目的:研究雷公藤合剂治疗原发性干燥综合征(pSS)的效果及对预后营养指数(PNI)的影响.方法:选取符合要求的64例pSS患者随机分为用雷公藤合剂治疗的治疗组及用硫酸羟氯喹片治疗的对照组,治疗12 w,对比两组治疗前后的ALB、LY、PNI、ESR、CRP、IgG、IL-1β、TNF-α、ESS-PRI.结果:治疗后对照组的ALB、PNI较治疗前无差异,两组的LY及治疗组的ALB、PNI均较治疗前提高(P<0.05);治疗后两组的ESR、CRP、IgG、IL-1β、TNF-α、ESSPRI均较治疗前下降(P<0.05),且治疗组明显低于对照组(P<0.05).Pearson线性相关性分析,治疗组治疗后的ESSPRI与ALB、LY、PNI呈负相关(P<0.05).结论:雷公藤合剂能降低急性炎症指标,提升营养状况,调节免疫,降低ESSPRI,减轻症状及改善预后,未发现严重不良反应,值得在临床上推广应用.

Background: Guizhi Gancao Longgu Muli Decoction can make a good effect on the insomnia under the catalogue of traditional Chinese medicine. Method: To search the databases:Pubmed, Web of Science, EMBASE, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), the China Biology Medicine disc (CBMdisc), the China Science and Technology Journal Database (VIP), the Wanfang. Results: Fifteen randomized controlled trials were included, totally including 1164 participants. After summarizing the observational index revised according to the "Guiding Principles for Clinical Research of New Chinese Medicines ", we found that the curative effect of the trial group is 2.29 times that of the control group in the fixed effect model which had a statistically significant difference [OR = 2.293681, 95%CI = 0.3266112-5.83]. And the Pittsburgh Sleep Quality Index (PSQI) which had 7 different dimensions, including subjective sleep quality[p = 0.001 < 0.05], sleep latency, sleep duration[p = 0.000 < 0.05], habitual SE[p = 0.000 < 0.05], sleep disorders [p = 0.002 < 0.05], use of sleep medications[p = 0.000 < 0.05], and daytime dysfunction[p = 0.000 < 0.05], showed a higher scores in the trial group than the one in the control group in every dimension. The final results of the total scores in PSQI also showed a higher scores in trial group with a p = 0.000 < 0.05 (Test of WMD), suggest a statistically significant difference. While the adverse effects showed a lower rate in the trial group than the one in the control group under a fixed-effect model, with a p = 0.000 < 0.05, indicate a statistically significant difference. Conclusion: The efficacy and safety of GGLMD in the trial groups are better than the modern western medicine in the control groups.

目的:研究参芪地黄汤联合缬沙坦胶囊对气阴两虚型早期糖尿病肾病的疗效、炎症因子及血液流变学的影响.方法:随机将62名糖尿病肾病患者分为对照组和观察组各31名.对照组给予常规降糖治疗(包括口服药及胰岛素)及缬沙坦胶囊降蛋白治疗;观察组在对照组降糖、降蛋白的基础上加用参芪地黄汤治疗.评估两组观察对象的临床疗效及不良反应.结果:观察组总有效率(93.55％)优于对照组总有效率(74.19％),差异具有统计学意义(P<0.05)(P<0.05);两组患者治疗后中医证候积分、空腹血糖、糖化血红蛋白、尿白蛋白/肌酐比值、C-反应蛋白、肿瘤坏死因子-α、白细胞介素-6、全血高切粘度、低切粘度、血浆粘度水平均较治疗前降低,且观察组比对照组降低更明显,差异均具有统计学意义(P<0.05).结论:参芪地黄汤联合缬沙坦胶囊能显著缓解气阴两虚型早期糖尿病肾病的临床症状、炎症反应、血流动力学障碍,同时改善患者血糖、进一步降低尿微量白蛋白,疗效显著,值得在临床治疗中推广.

目的:观察中医适宜技术"经络刮疗+关节操"对活动期类风湿关节炎ACR20的疗效.方法:将66例活动期类风湿关节炎患者随机分为治疗组和对照组,每组33例.对照组给予常规药物治疗,治疗组在对照组治疗基础上联合中医适宜技术"经络刮疗+关节操".2组均以3个月为1个疗程.观察2组的疗效指标ACR20,包括关节肿胀数、关节压痛数、休息痛(VAS1)、患者对疾病活动程度的评价(VAS2)、医生对疾病活动程度的评价(VAS3).结果:第4周ACR20达标率,第4,8,12周的关节压痛数、VAS1、VAS2、VAS3的改善情况,治疗组均优于对照组(P<0.05).结论:对于活动期类风湿关节炎患者,中医适宜技术可促进关节功能的恢复、生活质量的优化,使ACR20早期达标,值得推广应用.

