This study investigated the differential metabolites after rheumatoid arthritis (RA) rats were treated with Jinteng Qingbi granules. Collagen-induced arthritis rats were divided into three groups, namely normal group, model group, and Jinteng Qingbi granules group. Serum compounds were identified, annotated, and classified using metabolomics to explain the physicochemical properties and biological functions. The metabolites were screened using univariate and multivariate statistical analyses. There were differences in serum metabolites between RA and normal rats; Jinteng Qingbi granules improved RA and recovered the metabolite levels to normal. Compared to the normal group, 51 differential ions were screened, and 108 ions were changed in the Jinteng Qingbi granules group compared to the RA model. Eight metabolites were upregulated in the RA model group compared to the normal group, whereas 10 metabolites were downregulated. Treatment with Jinteng Qingbi granules increased the levels of 12 metabolites such as cinnamate and decreased the levels of 16 metabolites such as allamandin in the RA model. Differential ion enrichment was mainly related to the histidine metabolic pathway in amino acid metabolism. Jinteng Qingbi granules resulted in improvements in the RA model, which were mainly associated with lipids and lipid-like molecules, organic acids, and derivatives, providing a new possibility and basis for screening biomarkers for the diagnosis and treatment of RA.

目的:基于数据挖掘技术探讨房定亚教授治疗急性痛风性关节炎的临床用药规律.方法:收集 2014 年 10 月至 2019 年 12 月在中国中医科学院西苑医院房定亚教授特需门诊就诊的 78 例急性痛风性关节炎患者的中药处方,应用中医传承辅助平台(V2.5)临床采集系统,录入数据,采用复杂系统熵聚类、关联规则算法等数据挖掘的方法,分析房定亚教授治疗急性痛风性关节炎的组方特点和用药规律.结果:共纳入中药处方78首,辨证以湿热阻络为主,涉及药物93味,使用频次 ﹥30次的药物有葛根、土茯苓、车前草、马齿苋、玄参等 9 味,获得置信度为 1 的药物组合 24 个,提取核心药物组合 8 个,挖掘潜在治疗新处方 4 首.结论:房定亚教授治疗急性痛风性关节炎以清热利湿为主,佐以活血通络,体现其辨病与辨证相结合,专病专方治疗疾病的思想.

目的 研究金藤清痹颗粒通过调节免疫微环境对类风湿关节炎大鼠的干预作用及其机制.方法 通过注射牛Ⅱ型胶原和弗氏不完全佐剂建立胶原诱导型关节炎(CIA)大鼠模型,造模成功后随机分为模型组、甲氨蝶呤组、雷公藤多苷组及金藤清痹颗粒低、中、高剂量组,每组10只,另以10只正常大鼠作为正常组,给药组灌胃给予相应剂量药物,模型组和正常组灌胃给予等体积0.9％氯化钠注射液.每7 d进行1次足底厚度检测和关节指数评分,HE染色观察膝关节滑膜病理改变,免疫组化检测滑膜CD68、CD86、CD206表达,流式细胞术检测外周血中辅助性T细胞17(Th17)和调节性T细胞(Treg)比例,Western blot法检测TLR4/NF-κB信号通路蛋白表达,RT-qPCR法检测TLR4、IKKβmRNA表达.结果 金藤清痹颗粒与甲氨蝶呤、 雷公藤多苷均能减轻CIA大鼠四肢关节肿胀(P<0.05),降低M1/M2型巨噬细胞比例、Th17/Treg细胞比例、TLR4 mRNA及TLR4、p-IκBα、细胞核p65蛋白表达(P<0.05,P<0.01),升高IKKβ、 胞质p65蛋白及IKKβmRNA表达(P<0.05,P<0.01),并呈剂量依赖性.结论 金藤清痹颗粒能够通过影响M1/M2型巨噬细胞极化,调节Th17/Treg细胞平衡,调控TLR4/NF-κB信号通路表达,改善免疫微环境,从而缓解类风湿关节炎大鼠关节肿胀症状.

