患者早期心理干预及药物治疗，改善患者生存质量。
摘要:目的:评价膝关节滑膜超声检查在类风湿关节炎(RA)患者随访中的价值及其与RA临床活动度之间的相关性。方法:收集确诊的RA病人40例,其中68个膝关节有阳性症状。分别收集40例RA患者的临床资料,计算其疾病活动度DSA28,同时行膝关节超声检查,对有阳性症状的膝关节动态随访三次上述指标,每月一次。结果:每月RA患者的DSA28分值与受检膝关节髌上囊内液体深度、滑膜内血流信号等级呈正相关(Plt;0.05);膝关节髌上囊内液体深度、滑膜内血流信号等级以及滑膜厚度三者之间均呈正相关(Plt;0.05)。结论:膝关节滑膜内血流信号等级和膝关节髌上囊内液体深度是良好的随访RA患者疗效与评估RA患者活动度的超声指标。Abstract: Objective: To evaluation the disease of synovial in knee joints in patients with RA by ultrasound, and investigate the relationship between the clinic activity of RA and findings by ultrasound. Methods: The clinic dates and ultrasound of 40 RA patients, including 68 knee joints have positive symptom were collected by every month. The course of treatment was 3 months. Results: The score of DSA28 was correlated with the thick of effusion in bursa supragenual and the blood single of synovial in knee joints(Plt;0.05);the correlation also found among the thick of effusion in bursa supragenual.the thick of synovial and the blood singal of synovial in knee joints (Plt;0.05). Conclusion: The thick of effusion in bursa supragenual and the blood single of synovial in knee joints was excellent ultrasound index in RA.
Objective To systematically review the efficacy and safety of denosumab in the treatment of rheumatoid arthritis. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data, and VIP databases were searched to collect randomized controlled trials (RCTs) of denosumab in the treatment of rheumatoid arthritis. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 7 RCTs including 2 346 patients were included. The results of meta-analysis showed that administering 60 mg densuzumab every 6 months (Q6M) was superior to placebo in increasing the bone mineral density (BMD) of the lumbar spine, the hip, the femoral neck, and improving the modified total Sharp score. Administering 60 mg denosumab every 3 months (Q3M) and 60 mg Q6M were both superior to the placebo group at improving erosion score; in addition, the 60 mg Q3M group was superior to the 60 mg Q6M group. There was no significant difference between denosumab and the placebo in improving joint space narrowing score, the American College of Rheumatology 20%, 50%, or 70% responses, health assessment questionnaire disability index, or disease activity score. In terms of safety, there was no significant difference between denosumab and the placebo group. Conclusion Densuzumab can delay the progression of rheumatoid arthritis bone erosion, and its safety is acceptable. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
目的:本文研究5·12四川汶川大地震造成停药、居住条件恶劣、创伤后应激障碍（posttraumatic stress disorder，PTSD）、是否并发感染、地震破坏烈度等多种因素对类风湿关节炎（RA）患者的影响。方法:对58例确诊为RA的重灾区（北川、平武、江油、安县）地震前病情稳定患者震后一月进行血沉（ESR）和C反应蛋白（CRP）测定，同时评估患者关节肿胀、关节压痛、晨僵情况，了解患者是否病情活动，分析地震造成停药、居住条件恶劣、PTSD、并发感染及地震破坏烈度等多种因素对RA的影响。采用fisher确切概率法，分析地震破坏烈度与疾病活动是否有相关性，采用SPSS12.0软件对地震可能影响RA患者病情活动的其它相关因素进行Logistic回归分析。结果:58例患者中34例RA患者出现病情活动。fisher确切概率法分析显示:上述四县患者疾病活动构成比差别无统计学意义。病情活动者中62%患者停药；85%患者居住条件恶劣；59%患者患有PTSD；35%患者并发感染。Logistic回归分析发现停药、居住条件恶劣、PTSD及并发感染与RA患者病情活动相关（P均小于0.05）。结论：本研究中涉及的四个县RA患者疾病活动构成比差异无显著性，地震造成的停药、居住条件恶劣、PTSD、并发感染可使一部分RA患者病情活动。
Rheumatoid arthritis (RA) is a chronic autoimmune disease remarkably characterized by synovitis of joints, whose pathogenesis is complicated and not yet fully elucidated. A variety of cells, cytokines and intercellular signaling pathways are involved in the occurrence and development of RA. The mitogen activation protein kinase (MAPK) signaling pathway is closely related to the pathogenesis of RA, and plays an important role in the formation of pannus, synovitis, and bone destruction. This paper reviews the research progress of MAPK signaling pathway in RA from the aspects of the interaction of MAPK signaling pathway with a variety of key cells and cytokines in the pathogenesis of RA, in order to provide a direction and theoretical basis for anti-RA drug therapy research.