目的:观察自拟中药熏蒸Ⅰ号方联合来氟米特及塞来昔布治疗活动期类风湿关节炎的临床疗效,并探讨其改善类风湿关节炎的作用机制.方法:将91例类风湿关节炎患者按照随机数字表法分为对照组30例、治疗组30例、联合组31例.对照组给予来氟米特片联合塞来昔布胶囊口服,治疗组给予中药熏蒸Ⅰ号方熏蒸,联合组采用西药口服联合中药熏蒸Ⅰ号方熏蒸,3组疗程均为4周.观察3组临床疗效,以及治疗前后肿胀关节数、晨僵时间、握力、DAS28评分,检测红细胞沉降率(ESR)、C-反应蛋白(CRP)、白细胞介素(IL)-1Ra、IL-1β含量.结果:联合组显效5例,有效25例,无效1例,总有效率为96.77％;治疗组显效0例,有效18例,无效12例,总有效率为60.00％;对照组显效1例,有效18例,无效11例,总有效率为63.33％.联合组总有效率优于治疗组和对照组,差异有统计学意义(P<0.05).治疗后,3组肿胀关节数、晨僵时间、DAS28评分、ESR、CRP明显降低,握力增加,IL-1Ra含量、IL-1Ra/IL-1β比值升高,IL-1β含量下降(P<0.05),且联合组优于治疗组和对照组(P<0.05).结论:自拟中药熏蒸Ⅰ号方联合来氟米特及塞来昔布能明显改善活动期类风湿关节炎的症状、体征及炎症指标,无明显不良反应,这种疗效可能是通过升高IL-1Ra含量、IL-1Ra/IL-1β比值,抑制IL-1β含量实现的.

Abstract Background: Systemic Lupus Erythematosus (SLE) is a diffuse connetive tissue disease, which is difficult to be conquered. However, the traditional Chinese medicine is significant in the treatment. And the Chinese medicine tripterygium and its plant extraction can help us to overcome this disease, to some extent. Methods: The deadline should be from inception to February 2020 by computer from the databases: the Cochrane Library, Pubmed, Embase, Web of Science in English and the Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and Chinese Science, Chinese Traditional Medicine Database, Chinese Science and Technology Periodical Database in Chinese. Included criteria are randomized controlled trials. The primary outcomes are the clinical symptoms, systemic lupus erythematosus disease activity index and quality of life questionnaire (the top 10 frequency). We will use RevMan 5.0 statistical software for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. The publish bias will be assessed by a funnel plot and the funnel plot symmetries will be evaluated by Begg and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. Results: This article will give a protocol for meta analysis which can make sure the efficacy and side effect of the tripterygium and its plant extraction for SLE. Conclusion: The efficacy and side effect of the tripterygium and its plant extraction for SLE will be evaluated. Ethics and dissemination: Without personal information involved, ethical approval and informed consent form is no need. The review will be submitted to a peer-reviewed journal prospectively to spread our findings. PROSPERO registration number: PROSPERO CRD42020176444

目的:观察自拟中药熏蒸I号方联合西药治疗活动期类风湿关节炎患者的临床疗效.方法:将91例患者按随机数字表法分为西药对照组30例、观察a组30例、观察b组31例,对照组予常规西药治疗,观察a组予中药熏蒸治疗,观察b组予中药熏蒸联合常规西药治疗,观察治疗前后肿胀关节数、晨僵时间、握力,检测治疗前后RF、ESR、CRP等指标.结果:观察b组的总有效率为96.77％,优于对照组及观察a组(P<0.05).治疗后,与对照组及观察a组相比,观察b组的肿胀关节数、晨僵时间、RF、ESR、CRP明显降低,握力增加(P<0.05).结论:自拟中药熏蒸I号方联合西药能明显改善活动期类风湿关节炎患者的肿胀关节数、晨僵时间、握力、RF、ESR、CRP,无明显毒副作用.

