Actinomycosis is a rare chronic granulomatous disease characterized by granuloma formation and tissue fibrosis with sinus tracts,often misdiagnosed due to its similarity to many infectious and non-infectious diseases.This report presents a case of a 60-year-old female with more than 10 years history of rheumatoid arthritis who developed actinomycosis infection after long-term treatment with immunosuppressants and biologics,including methotrexate,leflunomide,and infliximab,leading to recurrent joint pain,poorly controlled rheumatoid arthritis activity,and persistent elevation of white blood cell counts.Abdominal CT revealed a pelvic mass and right ureteral dilation.Pathological examination of cervical tissue showed significant neutrophil infiltration and sulfur granules,indicating actinomycosis.The patient received 18 months of doxycycline treatment for the infection and continued rheumatoid arthritis therapy with leflunomide,hydroxychloroquine sulfate,and tofacitinib,resulting in improved joint symptoms and normalized white blood cell counts.After 2 years of follow-up,the patient remained stable with no recurrence.This case highlights the importance of clinicians being vigilant for infections,particularly chronic,occult infections from rare pathogens,in rheumatoid arthritis patients on potent immunosuppressants and biologics,advocating for early screening and diagnosis.

Abstract Background For the unclear pathogenesis of Sjogren's syndrome (SS), further exploration is necessary. Mesenchymal stem cells (MSCs) and derived exosomes (MSCs‐exo) have exhibited promising results in treating SS. Object This study aimed to investigate the effect and mechanism of human umbilical cord MSCs (UC‐MSCs) on SS. Methods Nonobese Diabetic (NOD) mouse splenic T cells were co‐cultured with UC‐MSCs and UC‐MSCs‐exo, and interferon‐gamma (IFN‐γ), interleukin (IL)‐6, IL‐10, prostaglandin E2 (PGE2), and transforming growth factor‐β1 (TGF‐β1) levels in the supernatant were assessed by quantitative real‐time polymerase chain reaction and enzyme‐linked immunosorbent assay. Co‐cultured T cells were injected into NOD mice via the tail vein. The inflammatory cell infiltration in the intestine and the submandibular gland was characterized by hematoxylin‐eosin staining. Treg/Th17 homeostasis within the spleen was determined by flow cytometry. Gut microbiota was detected by 16S rRNA sequencing, and the relationship between differential microbiota and Treg/Th17 cytokines was analyzed by the Pearson correlation coefficient. Results UC‐MSCs, UC‐MSCs‐exo, and NOD mouse splenic T cells were successfully cultured and identified. After T cells were co‐cultured with UC‐MSCs and UC‐MSCs‐exo, both IFN‐γ and IL‐6 were decreased while IL‐10, PGE2, and TGF‐β1 were increased in transcriptional and translational levels. UC‐MSCs and UC‐MSCs‐exo partially restored salivary secretion function, reduced Ro/SSA antibody and α‐Fodrin immunoglobulin A levels, reduced inflammatory cell infiltration in the intestine and submandibular gland, raised proportion of Treg cells, decreased IFN‐γ, IL‐6, IL‐2, IL‐17, lipopolysaccharide, and tumor necrosis factor‐alpha levels, and raised IL‐10, Foxp3, and TGF‐β1 levels by affecting co‐cultured T cells. The intervention of UC‐MSCs and UC‐MSCs‐exo improved intestinal homeostasis in NOD mice by increasing microbiota diversity and richness. Additionally, differential microbiota was significantly associated with Treg/Th17 cytokine levels. Conclusion Human UC‐MSCs and UC‐MSCs‐exo improved disease characterization of SS in NOD mice through regulation of gut microbiota and Treg/Th17 cellular immunity.

