基于黄帝内经指导思想,从"诸痛痒疮,皆属于心"与"脾不统血"的角度辨证施治青斑样血管病1例.记述该病例病情变化中的中医思辨与实践过程,详细分析疾病诊断及发展过程中的变化规律、各阶段的治则治法以及遣方用药原则.青斑样血管病的病因病机符合内经理论,提示可以运用内经理论对青斑样血管病进行有效的辨证论治.

目的 评价团体认知行为治疗对强直性脊柱炎(AS)伴焦虑抑郁患者的效果.方法 采用病例对照研究,将107例经足量非甾体抗炎药物治疗12周后AS病情活动且伴焦虑抑郁的患者,随机数表法分为观察组及对照组,两组均给予非甾体类抗炎药及TNF-α拮抗剂治疗,对照组行常规治疗,观察组同时给予团体认知行为治疗,于基线期、治疗4及12周末进行汉密尔顿抑郁量表(HAMD)、焦虑自评量表(SAS)、Bath强直性脊柱炎疾病活动指数(BASDAI)及功能指数(BASFI)评估.结果 治疗4周后,观察组AS患者BASDAI、BASFI评分均低于对照组,差异有统计学意义(P<0.05);治疗12周后,观察组AS患者HAMD、SAS、BASDAI、BASFI评分均较对照组降低,差异有统计学意义(P<0.05).观察组AS患者临床缓解率及焦虑抑郁状态改善率均高于对照组,差异有统计学意义(P<0.05).结论 团体认知行为治疗在改善AS患者焦虑抑郁症状的同时,还可以降低AS患者疾病活动度.

文章深入探讨热毒为干燥综合征发病机制,热毒按致病因素分为外来热毒及内生热毒.文章结合传统医学和现代医学两方面,阐述了热毒作为病机在干燥综合征疾病发展过程中的重要性,并详细分析“炎症因子”与干燥综合征发病的关系.提出热毒启动了干燥综合征的发病,为本病的启动因子.丰富了中医对本病病机的认识,运用清热解毒之法治疗干燥综合征贯穿疾病始终,随证加减,在临床诊疗中具有一定的借鉴和指导意义.

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:观察中西医结合治疗腹膜后纤维化的临床疗效和安全性.方法:选取接受活血化痰中药联合糖皮质激素和环磷酰胺治疗的腹膜后纤维化患者16例,分析治疗12周后的临床疗效和不良反应发生情况.结果:16例患者主要临床症状为腰痛、腹痛和乏力,治疗12周后患者腹痛、腰痛、乏力等症状均明显缓解,红细胞沉降率、C-反应蛋白均明显下降(P<0.05);治疗后影像学临床控制3例(18.75％),显效8例(50.00％),有效4例(25.00％),无效1例(6.25％),总有效率为93.75％;治疗前后影像学分期比较,差异无统计学意义(P>0.05);治疗过程中无严重不良反应发生.结论:活血化痰中药联合糖皮质激素及环磷酰胺治疗腹膜后纤维化疗效显著,安全性较好,具有增效减毒的作用,值得临床进一步推广应用.治疗前后影像学分期比较无明显变化,说明影像学分期不适合作为疗效评价指标判断短期病情活动情况.

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.

介绍胡荫奇教授治疗原发性干燥综合征的经验.认为本病当从毒、瘀、虚论治,以先天禀赋不足为之本,热毒为之始,痰瘀为之形,阴虚为之终.本病分为三个阶段,初期热毒侵袭,予以清热解毒;进展期痰瘀内生,予以活血化瘀、清热散结;终末期阴虚内燥,予以滋阴润燥.

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.

