Objective To explore the impacts and effects of individualized diet management on the thrombospondin-1 (TSP-1) in patients with type 2 diabetes mellitus.Methods A total of 112 patients with type 2 diabetes mellitus admitted to our hospital were selected and randomly divided into an observation group and a control group (n=56,respectively).On the basis of the original therapeutic scheme,the control group received regular diet education and diabetic diet and the observation group received individualized diet management,remote follow-up and other nursing intervention.The TSP-1 levels and effects 12 months before and after the treatment between the two groups were compared.Results 12 months after the treatment and nursing,the FBG and 2 h PBG levels in the control group were improved,and the BMI,FBG,2 h PBG,HbA1c and TSP-1 levels in the observation group were also improved (P ＜ 0.05);the post-treatment BMI,FBG,2 h PBG,HbA1c and TSP-1 levels in the observation group were lower than those in the control group(P ＜ 0.05).In addition,the post-treatment scores of the scale of the diabetes self-care activities (SDSCA) in the observation group were significantly higher than those in the control group(P ＜ 0.05).Conclusion Individualized diet management can lower the TSP-1 levels in patients with type 2 diabetes mellitus,effectively control blood glucose,BMI and other indexes,and improve the diet therapy compliance of patients,so it has high clinical application value.

目的 比较两种不同漱口液在系统性红斑狼疮(SLE)患者激素治疗期预防口腔真菌感染的效果.方法 将108例系统性红斑狼疮患者随机分为对照组和实验组,每组54例.对照组在激素治疗期给予生理盐水、碳酸氢钠液交替漱口;实验组则给予0.02％呋喃西林溶液、制霉菌素500万U加入500 ml生理盐水中,交替漱口.观察比较两组口腔真菌感染的发生情况.结果 实验组口腔真菌感染率明显低于对照组(P＜0.05).结论 生理盐水+制霉菌素+呋喃西林溶液交替漱口可明显减少SLE患者激素治疗期口腔真菌感染的发生率,值得临床推广使用.

目的 探讨平衡针灸治疗风湿科患者使用激素导致失眠的临床效果及安全性.方法 选取北京军区总医院风湿科使用激素后导致失眠的患者共72例,随机分为治疗组及对照组,各36例.治疗组给予平衡针灸治疗,1次/d,2周为一疗程,共治疗2个疗程;对照组给予百乐眠胶囊口服,4粒/次,2次/d,4周为一疗程,治疗1个疗程.分别于治疗前和治疗后第4周使用匹兹堡睡眠质量指数(PSQI)对两组患者进行评价,同时对比分析两组患者的临床疗效及安全性.结果 经过不同治疗后,对照组PSQI评分与治疗前相比差异无统计学意义(P＞0.05),而治疗组PSQI评分则低于治疗前,差异有统计学意义(P＜0.05),两组相比,治疗组较对照组低,差异有统计学意义(P＜0.05).治疗组治疗总有效率为91.67％,高于对照组的66.67％,差异有统计学意义(P＜0.05).两组均无明显不良反应.结论 平衡针灸通过刺激神经,调节营卫气血及脏腑功能,提高患者睡眠质量,达到缓解风湿科患者使用激素所致失眠的作用,操作简便,安全性高,临床实用性强.

目的 探讨虎力散胶囊内药粉外敷治疗类风湿性关节炎的临床疗效.方法 将110例类风湿性关节炎患者分为两组,观察组55例,采用内服来氟米特+外虎力散胶囊内药粉外敷治疗;对照组55例,给予内服来氟米特+氟比洛芬巴布膏外敷治疗.治疗4w后,观察比较两组治疗效果.结果 治疗4w后,两组都有效果,实验室检查血沉、C反应蛋白都有明显改善,总有效率两组间无统计学差异(P＞0.05).但观察组晨僵时间、肿胀指数、疼痛分值等局部关节症状改善程度比对照组更显著(P＜0.05).治疗期间两组均未出现明显不良反应.结论 口服来氟米特联合外敷虎力散胶囊内药粉对改善类风湿性关节炎患者晨僵时间、肿胀指数、疼痛分值等局部关节症状疗效更显著,且虎力散胶囊价格低廉,属于医保品种用药,患者易于接受,值得推广应用.

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.

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.

