目的 通过随机数字表法对照研究探析加味柴苓汤结合穴位贴敷对急性痛风性关节炎患者血清白介素-6(inter-leukin,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)表达的影响.方法 将2019年1月—2022年1月某院骨科收治的123例急性痛风性关节炎患者随机分成联合组和对照组,分别为61例和62例,对照组在常规健康宣教的基础上行加味柴苓汤干预,联合组在对照组基础上联合穴位贴敷干预,采集两组治疗前1小时、治疗后15天时的空腹外周血进行酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)法检测,将数据纳入SPSS21.0软件处理,比较治疗前后症状体征积分、IL-6、TNF-α表达差异.结果 ①两组治疗前1 h时IL-6、TNF-α表达量较治疗后15 d时更高(P＜0.05),联合组治疗后15 d时IL-6、TNF-α表达量显著低于对照组(P＜0.05).②两组治疗前1 h时SUA、CRP、ESR表达量均高于治疗后15 d时(P＜0.05),联合组治疗后15 d时SUA、CRP、ESR表达量均显著低于对照组(P＜0.05).③两组治疗前1 h时中医证候积分较治疗后显著偏高(P＜0.05),联合组治疗后15 d时中医证候积分显著低于对照组(P＜0.05).④联合组治疗后15 d时疼痛缓解时间、肿胀缓解时间均低于对照组(P＜0.05).结论 加味柴苓汤结合穴位贴敷能显著降低急性痛风性关节炎患者的IL-6、TNF-α表达,调节炎症机制.

Objective To explore the efficacy of guizhi shaoyao zhimu decoction in acute attack of gouty arthritis.Methods 80 cases of acute gouty arthritis patients admitted to our hospital from January 2020 to December 2021 were selected as the research object,and were divided into the control group and the observation group by random number table method,40 cases in each group.The control group was treated with conventional western medicine,and the observation group was treated with guizhi shaoyao zhimu decoction plus or minus treatment.The clinical efficacy,symptoms and signs,erythrocyte sedimentation rate(ESR),C-reactive protein and the incidence of adverse reactions were compared between the two groups.Results The total effective rate of the observation group was higher than the control group,the difference was statistically significant(P<0.05).Before treatment,there were no significant differences in joint swelling socre,ESR and C-reactive protein between the two groups(P>0.05).After treatment,joint swelling score,ESR and C-reactive protein levels in 2 groups were lower than before,and the observation group was lower than the control group,the difference was statistically significant(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Guizhi shaoyao zhimu decoction is effective in the treatment of acute gouty arthritis,and can promote the improvement of symptoms and signs of patients,with less adverse reactions and high safety,which is worthy of extensive clinical promotion and application.

腰椎间盘突出症是临床常见的腰椎退行性疾病,表现为腰椎间盘纤维环破坏,伴随髓核及软骨终板向外突出,刺激或压迫相应神经根[1].该病治疗可分为内科保守干预及手术两大类,对大多病情较轻的患者而言,应用解热镇痛药物、牵引等措施可有效改善腰痛,但对于病情反复发作,神经根明显受累的患者,通常经椎板间隙行椎间盘切除、部分椎板和关节突切除以解除压迫,恢复正常骨性位置[2];不少患者易出现术后综合证,主要包括腰腿痛、下肢麻木或出现相应支配区域神经压迫症状[3].该病属于中医"痹症"范畴,肝主筋,肾主骨,肝肾亏虚是其病机,五福饮是中医经典补益方[4],本文观察加减五福饮在缓解腰椎间盘突出症术后残留腰腿痛的疗效,现报道如下.

目的 探讨塞来昔布联合关通舒胶囊治疗膝关节骨性关节炎的效果.方法 2015年1月至2017年1月绍兴市柯桥区齐贤医院收治的膝关节骨性关节炎患者72例,随机分为观察组与对照组各36例.两组均口服关通舒胶囊,2粒/次,每日3次.观察组联合塞来昔布胶囊口服,2粒,每日1次.比较两组疗效、不良反应发生情况,治疗不同时间点的WOMAC骨关节炎指数、膝关节功能Lysholm评分.结果 治疗12周后观察组的膝关节活动度达优良率(91.7％)明显高于对照组(72.2％),治疗不同时间点观察组WOMAC骨关节炎指数及膝关节功能Lysholm评分均优于对照组,差异有统计学意义(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05).结论 塞来昔布联合关通舒胶囊治疗膝关节骨性关节炎效果优于单用关通舒胶囊,且安全.