目的:观察骨龙胶囊联合改善病情的抗风湿药物(disease-modifying anti-rheumatic drugs,DMARDs)治疗类风湿关节炎的临床疗效和安全性.方法:选择2012年3月-2013年9月7家医院收治的类风湿关节炎患者240例,随机分为试验组和对照组,各120例,其中试验组用药为骨龙胶囊联合甲氨蝶呤组40例,骨龙胶囊联合来氟米特组80例;对照组中,骨龙胶囊模拟剂联合甲氨蝶呤组(即单用甲氨蝶呤)40例,骨龙胶囊模拟剂联合来氟米特组(即单用来氟米特)80例,疗程均为12周,比较骨龙胶囊联用甲氨蝶呤组与单用甲氨蝶呤组、骨龙胶囊联用来氟米特组与单用来氟米特组之间,达到美国风湿病学会(ACR)评分标准改善程度≥20％ (ACR20)的患者比例、中医证候疗效、患者28处关节疾病活动度积分(DAS28)评分以及体征评分之间的差异,并进行安全性比较.结果:骨龙胶囊联合甲氨蝶呤组ACR20 (80.56％)高于单用甲氨蝶呤组(58.82％),差异有统计学意义(P＜0.05).中医证候疗效比较,治疗4周后骨龙胶囊联合甲氨蝶呤组有效率高于甲氨蝶呤单用组,差异有统计学意义(P＜0.05);治疗8,12周,骨龙胶囊联合甲氨蝶呤组仍高于单用甲氨蝶呤组,但差异无统计学意义,骨龙胶囊联合甲氨蝶呤组在缓解症状起效时间上快于单用甲氨蝶呤组.DAS28评分比较,治疗12周后,骨龙胶囊联合甲氨蝶呤组、单用甲氨蝶呤组DAS28与各自基线相比差异有显著统计学意义(P ＜0.001).两组均值和中位数在治疗12周后均有明显降低,骨龙胶囊联合甲氨蝶呤组的降低幅度-(1.73±0.95)大于单用甲氨蝶呤组-(1.00±0.81),差异有统计学意义(P＜0.05).骨龙胶囊联合来氟米特组ACR20(80.00％)高于单用来氟米特组(63.38％),差异有统计学意义(P＜0.05).中医证候疗效比较,治疗4,8周后,骨龙胶囊联合来氟米特组有效率高于单用来氟米特组,但差异无统计学意义;治疗12周后,骨龙胶囊联合来氟米特组中医症候疗效(94.29％)优于单用来氟米特组(76.06％),差异有统计学意义(P＜ 0.05);DAS28评分比较,治疗12周后骨龙胶囊联合来氟米特组、单用来氟米特组DAS28与各自基线相比,差异有显著统计学意义(P ＜0.001).两组均值和中位数在治疗12周后均有明显降低,骨龙胶囊联合来氟米特组的降低幅度-(1.51±0.89)大于单用甲氨蝶呤组-(0.71±0.81),差异有显著统计学意义(P ＜0.001).骨龙胶囊联合DMARDs组与单用DMARDs组不良反应及不良事件的发生率差异无统计学差异.结论:骨龙胶囊联合DMARDs治疗类风湿关节炎疗效优于单用DMARDs,可显著改善患者的临床症状和体征,是治疗类风湿关节炎有效的治疗方案.

Objective: To observe the clinical efficacy and safety of Gulong capsules in the treatment of knee osteoarthritis ( defined as deficiency of liver and kidney, blood stasis syndrome). Methods: A total of 240 patients with knee osteoarthritis [defined as deficiency of liver and kidney, and blood stasis syndrome in traditional Chinese medicine ( TCM) ]who were admitted to 7 hospitals from March 2012 to July 2013 were randomly dividedinto the control group and test group, with 120 in each. The control group was given Weiguli ( glucosamine sulfate) capsules and Gulong blank capsules for 12 weeks, while the test group was given Gulong capsules and Weiguli blank capsules during the same period. The comparison included visual analog scale ( VAS) scores of osteoarthritis pain, the Western Ontario and Mc Master Universities ( WOMAC) scores, the TCM syndrome scores, improvement of individual symptoms/signs, and occurrence of adverse reactions. Results: After 4, 8 and 12 weeks of treatment, the VAS scores of the two groups were significantly different from those before treatment. The decrease in the test group was higher than that in the control group. There was statistically significant difference between the two groups in terms of WOMAC scores before treatment. The decrease magnitudes of the test group at 4 weeks and 8 weeks were statistically larger than those of the control group. The 12-week decline was still higher than that of the control group, but the difference was not statistically significant. After 4 weeks of treatment, the proportion of patients with improvement of more than 30％ in the test group ( 49. 06％) was higher than the control group ( 29. 63％, P ＜0. 05) ; the decrease of WOMAC five pain score in the test group was statistically greater than the control group.The total scores of TCM syndromes in the two groups were statistically different from those before treatment. The test group had a higher decline than the control group; the recovery rate and significant effect of the test group were higher than those of the control group; the test group was superior to the control group in the improvement of TCM symptom, characterized by weakness in the waist and knees, unfavorable joint activities, and joint tenderness;there was no significant difference in the incidences of adverse reactions and adverse events between the two groups. Conclusion: Gulong capsules have better curative effect for the treatment of knee osteoarthritis than Velcro capsules, with effect of tonifying liver and kidney, promoting blood circulation and removing blood stasis. It is an effective and safe therapeutic medicine for the treatment of knee osteoarthritis. The sample size of this study is small, and it is nececcary to further carry out large-sample clinical studies.