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease characterized by progressive bone erosion on diarthrodial joints. RA patients usually experienced three stages before final diagnosis: the health period, the pre-clinical period (immune response exists without clinical symptoms), and the pre-RA period (immune response exists with mild inflammatory manifestation). Presently, there is seldom guidance referring to early intervention which is a benefit for stable disease conditions and low morbidity. Prophylactic treatment is a major feature of traditional Chinese medicine (TCM). In this present study, a multi-center, double-blind, placebo-controlled clinical trial is carried out to evaluate both efficacy and safety in preventing RA progression on Yunpi Qufeng Chushi formula (YQCF). Method: The multi-center, double-blind, placebo-controlled clinical trial is conducted in 13 hospitals nationwide. A total of 390 patients ages between 18 and 70 will be recruited in the trial. They will be randomly assigned to the intervention group (YQCF) and placebo group. The follow-up visit will be taken every 3 months from baseline to 1 year. Diagnosis, disease activity scores, clinical disease activity index (CDAI), simplified disease activity index (SDAI), TCM syndrome scores, and safety assessments will be recorded at every visit. Joint color doppler ultrasound, health assessment questionnaire-disability index (HAQ-DI), and functional assessment of chronic illness therapy-fatigue (FACIT-F) will be recorded at baseline and the last visit. Discussion: This work will provide evidence of YQCF in preventing RA progression. However, whether early intervention would benefit the controlling RA disease still needs a long-term follow-up. Ethics and dissemination: Protocol version 2 (201910-1). This research was approved by the medical ethics committee of Zhejiang Chinese Medical University (2019-045). Results will be published in a peer-reviewed academic journal. Trial registration numbers: http://www.chictr.org.cn/index.aspx, ChiCTR1900024166.

类风湿关节炎(rheumatoid arthritis,RA)是一种以侵蚀性关节炎症为主要临床表现的全身性自身免疫性疾病,可以发生于任何年龄[1,2].RA的发病机制目前尚不明确,其基本病理表现为"滑膜炎",并逐渐出现关节软骨和骨破坏,最终导致关节畸形和功能丧失,可并发肺部疾病、心血管疾病、恶性肿瘤、抑郁症等.流行病学显示,我国RA的患病率为0.42％,患者总数约500万[3],男女比约为1∶4[4,5].现代医学并无根治RA的方法,临床多采用非甾体抗炎药、激素、免疫抑制剂等[6].中医药对缓解RA关节及关节外症状、提高临床疗效、改善生活质量等方面具有独特优势[7,8].

大柴胡汤首载于《伤寒论》和《金匮要略》，是治疗少阳、阳明合病的经典方剂。房定亚教授善用大柴胡汤治疗符合少阳、阳明合病的各类疑难杂症，尤以肝胆疾病、胃肠疾病、肺系疾病、皮肤疾病为主。本文列举四则医案，体现房教授运用大柴胡汤的要点，并介绍本方与其他方剂合用的经验。

目的 建立并验证北京地区健康成年女性血清尿酸的参考区间.方法 选择2019年1月—10月在中国中医科学院西苑医院的健康女性体检者10459例作为研究对象,按年龄分成<25、<35、<45、<55、<65、<75、75岁共7组,采用Roche Cobas 8000全自动生化分析仪检测血清尿酸水平,并进行统计学分析.尿酸的参考区间以95％(P2.5～P97.5)的置信区间为准进行计算.结果 <25、<35、<45这3组尿酸水平相对稳定且差异无统计学意义,合并为<45组;<45组与另外4个组差异均有统计学意义;<55岁组及<65岁组、<65岁组及75岁组、<75岁组及75岁组差异有统计学意义(P<0.05);<55岁组及<75岁组、<55岁组及75岁组、<65岁组及<75岁组组间比较差异无统计学意义.结论 初步建立并验证北京地区健康成年女性血清尿酸的参考区间,为临床提供了相应的实验室参考依据.

葛根为临床常用中药,其临床应用广泛,运用葛根治疗风湿病,取得了一定疗效.结合临床病例,探讨运用葛根治疗强直性脊柱炎、干燥综合征、痛风3种风湿病的中医理论基础、现代药理依据、临床疗效和注意事项,以期为风湿病的治疗提供借鉴.

SAPHO综合征是一组罕见的以皮肤和/或骨与关节炎性病变为主要临床表现的异质性疾病,其典型皮肤表现包括无菌性脓疱病及重度痤疮,此外还涉及化脓性汗腺炎、寻常型银屑病等,部分患者皮肤表现也可缺失.现代医学对本病的亚型分类尚未得到公认,各种亚型在治疗上是否应区别对待也未达成共识.既往中医药诊治SAPHO综合征的病例报道极少,尤其缺乏对痤疮型病例的治疗探讨.本文报道1例患者以"面部炎性丘疹、结节、囊肿3年,右臀区、右髋疼痛2周"为主诉于2017-04-27入住中国中医科学院西苑医院风湿病科,诊断为痤疮型SAPHO综合征,采用中医药治疗有效,揭示本型以湿热毒瘀为本,筋脉拘挛为标,临证应注意清热解毒药物、解痉止痛药物、入心经药物及藤类药物的使用,并结合文献研究探讨本病亚型分类的必要性与可行性.