Objective To observe the effect of FTY720 on the osteoimmune mechanism of T helper 17 (Th17)/receptor activator of nuclear factor κb ligand (RANKL)/osteoprotegerin (OPG) in type 2 collagen-induced arthritis mice.Methods Ten weeks after establishment of type 2 collagen-induced rheumatoid arthritis (RA) osteoporosis model in mice,the animals were grouped.Mice were administrated by 0.25,0.5,1.0 mg/kg FTY720 for 8 weeks respectively.Serum interleukin (IL)-17,OPG,splenic IL-17,receptor-γt (ROR-γt),nuclear factor of activated T cell (NFAT),forkhead/winged helix transcription factor P3 (Foxp3) and bone RANKL mRNA were observed in RA osteoporosis mice.Results After model establishment in mice,the serum IL-17 level increased from (8.07 ± 0.98) pg/ml to (32.08 ±6.09) pg/ml in mice.After oral administration of FTY720,serum IL-17 levels in the high and medium dose groups were significantly reduced to (11.49 ± 3.07) pg/ml and (11.49 ± 3.07) pg/ml (P =0.009,P =0.048 respectively).The levels of NFAT,IL-17,ROR-γt mRNA in spleen of FTY720 high dose group were significantly decreased (P =0.000,P =0.009,P =0.001 respectively),meanwhile the level of FOXP3 mRNA was significantly increased (P =0.010).The serum OPG levels in FTY720 high and medium dose groups were significantly increased (P =0.019,P =0.007 respectively).The levels of OPG mRNA in the femur of FTY720 high,medium and low dose groups were significantly increased (P =0.000).The RANKL mRNA levels in the high and medium dose groups were significantly lower (P =0.049,P =0.040 respectively).Conclusion FTY720 can reduce the secretion of IL-17 by inhibiting Th17 cells and enhancing the regulatory T cell function,then affecting the levels of OPG/RANKL,and effectively inhibiting the incidence of osteoporosis in RA mice.

目的:观察益肾复原方治疗老年性骨质疏松症的临床疗效.方法:将60例肾精亏虚型老年性骨质疏松症患者60例随机分为治疗组30例,对照组30例.对照组给予钙尔奇D片、罗盖全胶丸、阿仑膦酸钠治疗.治疗组在对照组的基础上加用益肾复原方治疗,3月为1疗程,2疗程后判断临床疗效,并观察记录其药物不良反应,检测Ⅰ型原胶原N-端前肽(PINP)、骨吸收标志物βI型胶原羧基端肽(β-CTx)和骨密度指标.结果:总有效率治疗组为90.0％,对照组为70.0％,2组比较,差异有统计学意义(P＜0.05).治疗后,治疗组在腰膝酸软、耳鸣耳聋、性欲减淡、发脱齿松、两足萎软、舌淡、脉弱等中医证候评分均较对照组低(P＜0.05).治疗后,2组PINP水平较治疗前升高,β-CTx水平较治疗前降低,差异均有统计学意义(P＜0.05);且治疗组上述指标改善较对照组更显著(P＜0.05).治疗后,2组股骨颈、股骨粗隆和腰椎(L1-L4)部位骨密度均较治疗前升高(P＜0.05),且治疗组上述指标升高较对照组更显著(P＜0.05).用药治疗观察期间,2组均未发现明显不良反应.结论:在西药治疗的基础上,加用益肾复原方治疗老年性骨质疏松症可提高疗效,显著改善患者临床症状及血清PINP、β-CTx水平,安全有效.

肩关节周围炎是由于肩部关节囊及其周围软组织病变引起的以肩部疼痛、运动功能障碍为主症的肩关节疾病。多数病例由于风、寒、湿邪侵入所致，亦有外伤引起。晚期肩关节周围炎的特点为疼痛不明显，但肩关节活动功能严重受限，甚至完全丧失，并伴有局部肌肉萎缩，影响患者生活质量，是肩周炎治疗的难点所在[1]。笔者采用解凝汤配合肩关节松解术加施佩特关节腔注射治疗晚期肩关节周围炎，取得较满意的疗效。现报道如下。

妊娠肝内胆汁淤积症(ICP)是妊娠中晚期最常见的特发性肝脏功能紊乱性疾病,临床上以皮肤瘙痒及血清胆汁酸水平升高为典型特征,严重威胁着产妇及其胎儿的身心健康[1].近年来,笔者采用莲黄汤治疗妊娠肝内胆汁淤积症,取得较好疗效.现介绍如下.

膝关节骨性关节炎(KOA)又称为膝关节增生性关节炎、退行性关节炎及骨性关节病等, 是指由于膝关节软骨变性、骨质增生而引起的一种慢性骨关节疾病,主要表现是关节疼痛和活动不灵活,X线表现关节间隙变窄,软骨下骨质致密,骨小梁断裂,有硬化和囊性变.笔者采用隔物灸联合中药熏洗治疗肾虚寒凝型KOA患者39例,疗效满意,现报道如下.

