目的:观察金天格胶囊联合西药治疗强直性脊柱炎伴骨质疏松症患者的临床疗效及安全性.方法:将80例强直性脊柱炎伴骨质疏松症患者随机分为治疗组和对照组,每组40例.对照组给予沙利度胺、醋氯芬酸肠溶胶囊及维D钙咀嚼片治疗,治疗组在对照组的基础上予金天格胶囊治疗.2组疗程均为6个月.观察2组治疗前后骨密度、25羟基维生素D[25-(OH)D]、甲状旁腺激素(PTH)、疼痛视觉模拟评分法(VAS)评分、红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)变化情况.结果:治疗后,2组骨密度、25-(OH)D、PTH、VAS评分、ESR、hs-CRP较治疗前均有显著改善(P<0.05);且治疗组优于对照组(P<0.05).2组均未发现明显不良反应.结论:金天格胶囊联合西药治疗强直性脊柱炎伴骨质疏松症患者具有良好的抗骨质疏松、抗炎镇痛效果,安全性高.

目的:分析石家庄地区强直性脊柱炎中医证型分布特点及病情活动情况.方法:选取石家庄市第三医院风湿免疫科门诊及住院强直性脊柱炎患者,采集病史及相关信息,辨证为肾虚督寒证、肾虚湿热证、瘀血阻络证、邪痹肢节证、邪及肝肺证、邪郁化热证.分析中医证候分布及家族史、潮湿环境接触情况、Bath强直性脊柱炎疾病活动指数(BASDAI)、红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、D-二聚体(DD)等疾病活动指标情况.结果:共收集符合标准的强直性脊柱炎患者122例,证候分布情况肾虚督寒证比例最高(39.34％),其他依次为瘀血阻络证(23.77％),肾虚湿热证(13.11％),邪郁化热证(10.66％),邪痹肢节证(8.20％),邪及肝肺证(4.92％).不同证型患者的年龄、病程、BASDAI、ESR、hs-CRP、DD比较,差异均有统计学意义(P<0.01),肾虚督寒证多指标升高明显.结论:肾虚督寒证病情活动明显,且为石家庄地区强直性脊柱炎分布的主要证型,可能为临床诊治的主要标靶证型.

目的 分析女性强直性脊柱炎(ankylosing spondylitis,AS)的临床特征及误诊原因、防范措施.方法 对曾误诊的10例女性AS的临床资料进行回顾性分析.结果 本组10例,年龄(34.20±9.60)岁;病史(24.40±18.01)个月;9例有诱发因素;1例无诱因发病.3例出现肩、膝及踝等关节周围肌腱附着点僵痛症状,2例伴低热、盗汗,1例伴发葡萄膜炎.骶髂关节压痛、叩击痛和骨盆分离试验阳性各8例.超敏C反应蛋白升高10例,红细胞沉降率增快9例,D-二聚体升高8例.人类白细胞抗原B27阳性8例.6例于基层卫生院误诊为腰肌劳损,2例于某中医门诊误诊为产后风湿,1例在县级医院误诊为腰椎间盘突出症,1例于某诊所误诊为软组织损伤.误诊时间3个月～5年(47.00±39.05)个月.10例按误诊疾病予相应处理效果欠佳,后均依据临床表现、相关查体所示,结合骶骼关节影像学检查,根据相关诊断标准,确诊AS.给予相应治疗15 d,病情缓解出院.1例失访;9例随访1～3年,3例自行停药,1例出现病情活动,余均病情控制良好.结论 女性AS具有诱因多、遗传史隐匿、多外周关节受累和病变较轻等特点,临床易误诊.病情不典型、临床医生认知水平有限及诊断思维局限是导致其误诊的重要原因.临床应采取仔细病史采集、详细专科查体和及时更新专业知识等多项措施,把控好诊治时机,以提高女性AS诊治正确率.