Objective:To establish diagnostic system of TCM syndrome of rheumatoid arthritis (RA).Methods:A total of 1,000 RA patients′ diagnostic information of TCM syndrome was collected for multi-variate analysisthe syndrome information was collected to establish the diagnostic system of TCM syndrome of RA.Results:RA syndrome diagnostic criteria were establishedafter the 1,000 RA patients with 179 diagnostic elements were screenedincluding 10 basic syndromes and 56 diagnostic optimization indexes.Conclusion:RA mainly comprises 10 basic syndromes,and the diagnosis system has significant diagnostic value.It is effective to use multi-variate statistical analysis combined application in the study of diagnostic criteria of TCM syndrome screeningand it is worthy of further promotion.

Objective To investigate the value of T cell spot test (T-SPOT.TB) in thc diagnosis of the infection of tuberculosis in patients with rheumatic diseases.Methods From July 2010 to July 2014,266 patients screened for tuberculosis using T-SPOT.TB and examine the sputum in Department of Rheumatology,PLA Army General Hospital were selected.Among the patients,132 cases were diagnosed with rheumatic diseases (rheumatic diseases group),and 134 cases were non-rheumatic immunity (non-rheumatic immunity group).The results of T-SPOT.TB,sputum culture and anti-acid staining of patients were collected.The positive rate of tuberculosis diagnosed by T-SPOT.TB between the two groups.Results The positive rate of tuberculosis diagnosed by T-SPOT.TB in the rheumatic diseases group was 39.39％ (52/132),and the positive rate in the non-rheumatic diseases group was 46.53％ (67/134).There was no statistical significance difference (P ＞ 0.05).Conclusion T-SPOT.TB has certain diagnostic value for the screening of mycobacterium tuberculosis in patients with rheumatoid immunity.

Objective To observe the effect of tetrandrine in treating connective tissue disease caused interstitial lung disease (CTD-ILD). Method 32 case of CTD-ILD were randomly divided into two groups, each group 16 cases.Corticosteroids and immunosuppressive therapy were given to the control group. The treatment group on the basis of the above treatment with tetrandrine 40mg, 3 times a day orally, the course of treatment was three months for both groups. Result After treatment, the effective rate in the control group was 53.33%, in the treatment group was 87.50%, and there was significant difference between the two groups (P<0.05). After the treatment, the arterial partial pressure of oxygen and forced vital capacity, total lung capacity, diffusion capacity for carbon monoxide of lung were significantly improved than before(P<0.01), while the treatment group the various indicators improved significantly better than those of control group (P<0.05). Conclusion Tetrandrine has good clinical curative effect in treating connective tissue disease related interstitial lung disease, it can significantly improve the patient's lung function.