目的:观察类风湿关节炎(rheumatoid arthritis,RA)患者血清Ⅱ型胶原 C 端肽(type Ⅱcollagen C-terminal peptide,CTX-Ⅱ)、组蛋白去乙酰化酶 3(histone deacetylase 3,HDAC3)水平变化,分析其与免疫功能、疾病活动度的关系.方法:选取本院收治的 84 例RA患者(RA 组)和 84 例体检健康者(NC组).分析血清CTX-Ⅱ、HDAC3(酶联免疫吸附法)及免疫功能指标[免疫球蛋白(immunoglobu-lin,Ig)A、IgG、IgM、CD3+、CD4+、CD8+T 细胞比例]、疾病活动度相关指标[C 反应蛋白(C-reactive pro-tein,CRP)、血沉(erythrocyte sedimentation rate,ESR)]水平变化情况.Pearson 法分析血清 CTX-Ⅱ、HDAC3 分别与免疫指标、疾病活动度相关指标的相关性.结果:RA组CTX-Ⅱ(9.26±1.84 vs 4.59±0.62)、HDAC3(83.72±13.51 vs 20.15±4.90)水平高于NC组(t=22.044、40.542,P＜0.05).缓解组CTX-Ⅱ(7.37±1.71 vs 10.75±1.94)、HDAC3(72.97±12.10 vs 92.18±14.62)水平低于活动组(t=8.347、7.940,P＜0.05).RA组CD3+(64.42±6.91 vs 70.42±7.34)、CD4+(34.80±5.96 vs 39.74±5.80)T细胞比例低于NC组,而CD8+T细胞(31.68±6.15 vs 29.62±7.15)、IgM(2.06±0.39 vs 1.47±0.30)、IgA(2.96±0.50 vs 1.51±0.36)、IgG(15.49±3.05 vs 11.83±2.19)、ESR(28.32±7.60 vs 13.75±2.18)、CRP(10.94±2.02 vs 6.08±0.73)水平显著高于 NC 组(P＜0.05).活动组患者 CD3+(62.94±6.60 vs 66.30±7.30)、CD4+T(33.57±5.74 vs 36.36±6.24)细胞低于缓解组,IgM(2.19±0.41 vs 1.89±0.36)、IgA(3.08±0.54 vs 2.81±0.45)、IgG(16.16±3.27 vs 14.64±2.77)、ESR(30.06±8.15 vs 26.11±6.90)、CRP(12.37±2.24 vs 9.12±1.74)水平高于缓解组(P＜0.05).相关性分析显示,血清CTX-Ⅱ与ESR、CRP、28 个关节疾病活动(disease activity score in 28 joints,DAS28)呈正相关(r=0.572、0.495、0.809,P 均=0.000);血清HDAC3 分别与CD3+、CD4+T细胞比例存在负相关(r=-0.529、-0.464,P 均= 0.000),而与 IgM、IgA、IgG、ESR、CRP、DAS28 评分呈正相关(r= 0.460、0.491、0.445、0.540、0.519、0.864,P 均＜0.05).结论:类风湿关节炎患者血清 CTX-Ⅱ、HDAC3 水平均高于体检健康者,CTX-Ⅱ与 RA 疾病活动度有关,HDAC3 与RA免疫功能紊乱以及疾病活动度有关.

艾拉莫德是一种具有抗炎、抗骨吸收及免疫调节作用的新型小分子改善病情抗风湿药,多用于治疗类风湿关节炎.原发性干燥综合征目前尚无满意的治疗措施,临床上使用的药物多为经验性治疗.多项临床研究将艾拉莫德单药或与甲泼尼龙、硫酸羟氯喹、白芍总苷中的1种或2种药物联合应用于干燥综合征患者,可提高治疗总有效率、改善干燥症状、降低球蛋白、降低炎症水平及抗体水平、升高血小板、改善肺功能且不良反应发生率低.艾拉莫德可通过减轻腺体炎症及病理损伤、抑制B淋巴细胞及抗肺纤维化等多种机制发挥治疗干燥综合征的作用.

目的 分析云克治疗类风湿关节炎(rheumatoid arthritis,RA)患者合并骨质疏松的临床疗效.方法 选取我院2019年1月1日至2019年3月31日住院接受云克治疗的RA患者49名及未接受云克治疗的RA门诊患者30名并随访一年,收集患者临床资料.结果 两组患者基线临床资料年龄、病程、体质量指数、晨僵时间、疼痛评分、ESR、CRP、RF、骨密度、关节肿胀及压痛数目差异无统计学意义(P>0.05).使用云克治疗的研究组患者在治疗1年后各项临床指标均低于对照组(P<0.05).研究组经云克治疗后12个月骨密度有所改善(P<0.05),而对照组治疗前后腰椎及髋部BMD对比差异无统计学意义(P>0.05).结论 云克治疗类风湿关节炎合并骨质疏松不仅有良好的抗炎效果,亦可增加骨密度、抗骨质疏松.