目的:研究壮骨强脊颗粒治疗强直性脊柱炎(AS)肾虚督寒证的临床疗效及其对炎症因子肿瘤坏死因子α(TNF-α)、骨形态发生蛋白-2(BMP-2)的影响.方法:将73例活动期强直性脊柱炎肾虚督寒证患者随机分为2组.对照组37例予西医常规治疗;治疗组36例在对照组治疗基础上加服壮骨强脊颗粒.观察3个月,比较2组治疗前后脊柱痛视觉模拟评分(VAS)、患者总体评估指数(PGA)、Bath强直性脊柱炎病情活动指数(BASDAI)、Bath强直性脊柱炎功能指数(BASFI)、Bath强直性脊柱炎测量指数(BASMI)及超敏C反应蛋白(h-CRP)、红细胞沉降率(ESR)变化,TNF-α、BMP-2的水平,强直性脊柱炎国际工作组20疗效评价标准(ASAS20)、BASDAI50达标率并观测治疗安全性.结果:70例患者完成研究,2组各35例.治疗组和对照组ASAS20达标率分别为82.86％和65.71％,差异无显著性(P>0.05).BASDAI50达标情况治疗组为65.71％,对照组40.00％,治疗组高于对照组(P<0.05).治疗后2组脊柱痛VAS、PGA、BASDAI、BSAFI、BASMI均明显低于治疗前(P<0.01),治疗后治疗组同对照组相比各指标均减低(P<0.05或<0.01).治疗后2组ESR、h-CRP、BMP-2、TNF-α水平均明显低于治疗前(P<0.01),治疗组低于对照组(P<0.05或<0.01).2组安全性差异无显著性(P>0.05).结论:壮骨强脊颗粒治疗AS肾虚督寒证能够安全有效改善患者临床症状,降低炎症因子水平,缓解病情.

Objective To evaluate the effect of total glucosides of peony upon acute gouty arthritis (AGA) and serum levels of IL-6,IL-1β and TNF-α in AGA rat models.Methods Forty-eight male SD rats were chosen and randomly divided into the control,model,colchicine (0.8 mg/kg),low,moderate and high dose (75,150 and 300 mg/kg) of total glucosides of peony groups (n=8 for each group).At 5 d after medicine administration,AGA rat models were established by injection of microcrystalline monosodium urate (MSU) suspension in the ankle joint.The diameter of ankle joint at baseline and different time points after model establishment was measured.The difference in the ankle joint diameter before and after model establishment was used to reflect the degree of knee joint swelling.After experiment,blood sampling was collected via the abdominal aorta.The serum levels of IL-6,IL-1β and TNF-α were quantitatively measured by using ELISA and statistically compared among different groups.Results Compared with the control group,the degree of knee joint swelling in the model group was significantly enhanced at different time points (all P<0.01).Compared with the model group,the degree of joint swelling in the low-,moderate-and high-dose total glucosides of peony,and colchicine groups was significantly decreased at different time points (all P<0.05).No statistical significance was identified among different treatment groups (all P>0.05).Compared with the control group,the serum levels of IL-6,IL-1β and TNF-α in the model group were significantly up-regulated(all P<0.01).At 24 h after model establishment,the serum levels of IL-6,IL-1β and TNF-α in the low-,moderate-and high-dose total glucosides of peony and colchicine groups were considerably down-regulated than those in the model group (all P<0.01).No statistical significance was documented among different treatment groups (all P>0.05).Conclusion Use of total glucosides of peony exerts therapeutic effect upon AGA,probably by suppressing the production of pro-inflammatory cytokines of IL-6,IL-1β and TNF-α induced by MSU.

目的 针对大鼠急性痛风性关节炎(AGA)模型筛选最优抗炎配伍植物中药有效成分组合复方.方法 将SD雄性大鼠65只随机分成12组,并设置空白对照组,每组5只.按照正交t值表分配白芍总苷(TGP)、三七总皂苷(PNS)、青藤碱(SN)、雷公藤多苷(TG)及人参皂苷(GS)5种中药有效成分配伍组合,各组每只1.5 ml/d等体积灌胃给药.给药第6天第1～12组大鼠左踝关节腔注射PBS配制的微晶尿酸钠结晶(25 mg/ml) 100μl进行造模,造模前及造模后8h测量踝关节周径计算其肿胀度.结果 模型组与对照组相比造模8h后肿胀度均有显著增加(P＜0.01).经正交t值法肿胀度筛选,TGP、PNS、SN在复方组合中药效突出,其中SN最有意义(P＜0.01);而TGP和PNS在复方中也具有统计学意义(P＜0.05).结论 SN、TGP、PNS在5种有效成分组成的复方中发挥主导抗炎效应.