目的:探究四妙散对高尿酸血症小鼠回肠组织三磷酸腺苷结合盒转运蛋白转运体G2(ABCG2)、葡萄糖转运蛋白9(GLUT9)表达的影响.方法:将36只小鼠随机分为空白对照组,模型对照组,四妙散低、中、高剂量组,别嘌醇组,每组6只.除空白对照组外,其余各组建立高尿酸血症小鼠模型,四妙散低、中、高剂量组分别给予低剂量(0.175 g·mL-1)、中剂量(0.35 g·mL-1)、高剂量(0.7 g·mL-1)四妙散灌胃,别嘌醇组予别嘌醇(40 mg·kg-1)灌胃.检测各组小鼠血尿酸、回肠ABCG2和GLUT9表达变化,探究四妙散治疗高尿酸血症的可能机制.结果:各模型组小鼠血清尿酸明显高于空白对照组(P<0.05),不同剂量四妙散及别嘌醇治疗后小鼠血清尿酸水平降低,差异有统计学意义(P<0.05),回肠ABCG2表达升高,GLUT9表达下降,差异有统计学意义(P<0.05),其中四妙散中、高剂量组对ABCG2和GLUT9影响最大.结论:四妙散通过调节回肠ABCG2及GLUT9的表达起到降尿酸作用.

h Abstract Background: Systemic Lupus Erythematosus (SLE) is a diffuse connetive tissue disease, which is difficult to be conquered. However, the traditional Chinese medicine is significant in the treatment. And the Chinese medicine tripterygium and its plant extraction can help us to overcome this disease, to some extent. Methods: The deadline should be from inception to February 2020 by computer from the databases: the Cochrane Library, Pubmed, Embase, Web of Science in English and the Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database and Chinese Science, Chinese Traditional Medicine Database, Chinese Science and Technology Periodical Database in Chinese. Included criteria are randomized controlled trials. The primary outcomes are the clinical symptoms, systemic lupus erythematosus disease activity index and quality of life questionnaire (the top 10 frequency). We will use RevMan 5.0 statistical software for data synthesis, sensitivity analysis, meta regression, subgroup analysis, and risk of bias assessment. The publish bias will be assessed by a funnel plot and the funnel plot symmetries will be evaluated by Begg and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. Results:This article will give a protocol for meta analysis which can make sure the efficacy and side effect of the tripterygium and its plant extraction for SLE. Conclusion: The efficacy and side effect of the tripterygium and its plant extraction for SLE will be evaluated. Ethics and dissemination:Without personal information involved, ethical approval and informed consent form is no need. The review will be submitted to a peer-reviewed journal prospectively to spread our findings. PROSPERO registration number: PROSPERO CRD42020176444

目的:探讨痛风急性期起始小剂量降尿酸治疗对临床疗效及患者用药依从性的影响.方法:将70例痛风急性期患者随机分为治疗组和对照组,每组35例.治疗组予抗炎治疗同时降尿酸治疗,对照组予急性期缓解2周后起始降尿酸治疗.治疗期间对疼痛视觉模拟评分法(VAS)评分进行比较,并随访尿酸水平、复发次数及用药依从性.结果:治疗后2组患者各时间点疼痛VAS评分比较,差异均无统计学意义(P>0.05).2组痛风复发比较,差异无统计学意义(P>0.05).治疗组尿酸较对照组水平更低,差异有统计学意义(P<0.05).2组用药依从性比较,差异有统计学意义(P<0.05).结论:痛风急性期起始降尿酸治疗不影响急性期疗效,可使尿酸更早达标且提高患者用药依从性.

目的:研究痛风性关节炎患者血尿酸水平与血清促炎细胞因子水平及心脏功能的关系.方法:选取我院痛风性关节炎患者100例作为观察组,其中急性发作期患者52例作为观察A组,完全缓解期患者48例作为观察B组,另选取同期健康体检者92例作为对照组.三组均检测血尿酸、血清促炎细胞因子[白细胞介素1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]及心功能[左心室射血分数(LVEF)],并分析血尿酸与血清IL-1β、TNF-α、CRP及LVEF的关系.结果:经SNK法两两比较,观察A组血尿酸、血清IL-1β、TNF-α、CRP高于观察B组、对照组,LVEF低于观察B组、对照组(P<0.05);观察B组血尿酸、血清IL-1β、TNF-α、CRP高于对照组,LVEF低于对照组(P<0.05).经Pearson相关性分析,痛风性关节炎患者血尿酸水平与血清IL-1β(r=0.572)、TNF-α(r=0.503)、CRP(r=0.614)呈正相关,与LVEF(r=-0.551)呈负相关(P<0.05).结论:痛风性关节炎患者血尿酸与血清IL-1β、TNF-α、CRP呈正相关关系,与LVEF呈负相关,可为临床诊治提供可靠参考依据.