目的 观察人性化特色护理干预对类风湿性关节炎患者生活质量的影响.方法 将56例类风湿性关节炎患者随机分为实验组和对照组.每组28例.对照组给予常规类风湿药物治疗加护理,实验组在对照组治疗护理基础上给予人性化特色护理干预.两组以1个月为1个疗程,6个疗程后观察疗效.结果 治疗6个疗程后,实验组效果明显高于对照组,两组比较,差异有统计学意义(P＜0.05).结论 早期给予常规药物治疗联合人性化护理干预,更有利于提高类风湿性关节炎患者的生活质量,对临床有一定的借鉴意义.

Objective To establish a syndrome diagnostic criterion for rheumatoid arthritis( RA) and validate the diagnostic performance of the criteria. Methods We drew up a RA clinical syndrome questionnaire and applied cross-sectional study method. 700 RA patients were surveyed. Then survey information underwent multivariate statistical analysis,including cluster analysis,logistic stepwise regression analysis,stepwise discriminant analysis,principal component analysis,and factor analysis. The diagnostic performance of RA syndrome diagnostic criteria was validated with discriminant analysis. Results Diagnostic indicators of 700 RA patients were reduced from 179 to 124 after first screening; cluster analysis showed that the basic syndromes were damp-heat stagnation,liver-kidney yin deficiency,stagnation of blood stasis,cold-damp stagnation,blood and qi deficiency,phlegm and blood stasis blocking collaterals,and spleen-kidney yang deficiency. By Logistic stepwise regression analysis,the diagnostic indicators of these 7 syndromes were reduced from 124 to 41. Forty six diagnostic indicators were added after stepwise discriminant analysis. Summing up the indicators above,we confirmed that there were 52 sensitive diagnostic indicators for 7 basic syndromes of RA. And after principal component analysis was applied on these 52 indicators,47 remained. Factor analysis then was done on the 47 indicators. According to contributions of the symptoms to the syndrome,syndrome diagnostic criteria of 7 RA basic syndrome types were developed. It is proved with discriminant analysis that the diagnostic accuracy of the criteria was 83. 39%. Conclusion There are 7 basic TCM syndromes in RA,and TCM syndrome diagnostic criteria of RA have a relatively high diagnostic value.

类风湿关节炎（rheumatoid arthritis，RA）是一种系统性炎性疾病，主要侵犯活动关节的滑膜［1］。临床表现为对称性、进行性、侵蚀性关节炎及晨僵，病情迁延，如不及时治疗会导致受累关节的强直、畸形和功能丧失，严重影响患者生活质量。免疫功能失调为患者发病的重要原因之一，因此抑制炎症反应成为治疗类风湿关节炎的重要手段。白细胞介素-6（IL-6）是多功能细胞因子，与类风湿关节炎的发病密切相关，切断IL-6信号传导是治疗RA的新途径。生物制剂托珠单抗注射液（雅美罗）是由中国仓鼠卵巢细胞通过DNA重组技术制得的一种重组人源化抗人IL-6受体单克隆抗体，此药通过阻断IL-6的传导通路达到治疗类风湿关节炎的目的。此药自上市以来，我科2013年10月～2014年1月对8例患者进行临床应用，效果满意。但该药为生物制剂，临床应用时间较短，在使用过程中要密切观察病情并给予相应护理措施，现将我科使用中的护理体会做一介绍。

目的 了解不同文化水平的系统性红斑狼疮(SLE)患者对使用激素的认知、态度和行为状况,分析相关影响因素.方法 对2012年7月～2013年8月住院的120例不同文化水平的SLE患者,采用自行设计的问卷进行对激素知信行的调查.结果 不同文化水平的SLE患者对激素的认知、态度、行为有明显差异.在认知方面,大专以上文化组、初高中文化组和小学文化组平均得分分别为11.875、10.85、6.325分;态度方面,分别为3.7、3.075、2.425分;行为方面,分别是5.075、5.825、5.2分.结论 SLE患者总体对激素的认知水平中等,态度、行为在中低水平,直接影响患者的治疗和预后.不同文化水平患者的认知、态度和行为有明显差异:文化程度高者,对疾病知识掌握较多,但存在自主改变治疗方案的现象,影响系统治疗的效果;文化程度低者,对疾病知识掌握少,对激素了解不够详细,存在有病乱投医现象,或因担心副作用而自行停换药.今后应该加强对患者健康知识宣教,提高患者对激素的认知,改善用药态度,积极配合医生治疗,提高治疗效果.