目的:探讨DWI联合磁化传递对比成像(MT)能否提高对强直性脊柱炎(AS)骶髂关节炎活动性的诊断价值.方法:按照纽约标准将39例临床诊断的AS患者分为活动组和非活动组,测量骨髓水肿区(BME)、硬化区(Sc)、脂肪沉积区(FD)、正常骨髓区(NABM)的ADC值和骶髂关节软骨的磁化传递率(MTRc).采用独立样本t检验比较两组间5项参数值的差异,并采用ROC曲线分析各参数对骶髂关节炎活动性的诊断效能,将有预测价值的参数进行logistic回归联合,并采用ROC曲线分析回归方程对关节炎活动性的预测价值.结果:两组间ADCBME、ADCNABM和MTRc的差异有统计学意义(P =0.001,P＜0.001和P=0.025);ADCBME、ADCNABM、MTRc、ADCBME+ADCNABM、ADCNABM+MTRc和ADCBME+MTRc的ROC曲线下面积(AUC)分别为0.738、0.849、0.719、0.885、0.849和0.864(P值均＜0.05).联合指标(ADCBME+MTRc和ADCNABM+MTRc)预测骶髂关节炎活动性的价值提高.结论:DWI和MT联合能提高诊断AS的能力和预测AS活动性.

目的 探讨类风湿性关节炎(RA)、系统性红斑狼疮(SLE)及原发性干燥综合征(pSS)患者肾损伤与体液免疫的相关性.方法 选取2018年3月—11月于中国中医科学院西苑医院风湿免疫科收治的83例RA患者为RA组、40例SLE患者为SLE组和50例pSS患者为pSS组,另选50例同期健康体检者为对照组.检测受试者血清免疫球蛋白(IgG、IgA)及尿β2-微球蛋白(β2-MG)、α1-微球蛋白(α1-MG)、微量白蛋白(mALB)、肌酐(Cr)、ACR,采用Pearson分析肾损伤指标与体液免疫的相关性.结果 pSS组、SLE组与RA组血清IgG、IgA及尿β2-MG、α1-MG水平均高于对照组(P<0.05);pSS组与RA组尿Cr低于对照组,ACR高于对照组(P<0.05);各组尿mALB水平比较差异无统计学意义(P>0.05).RA组血清IgA、β2-MG与IgG呈正相关(P<0.05);SLE组血清IgA、mALB、α1-MG、β2-MG与IgG呈正相关(P<0.05);pSS组血清IgA、β2-MG与IgG呈正相关(P<0.05).结论 RA、SLE和pSS患者免疫学指标显著增高说明其体液免疫可能被不同程度激活,导致免疫功能发生紊乱;肾损伤指标显著增高提示RA、SLE和pSS患者可能有不同程度的肾损伤;肾损伤指标与免疫学指标正相关说明血清免疫球蛋白(IgG、IgA)可能参与肾损伤病理过程,可为临床诊治患者病情提供一定的参考价值.

Objective Iterative decomposition of water and fat with echo asymmetry and least-squares estimation-iron quantification (IDEAL-IQ) is a noninvasive and objective method used to quantitatively measure fat content. Although this technique has been used in the entire abdomen, IDEAL-IQ findings in the sacroiliac joint (SIJ) have rarely been reported. This preclinical study was performed to quantify the amount of fat in the SIJ in healthy volunteers by IDEAL-IQ. Methods From April to November 2017, 60 healthy volunteers with low back pain were included in this retrospective study. The participants were allocated into groups by age (15–30, 31–50, and ≥51 years), sex (male and female), and body mass index (BMI) (<18.5, 18.5–23.9, and ≥24.0 kg/m2). The iliac-side (Fi) and sacral-side (Fs) fat fractions were obtained in all groups. Two- and three-factor multivariate analyses were performed to analyze the effects of sex, age, and BMI on the Fi and Fs. Results The interaction among sex, age, and BMI had no statistically significant effect on the dependent variable. Both Fi and Fs were significantly influenced by age. Fs was significantly influenced by sex. Conclusion The IDEAL-IQ sequence can be used to quantitatively assess the SIJ fat content in healthy volunteers.