OBJECTIVE:To observe the effect of norcantharidin (NCTD) on collagen-induced arthritis (CIA) rats.METHODS:Sixty Sprague-Dawley(SD) rats were randomly divided into 6 groups (n=10): normal group, CIA model group(model group), NCTD low-dose group [1.35 mg/(kg•d)], NCTD middle-dose group [2.7 mg/(kg•d)], NCTD high-dose group [5.4 mg/(kg•d)] and methotrexate (MTX) group [1.8 mg/(kg/w)]. Anesthetized rats were sacrificed by luxation of cervical vertebra after 4 weeks of administration. The arthritis scores were evaluated twice a week. The pathological changes in the ankle joints of rats were observed by hematoxylin-eosin (H&E) staining. The serum levels of interleukin (IL) 1β, IL-6, tumor necrosis factor (TNF)-α, vascular endothelial growth factor (VEGF), IL-17 and transform growth factor (TGF) β were detected by enzyme linked immunosorbent assay (ELISA). The mRNA expression of retinoid-related orphan nuclear receptorγt (RORγt) and forkhead box P3 (Foxp3) in peripheral blood lymphocytes were confirmed by real-time polymerase chain reaction.RESULTS:MTX and high-dose NCTD not only decreased the arthritis scores but also alleviated the pathological changes in CIA rats' ankle joints compared with the model group (P<0.05 or P<0.01). All doses of NCTD significantly inhibited the serum levels of IL-6, IL-17 and TNF-α in CIA rats (P<0.05). Only middle- and high-dose of NCTD prominently decreased serum IL-1β and TGF-β levels of CIA rats (P<0.05). However, NCTD has no effect on vascular endothelial growth factor (VEGF) level in CIA rats. The Foxp3 mRNA expression in all NCTD groups were increased significantly than in the model group (P<0.05). The mRNA expression of RORγt in NCTD high-dose group was decreased apparently in comparison with the model group (P<0.05).CONCLUSIONS:NCTD showed therapeutic effect on CIA rats by inhibition of cytokines and regulation of Th17/Treg cells.

Objective:To observe the clinical effects of removing both phlegm and blood stasis therapy in treating connective tissue disease related interstitial lung disease (CTD-ILD);Methods:A total of 52 patients with CTD-ILD were randomly divided into treatment group and control group,with 26 cases in each group.The control group received glucocorticoid and immunosuppressive therapy,and the treatment group was added treatment with drugs of removing both phlegm and blood stasis on the basis of the above treatment for 3 months.The effective rate,he 6-minute walk distance,the arterial partial pressure of oxygen (PaO2),forced vital capacity (FVC),total lung capacity (TLC),and diffusion capacity for carbon monoxide of lung (DLCO) of two groups were evaluated.Results:After treatment,the effective rates in treatment group and control group were 88.46％ and 64.0％ respectively,and the difference between the two groups was statistically significant (P ＜ 0.05);After the treatment,the 6-minute walk distance,PaO2,FVC,TLC and DLCO were significantly improved than that before treatment (P ＜ 0.05),while the improvement of these indicators in the treatment group was significantly better than those of control group (P ＜ 0.05).The number of patients with adverse reactions in the control group was significantly larger than that in the treatment group (P ＜ 0.05).Conclusion:Removing both phlegm and blood stasis therapy has better clinical efficacy in treatment of CTD-ILD,which can significantly improve thepulmonary function of patients,as well as reduce the glucocorticoid and immunosuppressive drug toxicity,so it can be further applied and promoted in clinical practice.

目的 观察艾拉莫德联合治疗原发性干燥综合征(primary sjogren's syndrome,pSS)的临床效果和安全性.方法 选取我科2014年7月-2015年5月收治的pSS 60例,随机将其分为观察组和对照组各30例.观察组采用甲泼尼龙联合艾拉莫德治疗,对照组采用甲泼尼龙联合硫酸羟氯喹治疗,均治疗12周.观察比较两组临床疗效和安全性指标.结果 治疗12周后两组血清IgG含量、红细胞沉降率及类风湿因子水平均较治疗前有所改善,差异均有统计学意义(P ＜0.05);IgG降低到正常值观察组28例(93.3％),对照组22例(73.3％),观察组IgG降低有效率高于对照组,差异有统计学意义(P＜0.05).观察组治疗1周后发现1例血白细胞降低,加用利血生口服1周恢复正常;对照组治疗2d后1例出现皮疹、皮肤瘙痒,予以醋酸泼尼松乳膏外用3d症状消失.结论 糖皮质激素联合艾拉莫德能明显降低血清IgG水平,并能抑制相关炎症反应达到治疗pSS的目的,且其治疗pSS的效果优于糖皮质激素联合硫酸羟氯喹.