银屑病关节炎（ psoriatic arthritis，PsA）是一种与银屑病相关的炎性关节炎，受累关节可出现肿胀、疼痛、晨僵，晚期出现关节畸形或致残，从而导致患者生活不能自理，自我形象紊乱，多数患者产生自卑心理，内心十分痛苦，生活质量降低。而早诊断、早治疗、规范用药、做好护理工作，对银屑病关节炎具有十分重要的意义，对改善患者预后有很大帮助。本院2009年5月～2013年5月在门诊和病房共收治80例银屑病关节炎患者，经过治疗与精心护理，患者病情均有程度不同的好转并陆续出院，现将护理体会小结如下。

Objective To investigate the clinical characteristics of lung injury in patients with antineutrophil cytoplasmic antibody associated systemic vasculitis (AASV).Methods The clinical data of 14 cases with lung involvement in patients with AASV were retrospectively analyzed,the characteristics of lung injury were summarized.Results Pulmonary manifestations were cough (92.86％),expectoration (78.57％),chest tightness (64.29％),shortness of breath (50.00％),diffusion ventilation dysfunction (85.71％),pulmonary fibrosis (57.14％).Laboratory examination showed elevated erythrocyte sedimentation rate and C-reactive protein,anemia (57.14 ％),pANCA (+) (71.43 ％).Extrapulmonary manifestations were fever (78.57％),fatigue (50.00％),renal injury (71.43％),and digestive tract injury (42.86％).11 patients (78.57％) improved after the treatment of corticosteroid and immunosuppressive agent,three cases (21.43％) were invalid,including two cases died,one patient in end-stage renal failure need hemodialysis treatment.Conclusions The clinical manifestation of AASV is complicated with lung injury,mainly including cough and expectoration,interstitial pulmonary fibrosis,and extrapulmonary manifestations with fever and kidney damage,early diagnosis and timely treatment may improve the prognosis.

<正>护理是一项细致而复杂的工作,在评定医院质量指标中,护理质量是一项重要指标。随着责任制护理模式的深入开展,如何提高护理质量,激发临床一线护士工作的积极性、主动性和创造性,体现多劳多得、优劳优酬的分配原则,成为护理管理人员研究和探索的课题。我科于2011年实施了护士绩效考核,取得了明显的效果,现汇报如下。

Objective:To observe efficacy and safety of the traditional Chinese medicine Hulisan Capsule on the treatment of knee osteoarthritis.Methods:64 patients with KOA were randomly divided into two groups,namely control group(32 cases) and treatment group(32 cases),two groups were treated with glucosamine sulfate capsule,on this basis,the treatment group was given Hulisan capsule for external application,the control group was given diclofenac emulsion for external application,the course of treatment was 4 weeks,to observe the changes of symptoms and signs of the two groups of patients before and after treatment.Results:After 4 weeks treatment,VAS score and the score of joint function of two groups were significantly improved(P<0.05) compared with those before treatment,and those of the treatment group were better than control group(P<0.05),the clinical effect of the treatment group was significantly better than that of control group.No obvious adverse reactions were found during treatment.Conclusion:Hulisan Capsule can significantly reduce the joint swelling and pain,improve joint function,has a good clinical effect,and high security,is worthy of clinical application.

Objective: To observe the clinical efficacy and safety of Diyu Huaihua decoction combinde with methotrexate in treating pso- riatic arthritis. Methods: A randomized controlled study was conducted. 51 cases of PSA were randomly divided into two groups,the control group ( 25 cases) was given methotrexate therapy while the treatment group ( 26 cases) was given Diyu Huaihua decoction and methotrexate combination treatment for 12 weeks,observed the changes of clinical and laboratory parameters in the two groups of patients before and after treatment. Results: After 12 weeks of treatment,compared with pre-treatment,the VAS score,duration of morning stiff- ness,swollen joint count,tender joint count,ESR,C-RP and skin lesions PASI score of the two groups showed significant improvement ( P<0.05) ,and compared with the control group,the differences of these index in treatment group before and after treatment were sig- nificant( P < 0. 05) ; the incidence of adverse reactions was significantly higher in control group when compared with treatment group ( P < 0. 05) . Conclusion: Diyu Huaihua decoction combined with methotrexate combination can significantly improve joint symptoms,re- lieve skin lesions and has smaller adverse reactions.