Objective:To investigate the expression of serum matrix metalloproteinase 3 (MMP-3) in patients with rheumatoid arthritis (RA) and analyze its correlation with bone erosion and disease activity.Methods:100 RA patients diagnosed in the First People's Hospital of Changde from July 2018 to December 2019 were selected as the RA group, and 35 healthy volunteers who came to the hospital for physical examination at the same time were selected as the control group. The clinical data of the patients were collected, and the serum MMP-3 levels of the patients and healthy volunteers were detected by enzyme-linked immunosorbent assay (ELISA). The serum MMP3 levels of RA patients with different disease activity, different imaging stages and different bone mineral density were compared, and the correlation with clinical indicators were analyzed.Results:⑴ RA patients were grouped according to the Disease Activity Score (DAS) 28. Serum MMP-3 levels in the highly active group (300.87±15.93)ng/ml and in the moderately active group (213.78±12.79)ng/ml were higher than those in the clinical remission group (82.87±8.19)ng/ml increased significantly. ⑵ The serum MMP3 level in the RA group (190.98±13.43)ng/ml was significantly higher than that in the healthy control group (69.97±10.63)ng/ml. ⑶ There were significant differences in serum MMP-3 levels among RA patients with different imaging stages ( P<0.05). The level of MMP-3 in stage Ⅲ (206.18±13.58)ng/ml and stage Ⅳ (301.72±13.43)ng/ml were significantly higher than those in stage Ⅰ (89.16±10.13)ng/ml. ⑷ RA patients were divided into normal group, osteopenia group, and osteoporosis group according to bone mineral density. The serum MMP-3 level in the osteopenia group (180.87±12.69)ng/ml and osteoporosis group (289.54±13.28)ng/ml were significantly higher than that in the normal group (121.05±8.45)ng/ml. ⑸ Serum MMP-3 levels were positively correlated with C-reaction (CRP), erythrocyte sedimentation rate (ESR), DSA 28, rheumatoid factor (RF), joint swelling index, joint tenderness index, and platelet count in the RA group ( P<0.05). Conclusions:The serum MMP-3 plays an important role in the progression of RA, and is closely related to RA disease activity and bone erosion. It is expected to become a serological indicator for predicting RA bone erosion and radiological progress.

目的:观察艾拉莫德、来氟米特联合云克治疗类风湿关节炎(RA)的效果.方法:2016年5月-2017年5月收治RA患者100例,随机分为两组,各50例.对照组给予艾拉莫德、来氟米特口服治疗,观察组在艾拉莫德、来氟米特基础上联合使用云克注射液治疗.比较两组治疗效果.结果:观察组临床疗效高于对照组,DAS28评分及炎性因子水平均显著低于对照组,差异均有统计学意义(P＜0.05).结论:艾拉莫德、来氟米特联合云克治疗RA,可明显减轻患者临床症状,有效性和安全性高.

目的:探究类风湿性关节炎患者血清炎性细胞因子水平的临床价值.方法:选取2017年4月-2018年5月类风湿关节炎患者89例作为试验组;同时选取85例健康志愿者作为对照组.检测两组外周血中白介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)、白细胞介素2(IL-2)、白细胞介素6(IL-6)等炎性细胞因子水平.结果:试验组TNF-α及IL-1β水平均显著高于对照组,差异有统计学意义(P＜0.05);两组IL-2及IL-6水平比较,差异无统计学意义(P＞0.05).结论:及早测定类风湿关节炎患者血清中IL-1β、TNF-α含量,可较好地指导临床治疗工作,具备较高的临床指导价值.

目的:探讨双醋瑞因联合白芍总苷治疗膝骨关节炎的临床疗效及安全性.方法:2017年6月-2018年6月收治膝骨关节炎患者112例,随机分为两组,各56例.对照组服用双醋瑞因治疗;观察组服用双醋瑞因联合白芍总苷治疗.比较两组治疗效果.结果:观察组治疗总有效率、Lequesne评分、膝关节VAS评分和15 m行走时间均显著优于对照组,差异有统计学意义(P＜0.05),结论:双醋瑞因联合白芍总苷治疗膝骨关节炎疗效明显,安全性高.

目的分析IgA肾病患者的临床特点以及临床治疗方案,为IgA肾病患者后期的临床治疗工作提供参考。方法回顾分析近年来收治的60例IgA肾病患者的临床资料,按照临床治疗方式分为观察组(西医治疗)和对照组(中医治疗)两组,对比两组IgA肾病患者的总体临床治疗效果。结果治疗后,观察组患者的临床有效率为(86.7%),明显高于对照组(36.7%),组间总有效率比较差异有统计学意义(P<0.05)。结论对于IgA肾病患者来说,采用西医结合治疗的效果明显优于中医治疗。