目的:探讨类风湿关节炎(RA)患者手部X线的表现与临床指标关系。方法:对60例临床资料完整的RA病例行双手正侧位X线检查,分为符合类风湿关节炎X线I期表现的32例(第1组),符合类风湿关节炎Ⅱ期及以上表现的患者28例(第2组),分别统计类风湿关节炎患者的临床指标类风湿因子(RF)、红细胞沉降率(ESR)、C反应蛋白(CRP)和关节肿胀个数进行两组比较,以及对影像学Sharp评分和临床各指标相关性进行评价分析。结果:两组RA患者的RF、ESR、CRP和关节肿胀数第2组明显高于第1组,两组差异均具有显著性(Plt;0.05),Sharp评分与ESR、CRP、RF、关节肿胀数均有相关性,它们的r值、P值分别为r=0.414,P=0001;r=0.481,P=0.000;r=0.333,P=0.009;r=0.261,P=0.044。结论:类风湿关节炎Ⅱ期及以上表现的患者RF、ESR、CRP和关节肿胀数明显高于类风湿关节炎X线Ⅰ期表现的患者,Sharp评分和RF、ESR、CRP和关节肿胀数有一定相关性,说明RF、ESR、CRP和关节肿胀数对类风湿关节炎的预后有预测作用。
ObjectiveTo investigate the efficacy and safety of recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) for treatment of active rheumatoid arthritis (RA). MethodsThis study included 86 patients with active rheumatoid arthritis treated between September 2011 and January 2013. They were divided into two groups randomly. Forty-three patients in the treatment group received rhTNFR:Fc (25 mg, twice a week) by subcutaneous injection and methotrexate (MTX) (10 mg, orally once a week), and the other 43 patients in the contrast group received MTX (10 mg, orally once a week), hydroxychloroquine (100 mg, orally twice daily), and leflunomide (10 mg, orally once daily). The clinical efficacy of the treatments 12 weeks later were compared between the two groups. American College of Rheumatology (ACR) 20, 50, and 70 evaluation criteria were used for efficacy evaluation. ResultsThe ACR 20, 50 and 70 effective rates in 4, 8 and 12 weeks after the treatment in the treatment group were significantly higher than those in the control group (P<0.05). The seven indicators including the duration of morning stiffness, joint tenderness index, joint swelling index, erythrocyte sedimentation rate, C-reactive protein, platelets and rheumatoid factors within 12 weeks after treatment were significantly improved in both the two groups, and the improvements in the treatment group were more significant (P<0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups (P>0.05). ConclusionRhTNFR:Fc is effecive and safe in treating active RA.
ObjectiveTo discuss the changes of joint fluid and blood-related indexes in patients with gouty arthritis and rheumatoid arthritis, and to analyze the clinical significance of these changes. MethodsSeventy-five patients with gouty arthritis and 68 with rheumatoid arthritis treated between January and December 2014 were included in our study. Their joint fluid-related indicators including white blood cell count (WBC), total protein (TP), albumin (ALB), glucose (GLU), and uric acid (UA), and their blood indicators including immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), C3 and C4, rheumatoid factor (RF), anti-streptolysin O (ASO), and c-reactive protein (CRP) were detected. ResultsFor joint fluid-related indicators, TP and ALB levels were not significantly different between the two groups (P > 0.05), while WBC, GLU, UA, RF and ASO between the two groups were significantly different (P < 0.05); For blood indexes, C4 was not significantly different between the two groups (P > 0.05), but IgG, IgM, IgA, CRP, C3, UA, RF and ASO were significantly different between the two groups (P < 0.05). The detection rate of ASO from the joint fluid was significantly higher than that detected from the blood in both the two groups (P < 0.05), while UA level was not significantly different between the joint fluid and the blood (P > 0.05). In patients with rheumatoid arthritis, RF detection rate was not significantly different between the joint fluid and the blood (P > 0.05), but it was significantly different for patients with gouty arthritis (P < 0.05). The positive rate of ASO in the blood and joint fluid of patients with gouty arthritis was respectively 38.7% and 44.0%, and it was 75.0% and 73.5% for patients with rheumatoid arthritis. UA positive rate in the blood and joint fluid of patients with gouty arthritis was 92.0% and 80.0% respectively, while it was 38.2% and 32.4% for patients with rheumatoid arthritis. RF positive rate was 33.3% and 40.0% in the blood and joint fluid of patients with gouty arthritis, while the rate was 86.8% and 91.2% for patients with rheumatoid arthritis. ConclusionThe joint fluid and blood indicators are in change in patients with gouty arthritis and rheumatoid arthritis, which has a certain clinical value in disease diagnosis and curative effect observation.