目的:探讨艾拉莫德治疗中轴型脊柱关节炎(SpA)的临床效果和安全性.方法:选取2017年1月-2020年1月本院收治的中轴型SpA患者共86例,按照随机数字表法将其分为治疗组和对照组,每组43例.治疗组给予艾拉莫德和塞来昔布治疗,对照组给予柳氮磺吡啶肠溶片和塞来昔布治疗,两组疗程均为12周.比较两组治疗前后的疼痛程度、病情严重程度、炎症指标、骶髂关节骨髓水肿情况及不良反应发生情况.结果:治疗后,两组视觉模拟评分法(visual analogue score,VAS)评分、Bath强直性脊柱炎活动指数(BASDAI)、红细胞沉降率(ESR)、C反应蛋白(CRP)及加拿大脊柱关节研究协会(spondyloarthritis research consortium of canada,SPARCC)评分均低于治疗前,且治疗组均低于对照组(P<0.05).两组不良反应发生率比较,差异无统计学意义(P>0.05).结论:艾拉莫德对中轴型SpA的疗效良好,可缓解关节疼痛,改善病情、减轻炎症反应及骶髂关节骨髓水肿,安全性较好,值得临床推广.

目的 观察联合重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗活动性强直性脊柱炎(an-kylosing spondylitis,AS)继发骨质疏松症(osteoporosis,OP)的临床效果.方法 选取活动性AS继发OP 68例,采用随机数字表法随机将其分为观察组和对照组两组各34例,研究过程中对照组脱落1例.观察组在常规治疗基础上给予注射用重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白,对照组给予常规治疗,疗程均为24周.比较两组治疗前和治疗24周后炎性指标和Bath AS疾病活动性指数(BASDAI)评分,治疗24周后AS 20％改善程度(ASAS 20)达标率,治疗前和治疗24周后骨代谢标志物和双侧股骨颈、腰1～腰4骨密度(BMD),以及治疗期间不良反应发生情况.结果 治疗前,两组炎性指标及BASDAI评分、骨代谢标志物、双侧股骨颈和腰1～腰4 BMD比较差异均无统计学意义(P>0.05).治疗24周后,两组炎性指标和BASDAI评分、Ⅰ型胶原交联C末端肽(CTX-Ⅰ)低于治疗前,观察组血清碱性磷酸酶(ALP)和两组双侧股骨颈、腰1～腰4 BMD高于治疗前;观察组炎性指标和BASDAI评分、CTX-Ⅰ低于对照组,ASAS 20达标率和双侧股骨颈、腰1～腰4 BMD高于对照组,差异均有统计学意义(P<0.05或P<0.01).治疗期间,两组均未发生明显不良反应.结论 联合重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白治疗活动性AS继发OP可控制炎症,抑制破骨细胞活性,提升BMD,显著改善AS继发OP.

Objective:To explore the clinical features and diagnosis of coexistence of ankylosing spondylitis (AS) and Beh?et's disease associated with antiphospholipid syndrome (APS).Methods:We analyzed a case of coexistence of ankylosing spondylitis and Beh?et's disease associated with APS in Seventh Medical Center of Chinese PLA General Hospital in 2016, and the related literature were reviewed.Results:A 26-year-old male patient suffered from inflammatory low back pain, arthralgia and iritis. A His CT imaging revealed bilateral grade Ⅱ of bilateral sacroiliac arthritis. He was diagnosed as AS. He also had recurrent oral ulceration, iritis, vascular disorders and positive acupuncture pathergy test. He was diagnosed as Beh?et's disease. He suffered from recurrentpeated venous thrombosis. Laboratory tests revealed positive antiphospholipid antibodies. He was diagnosed as secondary APS complicated with Beh?et's disease. After he was treated with of glucocorticosteroid, cyclophosphamide, adalimumab and dabigatran, his condition improved significantly.Conclusion:There are some cases reported of AS with Beh?et's disease, or Beh?et's disease with APS, or AS with APS. The relationship between them is complex. The possibility of coexistence of AS and Beh?et's disease and APS should not be ignored, in order to avoid misdiagnosis.

Objective To observe clinical characteristics of hypoglycemia induced by glucocorticoid in treatment of connective tissue disease( CTD). Methods Clinical data of 28 patients with hypoglycemia induced by glucocorticoid in treatment of CTD in our hospital was retrospectively analyzed. Results There were 19 patients( 67. 86%) with systemic lupus erythematosus in the 28 patients with CTD; the number of females was larger than that of males( male∶ female = 1∶ 8. 3); patients aged at 15-30 at onset accounted for 67. 86%( 19 cases); the longest course of disease and cumulative time of using glucocorticoid lasted 24-60 months, and accounted for 42. 86% and 32. 14% respectively; the amount of the largest cumulative dose of glucocorticoids was 5000-10 000 mg,and accounted for 46. 43%. No hypoglycemia symptoms occurred when the 28 patients had hypoglycemia,and average blood glucose was 3. 2 mmol / L. The blood glucose in 26 patients returned to normal after regular reduction treatment with glucocorticoid; but the other 2 patients did not recover,and then same glucocorticoid therapy was continued with regular reduction,and follow-up is still under way. Conclusion Long-term and high-dose glucocorticoids to younger female patients with CTD may induce hypoglycemia,so glucocorticoid dosage should be adjusted in time to control the incidence of hypoglycemia.

<正>类风湿关节炎(RA)是一种以慢性进行性关节滑膜病变为特征的全身性自身免疫病,主要表现为对称性侵蚀性关节炎,病程迁延,如不及时治疗,最终会导致受累关节的畸形和功能丧失,严重影响生活质量。因而,早期诊断、早期治疗尤为重要。鹿瓜多肽注射液是分别提取鹿科动物梅花鹿的骨骼和葫芦科植物甜瓜

患者,女性,48岁.主因面部皮疹、口腔溃疡10年,恶心、呕吐2月余于2008年12月2日入院.入院前10年患者无明显诱因出现面部红斑,当地医院给予中药口服及静脉用药(具体不详)后症状逐渐缓解,其后反复出现口腔溃疡,双手近端指间关节肿痛,1.5年前出现口干、进食不受限,眼干、视物无异常.2月前患者食生冷食物后出现恶心、非喷射性呕吐,呕吐物为胃内容物,无发酵及粪臭味,与进食无关,次数不详.伴上腹隐痛、腹泻黄色黏液便,5～6次/d.