系统性红斑狼疮(systemic lupus erythematosus,SLE)是风湿科常见的、病情较重的疾病之一,可累及多个系统,严重危害人类健康.糖皮质激素及免疫抑制剂的使用在缓解病情、控制临床症状及改善预后等方面取得了一定的疗效,但是长期或大剂量应用会引起严重的毒副反应,如性腺抑制、感染、骨质疏松、无菌性骨坏死、高血压、高血糖、高血脂等[1].房定亚教授为著名的中医风湿病专家,在数十年的临床诊疗中,对于SLE患者应用西药的同时分期辨证选用中药,协同增效,减少西药的不良反应,取得了良好的效果,现将其经验介绍如下.

痛风性关节炎是以血尿酸升高沉积于关节引起的急性关节炎,根据其发作情况分为急性发作期和慢性缓解期.中国中医科学院房定亚教授为著名的风湿病专家,经过长期的临床实践提出分期辨证论治痛风性关节炎,即急性发作期关节表现为红肿热痛时治宜清热利湿,以自拟痛风方加减,并配合自制外敷药清热消肿;慢性缓解期宜从本论治、补益脾肾,常选清宫寿桃丸;若合并出现尿蛋白者以芡实合剂加减,并认为瘀血贯穿痛风性关节炎疾病的始终,治疗需活血化瘀,可应用血府逐瘀汤加减取得良好临床疗效.

This article briefly introduces FANG Dingya's experience in preventing and treating urarthritis with the idea of "preventive treatment of disease",which has three aspects,including preventing disease before it arises,controlling the development of existing disease and preventing the recurrence after cure.During the asymptomatic hyperuricemia period,physicians should focus on "preventing disease before it arises" with the health education for patients,meanwhile clearing heat,draining dampness,draining turbid and expelling stones are the main therapeutic principles,to prevent and treat the acute onset of gout and the formation of urinary stones.During the intermission period and the chronic period,"controlling the development of existing disease" is important,the therapeutic principles are regulating Qi,invigorating blood,dissolving stasis and unblocking the collaterals.For the remission period,tonifying liver and kidney should be emphasized based on "preventing the recurrence after cure".

Lobular panniculitis is a rarely - seen non - suppurative inflammation primarily occurring at fat lobules,characterized as recurrent occurrence of painful nodules and fever. In western medicine in sub-cutaneous fat. Corticosteroids and immunosuppressive agents are commonly used,but with many adverse reac-tions. The integration of Chinese and western medicine plays the co - work on the therapeutic effects and ef-fectively reduces the side effects induced by western medicine. Prof. Fang Dingya is the famous expert on rheumatic disorders and believes that the basic pathological manifestations of panniculitis include vasculitis and panniculitis nodules. The internal accumulation of heat toxin is involved in the acute stage and heat toxin consuming qi and yin involved in the recovery stage. The modified simiao yongan decoction and the empirical formula"san liang san"are adopted in different stages for detoxification and removing masses. The therapeutic effects are satisfactory.

产后关节疼痛是产后经常出现的病症之一，历代医家多以补肾、补益气血、祛风论治，房定亚教授认为产后身痛病机肾虚为主，肝气郁滞贯穿疾病始终，并重视西医病理机制的研究，治疗上补肾疏肝，并酌情根据中药药理选择药物加减，取得较好疗效。

目的:探讨鹤膝风发病特点及中医证型分布情况. 方法:收集143例鹤膝风患者临床资料,包括年龄、病程、病种、C反应蛋白(CRP)等,进行中医辨证分型,分为热毒蕴结型、痰瘀互结型、肝肾不足型、阳虚寒凝型四型. 分析不同病种、年龄、病程及CRP水平各证型分布情况. 结果:143例患者热毒蕴结型63例、痰瘀互结型38例、肝肾不足型36例、阳虚寒凝型6例. 不同年龄、病程、病种及CRP水平各证型分布差异均有统计学意义(P<0.05). 结论:鹤膝风常见证型为热毒蕴结型,其中医证型分布与发病年龄、病种、病程及CRP水平有一定关系.

全国高等中医药院校规划教材(第九版)由中国中医药出版社于2012年7月出版,至今2年有余.笔者担任《中医内科学·肢体经络病证》讲师多年,在近2年的理论及临床教学中,体会到九版教材痹证章节对热痹的重视程度空前提高,在历史沿革、病因病机、辨证论治、医案举隅等方面均强化了热痹的概念,使理论教材更加切合风湿病临床实际,值得教学工作者重视.