目的:目的探讨外周血单个核细胞中核苷酸结合寡聚化结构域样受体3(NLRP3)、半胱天冬酶-1(CASP1)、凋亡相关斑点样蛋白(PYCARD)在痛风性关节炎(GA)患者中的变化特点及其意义.方法:选取我院2016年2月至2017年4月确诊的90例GA患者(GA组)、选取健康体检志愿者90例(对照组),采用RT-PCR技术检测两组NLRP3、PYCARD、CASP1 mRNA表达水平,并按照患者病情、治疗前后进行分层分析,分析GA患者NLRP3、PYCARD、CASP1 mRNA与患者血清炎症因子的关系.结果:GA组患者的NLRP3 mRNA表达水平低于对照组(t=-9.263,P<0.001),GA组患者的PYCARD、CASP1 mRNA表达水平高于对照组(t=13.975,t=10.064;P均<0.001);急性GA患者(AGA组)患者的NLRP3、CASP1 mRNA表达水平高于非急性GA患者(NAGA组)(t=8.872,t=12.062;P均<0.001),AGA组和NAGA组的PYCARD mRNA差异无统计学意义(t=0.823,P=0.413);GA组患者的治疗后的NLRP3 mRNA水平显著升高(t=-6.542,P<0.001),CASP1 mRNA、PYCARD mRNA表达水平在治疗后显著降低(t=9.827,t=5.788;P均<0.001);AGA组患者的IL-6、TNF-α表达水平高于NAGA组(t=8.403、5.329,P<0.001);GA组患者的NLRP3 mRNA与IL-6、TNF-α 呈负相关关系(r=-0.345、r=-0.524,P<0.001);PYCARD、CASP1 mRNA与GA患者的IL-6、TNF-α呈正相关关系(r=0.645,r=0.682,r=0.634,r=0.713,P<0.001).结论:GA患者NLRP3、PYCARD、CASP1 mRNA表达水平变化与患者病情及炎症反应程度有关.

目的:探讨骨痹的中医辨证论治.方法:在研究古今中外文献的基础上,提取有效信息,进行总结、分类,而后设计、研制调查问卷,采用德尔菲法专家调查问卷,两轮问卷结束,条文均已通过后形成骨痹的中医辨证论治初步专家共识.结果:根据两轮调查问卷形成骨痹的中医辨证论治初步专家共识,内容包括骨痹的病因、病机、证型、治法、方药.结论:德尔菲法专家调查问卷结合文献研究,可有效提取古代及现代专家经验,形成有效的专家共识,将古今专家经验集成融入循证医学诊疗指南.

目的:研究"治未病"思想在痛风健康教育中的应用效果.方法:将60例痛风患者随机分为试验组和对照组,每组30例.对照组采用常规健康教育,试验组在常规健康教育的基础上向患者宣教中医"治未病"思想,比较2组患者干预后的血尿酸水平、痛风复发次数.结果:干预后,试验组患者血尿酸水平控制较对照组好,痛风复发次数低于对照组,差异有统计学意义(P<0.05).结论:将"治未病"思想应用于痛风患者中有利于控制血尿酸水平,减少痛风复发次数.

类风湿关节炎(RA)是一种炎症性的自身免疫性疾病,其特点是慢性炎性关节病变,并伴有全身多个系统受累,主要病理变化为关节滑膜的慢性炎症,滑膜血管翳形成,软骨及骨组织的侵蚀.未经系统治疗的RA可反复迁延多年,最终导致关节畸形及功能丧失.本病属于中医学痹证范畴,古今医家均认为此病为难治之证.近年来我科运用临床经验方通痹汤治疗类风湿关节炎34例,取得了良好的疗效,现报告如下.