Objective:To observe the curative effect and safety of integrated traditional Chinese and western medicine in treating systemic lupus erythematosus (SLE)complicated with herpes zoster (HZ).Methods:A total of 56 cases of patients with SLE were randomly divided into treatment group and control group with 28 patients in each.Both groups were treated wiht conventional treatment and acyclovir orally.Additionally,heat-clearing,blood-cooling antitoxicant herbs and helium-neon laser therapy were given to the treatment group.The treatment lasts for 1 4 days.Results:After treatment,the results of medicinal diagnosis in treat-ment group showed better than the control group in the clinical manifestation of total effective rate,pain outcome,the duration of herpes regression,and the duration of crusts form and fall.The results is of statistical significance with P <0.05.Adverse reaction has not been seen in both groups.Conclusion:Integrated traditional Chinese and western medicine is an effective and safe way to treat SLE complicated with HZ,and worth spreading for clinical use.

目的:观察中药虎力散胶囊治疗膝骨关节炎的有效性与安全性.方法:将350例膝关节骨性关节患者随机分为两组,试验组采用虎力散胶囊口服,对照组采用双氯芬酸钠肠溶片口服,连续用药14d,观察两组的治疗效果及不良反应情况.结果:治疗2周后,两组视觉模拟评分(VAS)评分和关节功能评分较治疗前均有明显改善,且试验组关节功能评分改善优于对照组(P＜0.05),试验组不良反应发生率低于对照组,差异有统计学意义(P＜0.01).结论:虎力散胶囊治疗膝骨关节炎可使关节肿胀、疼痛等症状消失或明显好转,并在一定程度上改善关节功能,不良反应少,安全性好.

Objective Exploring the related risk factors in patients with systemic lupus erythematosus complicated with herpes zoster,to prevent and control herpes zoster. Method Enrolled 26 cases of systemic lupus erythematosus patients with herpes zoster as the observation group from inpatients of Department of Rheumatism of General Hospital of Beijing Military Region,35 cases of systemic lupus erythematosus patients hospitalized in the same period as the control group. The clinical data of two groups of successively by single factor analysis and multi factor non condition-al Logistic regression analysis. Result Course of disease,the value of lymphocyte,hormone treatment time,the hor-mone impact cases,immunosuppressive treatment time,whether treated with cyclophosphamide in one month as well as CD+3 ,CD+4 ,CD+8 value,CD+4/CD+8 ratio were significantly correlated with the occurrence of herpes zoster ( all P<0. 05). Multivariate Logistic regression analysis showed that hormone therapy time and number of cases received hor-mone impact treatment were significantly positive correlation with herpes zoster, absolute value of lymphocyte was negatively correlated with herpes zoster (P<0. 05). Conclusion Hormone in patients with systemic lupus erythema-tosus using time prolonged,the hormone impact treatment and reduction in absolute lymphocyte are major risk factors of herpes zoster occurred;while patients with the extension of course,immunosuppressive treatment time prolonged, treated with cyclophosphamide in one month and CD+3 , CD+4 decreased and CD+8 increased,the numerical value of CD+4/CD+8 ratio decreased are secondary risk factors,clinicians should give early attention and positive prevention of herpes zoster.

Objective To evaluate the efficacy and safety of the external application of traditional Chinese medicine Hulisan capsule for the treatment of knee osteoarthritis ( OA ) . Methods A randomized, positive-controlled and multi-center clinical trial was carried out.Five-hundred patients with knee OA were recruited and randomly divided into two groups:the treatment group and the control group. Each patient of the treatment group ( n=350 ) was given eight Hulisan capsules for external application once a day, while the patients of the control group ( n=150) adopted diclofenac emulsion three times per day.Both the groups were treated for 14 days.The changes of symptoms and signs before and after the treatment and the incidence of adverse events were observed.Results A total of 442 patients completed the trial.After 14 days treatment, the visual analog scale (VAS) pain score and the joint function score of the two groups were significantly improved ( P<0.01 ) compared with those before the treatment; but the VAS score and the joint function score were improved better in the treatment group than in the control group (P<0.01).The incidences of related side effects (mainly as skin allergies) of the Hulisan capsule and the diclofenac emulsions were 1.63% and 0.74% respectively, and no statistical difference between the two groups ( P>0.05) .Conclusion External application of Hulisan capsule can significantly reduce the joint pain and improve joint function within two weeks with a good safety profile of low incidence of adverse reaction.