Objective To investigate the cognition and behavior for diet control in patients with gout,and to discuss its influencing factors.Methods A self-designed questionnaire was applied to investigate the cognition and behavior for diet control in 68 patients with gout.Results The cognition score of diet was 5.71±2.37 with a scoring rate of 53.92%,and the score of behavior was 4.63±1.78 with a scoring rate of 43.63%.The scores of cognition for whether family members know the diet requirements and behavior for periodic inspection of blood uric acid were the lowest which were 41.18% and 32.35%,respectively.The multiple linear regression indicated that patients' education background and occupation were the major influencing factors on cognition and behavior for diet control(P<0.01 or P<0.05).Conclusion The patients with gout have middle level of cognition and middle and low level of behavior for diet control.and in medium or low levels of behavior.It is recommended that more health education should be promoted to improve patient's cognition level and capability of diet control and directed education should be provided according to their culture,occupation,and receptive ability.

Objective To analyze misdiagnosis causes of Brucellosis infection and to propose precautionary measures.Methods Clinical data of 5 misdiagnosed patients with Brucellosis infection in our department during June 2011 and August 2012 was retrospectively analyzed.Results All the 5 patients had fever for 1 month before admission,one patient with erythrodysesthesia in elbow joint,one with pains in both thighs muscles and right hip,one with multiple unpainful nodes in right upper extremity,and two with pains in waist and shoulder.The 5 patients visited rheumatism and immunology department at first,and one patient was misdiagnosed as having undifferentiated connective tissue disease and osteoarthritis,one as having Sjogren's syndrome,and the other three patients as having bacterial infections.Results of serumal agglutination tests for brucellosis in 5 patients turned to positive,and the diagnosis of brucellosis was confirmed.All the patients were cured after six weeks combination therapy with rifampin and doxycycline hydrochloride.Conclusion The brucellosis variation and epidemiological changes lead to untypical clinical symptoms for brucellosis.Medical history and brucellosis agglutination test should be performed for patients with chronicity fever and joint symptoms so as to reduce misdiagnosis rate.

Objective: The observe and care of osteoporosis treated by MDP calcium and traditional Chinese medicine.Method: From October 2005 to December 2010,128 cases of patients with osteoporosis were admitted to our department.They were treated with MDP calcium and traditional Chinese medicine.A course of treatment is continuous infusion of 15 days.Each treatment interval was 4-6 weeks.The general treatment continues at least three courses.Result: 120 patients adhere to treatment for 3 courses.After 3 courses,bone mineral density of 106 cases(83.30%) patients improved.Bone mineral density of 50 cases(41.67%) patients improved significantly(T value increased by 0.5 or more),while 14 cases(16.7%) without improvement.Conclusion: The clinical efficacy of osteoporosis treated by MDP calcium and traditional Chinese medicine is good,quick,good security.It can significantly improve the patient's pain and bone mineral density.The operation is simple.It can maximize the drug effects to improve the therapeutic effect and reduce the suffering of the patients.

<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

OBJECTIVE:To study the effects of environmental factors on the degree of injury and expression of vascular endothelial growth factor(VEGF) and interleukin-1(IL-1) in cartilage cells of the joint in a rat model of adjuvant arthritis(AA).METHODS:SD rats aged 10 months were randomly divided into 4 groups that varied by temperature and humidity housing conditions and induction of AA:a control group,a model group,a cold-damp group,and a hot-damp group.All groups except the control group were induced with AA.After 4 w,VEGF and IL-1 expression in cartilage cells of ankle joints of hind limbs were observed.RESULTS:Mean area,optical density,and numbers of VEGF-and IL-1-positive cells in the model group,the cold-damp group,and the hot-damp group were significantly higher than that of the control group(all P<0.05).Optical density and positive cell numbers in the cold-damp group and the hot-damp group were significantly higher than that of the model group(all P<0.05).Optical density and positive cell numbers in the hot-damp group were significantly higher than that of the cold-damp group.Bone in the hot-damp and cold-damp groups was severely injured.CONCLUSION:Environmental factors such as high humidity combined with either high or low temperature increase the severity of damage and expression of VEGF and IL-1 in cartilage cells of joints in rats induced with AA.