目的:观察比较传统封闭疗法与超声电导中药(活血止痛方)透入治疗桡骨茎突狭窄性腱鞘炎临床疗效,为临床治疗方案选择提供参考.方法:将80例桡骨茎突狭窄性睫鞘炎患者随机分为2组,各40例,对照组采用常规封闭疗法,观察组采用超声电导中药(活血止痛方)透入治疗,观察比较2组患者治疗前后中医症状、体征积分变化、临床疗效及不良反应;随访6～12月,统计2组治愈病例复发率.结果:治疗后2组患者压痛、握拇尺偏实验、休息痛、肿胀评分较治疗前明显下降(P＜0.05),且观察组各项积分下降较对照组更显著(P＜0.05).总有效率观察组为95.0％,对照组为67.5％,2组比较,差异有统计学意义(P＜0.05).复发率观察组为3.33％,对照组为23.5％,2组比较,差异有统计学意义(P＜0.05).结论:应用超声电导中药(活血止痛方)透入治疗挠骨茎突狭窄性腱鞘炎疗效显著,且复发李较低.

目的:观察加味左归丸对绝经后骨质疏松症肝肾不足证患者骨密度的影响.方法:将92例绝经后骨质疏松症肝肾不足证患者随机分为2组,治疗组53例,对照组39例.治疗组采用加味左归丸治疗,对照组采用骨康胶囊治疗.比较2组患者的骨密度,临床疗效和不良反应发生情况.结果:①骨密度.治疗前2组患者骨密度比较,差异无统计学意义(t=0.727,P=0.469),治疗后2组患者的骨密度均增加[(-3.58±0.79),(-2.19±0.67),t=9.769,P=0.000;(-3.71±0.92),(-3.21±0.49),t=2.996,P=0.004],治疗组增加更明显[(1.57±0.74),(1.24±0.65),t=2.224,P=0.029].②临床疗效.治疗组临床控制33例、显著进步8例、进步7例、无效5例,对照组临床控制13例、显著进步7例、进步10例、无效9例.治疗组临床疗效优于对照组.③不良反应发生率.治疗期间治疗组3例患者出现腹胀、1例发生口腔溃疡,对照组2例出现恶心症状,经对症处理后均治愈.结论:加味左归丸能明显增加绝经后骨质疏松症肝肾不足证患者的骨密度,是治疗该病的有效手段.

OBJECTIVE To observe the clinical effect of compound Rhizoma Corydalis Decumbentis Tablet on Cervical Spondylosis of Cold-dampness Type. METHODS Totally 138 enrolled patients were randomized into two groups. The treatment group was given compound Rhizoma Corydalis Decumbentis Tablet combined with acupuncture and traction (84 cases), while the control group was treated with loxoprofen sodium combined with acupuncture and traction (54 cases), then the comprehensive effect on Cervical Spondylosis of Cold-dampness Type was observed. RESULTS In these patients from clinic, totally 126 cases, there were 78 cases in treatment group and 54 cases in control group. There were 38 cases cured, 20 cases remarkably effective, 14 cases effective and 6 cases ineffective in the treatment group, the total effective rate was 92.3%. while 18 cases cared, 12 cases remarkably effective, 6 cases effective and 12 cases ineffective in the control group, the total effective rate was 75.0%. With the two effective rates, there was no significant difference (P<0.05). CONCLUSION Compound Rhizoma Corydalis Decumbentis Tablet combined with acupuncture traction treatment on Cold-dampness Type is more effective than loxoprofen sodium combined with that.

Objective:To explore the role of Platelet parameters(PLT、MPV) in activity ankylosing spondylitis,Discusses the mechanism and clinical value.Methods:by the whole blood cells analyser and immunology detection methods,detected the Venous blood platelets parameter(PLT、MPV)and CRP of 53 cases activity ankylosing spondylitis and 39 cases Health group,And do statistical analysis.Results:the CRP and PLT of activity ankylosing spondylitis are Significantly higher than health group,MPV significantly smaller than healthy group(P =0.000,P0.05),there is positively correlated between PLT and CRP(r=0.421,P0.05),MPV and CRP(r=-0.325,P0.05),negative correlation exists.Conclusion:Platelet parameters(PLT,MPV)have relations with the activity ankylosing spondylitis disease,Can be used as a reaction index condition monitoring.And as the same important role of CRP.

OBJECTIVE:To explore the effects of Yiqi qingbi jiedu decoction combined with etanercept on TNF-α and IL-6 in patients with refractory spondylitis at active phase.METHODS:76 refractory spondylitis patients at active phase were randomly divided into treatment group(51 cases,Yiqi qingbi jiedu decoction and etanercept needle) and control group(29 cases,etanercept needle).After 3 month of treatment,clinical efficacy and TNF-α and IL-6 level were observed and compared between 2 groups.RESULTS:The effective rates of treatment group and control group were 94.12% and 64.00%,there was statistical significance between 2 groups(P0.05);TNF-α and IL-6 levels of treatment group was more significantly than control group(P0.05).CONCLUSION:Yiqi qingbi jiedu decoction combined with etanercept can rapidly improve the clinical symptoms,and inhibit the expression of TNF-α and IL-6 in refractory spondylitis patients at active phase significantly.