目的：探讨Rhupus综合征（类风湿关节炎重叠系统性红斑狼疮）的其临床特点。方法：对确诊为Rhupus综合征的16例患者的临床资料进行回顾性调查分析。结果：以类风湿关节炎起病者13例，以系统性红斑狼疮起病者1例，同时起病者2例；常见临床表现为关节痛/关节炎、晨僵，其次为发热、肺部病变；常见免疫学指标为抗核抗体和类风湿因子，其次为抗SSA抗体、抗CCP抗体、抗SM抗体、抗ds-DNA抗体；存在肺部病变者8例，其中肺动脉高压4例。结论：Rhupus综合征多以类风湿关节炎起病且类风湿关节炎相关表现严重于系统性红斑狼疮相关表现，其具有相对明确的临床特点。

目的：探讨代谢综合征对骨关节炎关节病变的影响。方法：选取216例骨关节炎患者，按出院时诊断分为代谢综合征组55例和非代谢综合征组161例，对受累关节部位数量、关节影像学评级、C-反应蛋白水平进行评估比较。结果：代谢综合征组中关节受累为单部位、双部位、多部位的分别为10，15，30例，非代谢综合征组中分别为96，42，23例。两组比较，差异有统计学意义（P<0.05）。两组中膝关节KL评级比较，差异有统计学意义（P<0.05）；C-反应蛋白水平比较，差异有统计学意义（P<0.001）。结论：合并有代谢综合征的骨关节炎患者关节严重性和复杂性明显高于非代谢综合征患者。

目的：调查福州地区系统性红斑狼疮患者中医证素分布情况。方法：以朱文锋教授主编的《中医主症鉴别诊断学》“600常见症状的辨证意义”为依据，结合郑筱萸主编的《中药新药临床研究指导原则》对症状轻、中、重程度的定义，制定全面、规范的四诊资料规范化采集量表。参照“600种常见症状的辨证意义”，将受检者的症状、体征对于各对应辨证要素的贡献度进行相加，以所得的贡献度之和作为该证素的积分。积分＜70，归为0级，说明基本无病理变化；70≤积分＜100，归为1级，说明存在轻度病理变化；100≤积分＜150，归为2级，说明存在中度病理变化；积分≥150，归为3级，说明存在严重病理变化。结果：福州地区系统性红斑狼疮证素分布情况：病位依次为肾、肝、脾、心，与肺、经络、筋骨、肌肤、脑、胃相关。主要病性证素为阴虚、阳虚、热、毒、血瘀。主要证型分布依次为脾肾阳虚、肝肾阴虚、热毒炽盛、阴虚内热、气阴两虚、风湿热痹。结论：福州地区系统性红斑狼疮的发病部位主要在肾、肝、脾三脏，是以热、毒、瘀为标，肝脾肾亏虚为本的虚实夹杂疾病。“瘀”既是系统性红斑狼疮病理机制中的重要环节，也是病程中的重要病理产物。

Objective:To observe the adverse reaction in the treatment of dampness-heat-blockage-type rheumatoid arthritis with optimized scheme of traditional Chinese medicine to probe the impact of changes of sex hormones on patient’s condition.Methods:60 cases with rheumatoid arthritis were randomly divided into a treatment group and a control group,30 cases in each.The control group were given methotrexate,lelfunomide,and the combination of modiifed Xuanbi Decoction and Ermiao San;while the treatment group,based on the treatment of the control group,were given Tripterygium Wilfordii Mixture combined with joint exercise.Two groups were treated for 1 course(3 months).Comparisons were made on the aspects of blood routine,liver and kidney functions,sex hormone levels and adverse reaction of the two groups before and 4,8,12 weeks after the treatment. Results:After 12 weeks,comparing the blood cell count(WBC),alanine transarninase(ALT),and sex hormone (including follicle stimulating hormone,luteinizing hormone,estradiol,testosterone,prolactin level) of the two groups with those before the treatment,the differences were statistically significant (P < 0.05);the difference of serum creatinine (SCr) before and after the treatment was not significant(P > 0.05);the difference between the levels of WBC,ALT,SCr and sex hormone between the two groups had no significant difference(P > 0.05).There are mild adverse reactions of the two groups,returning to normal after proper treatment and having no effects on the treatment.In the treatment group, 2 cases had leukopenia,2 cases had gastrointestinal reaction,1 case had liver function damage,and the menstrual blood volume reduced in 1 case,the incidence rate of adverse reaction being 20%;while in the control group, 1 case had leukopenia,1 case had gastrointestinal reaction,2 cases had liver function damage,and 1 case had skin allergy,the rate of adverse reaction being 16.66%.The difference between the two groups was not significant (P > 0.05).Conclusion:There were no serious adverse reactions in the treatment of dampness-heat-blockagetype rheumatoid arthritis with optimized scheme of traditional Chinese medicine,safe in clinical application.