Objective To investigate the therapeutic effect of Simiaoyong’an recipe aqueous extract(SMYA)and its influence on serum levels of macrophage migration inhibitory factor(MIF),interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)in rat models with acute gouty arthritis(AGA). Methods A total of 40 SD male rats were randomly di-vided into SMYA group,Colchicine(COL)group,model group and control group(n = 10 for each group). SMYA and COL groups were respectively administered with Simiaoyong’an decoction,which was equivalent to crude drug 1 g / kg and COL 0. 8 mg / kg daily,while model and control groups were lavaged with the same volume of physiological saline daily. On the 5th d of drug intervention,models in model,COL and SMYA groups were injected with 100 μl crystallization of micro-crystal uric acid sodium(25 mg / ml)prepared by phosphate buffer(PBS)into left ankle joint cavity,and the AGA models were established. The swelling degrees of ankle joint were recorded using vernier caliper at 1st ,2nd ,4th ,6th ,8th ,12th and 24th h after the model establishment respectively. The blood samples of abdominal aorta were collected 24 h after the model establishment,and serum MIF,IL-1β and TNF-α levels were detected using enzyme linked immunosorbent assay (ELISA). Results The swelling degrees of ankle joint in SMYA,COL and model groups reached the peak at 8th h after the model establishment,and then the values decreased slowly. The swelling degrees of ankle joint at 4th ,6th ,8th ,12th and 24th h after the model establishment in SMYA,COL and model groups were significantly larger than those in normal group&nbsp;(P ﹤ 0. 05),and the degrees in SMYA and COL groups were significantly lower than those in model group(P ﹤ 0. 05), and at 8th h the above difference was the most significant(P ﹤ 0. 01). The swelling degrees of ankle joint at 12th and 24th h after the model establishment in SMYA group were significantly lower than those in COL group(P ﹤ 0. 05). Compared with those in model group,MIF,IL-1β and TNF-α levels were significantly reduced in SMYA and COL groups(P ﹤ 0. 05). Compared with those in COL group,the MIF and IL-1β levels were higher,and the TNF-α level was lower in SMYA group (P ﹤ 0. 05). Conclusion Simiaoyong’an recipe aqueous extract has significant therapeutic effect on rats with acute gouty arthritis,and its mechanisms may be related to inhibition of the proinflammatory cytokine MIF,IL-1β and TNF-α expres-sions.

Objective To detect D-dimer level in ankylosing spondylitis ( AS) patients, and to discuss its clini-cal significance in AS. Methods A total of 60 AS patients admitted during March and October in 2013 were chosen as AS group, in which 38 patients with Bath AS disease activity index ( BASDAI) ≥4 were as high disease activity sub-group, and other 22 patients with BASDAI <4 were as low disease activity subgroups. A total of 60 patients taking medi-cal examination in September 2013 were chosen as control group. The D-dimer levels in all cases were detected respec-tively, and the differences were also compared. The correlations between D- dimer level with BASDAI, age, gender, ESR (erythrocyte sedimentation rate), CRP(C-reactive protein), blood fat and blood clotting function were analyzed. Results plasma D-dimer level In AS group was significantly higher than that in control group (P<0. 01);plasma D-dimer level in high disease activity subgroup was significantly higher than that in low disease activity subgroup ( P <0. 01 ) . The D-dimer level had positive correlations with BASDAI, ESR, CRP, hs-CRP ( high-sensitivity C-reactive pro-tein), lipoprotein α and fibrinogen content (P<0. 05, P<0. 01), while the D- dimer level had negative correlations with fibrin time and apolipoprotein-A (P<0. 01). Conclusion D-dimer may play an important role in the pathogenesis and disease outcome of AS, and may be used as a serum marker of disease activity.

Objective To investigate the effect of short-term administration of Panax Notoginsenosidum ( PNS) , a drug for invigorating blood circulation and eliminating stasis, on pathogenetic condition of ankylosing spondylitis ( AS) . Methods Clinical data of 42 patients with ankylosing spondylitis during May 2012 and May 2014 was retrospectively an-alyzed,and the patients were divided into control group (n=23) and promoting circulation treatment group (PNS group, n=19). The control group received conventional treatment, while the PNS group was treated with Xueshuantong, a drug for invigorating blood circulation and eliminating stasis, based on the conventional treatment. Erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP)and platelet count (PLT), Bath AS disease activity index ( BASDAI) , Bath AS function index ( BASFI) , Bath AS metrology index ( BASMI) , patient global assessment ( PG) , night pain of visual analogue score ( night pain VAS) , values of AS disease activity score ( ASDAS) based on the hs-CRP value on admission and discharge were monitored respectively. Results The values of hs-CRP, PLT, BASDAI, night pain VAS and BASMI after the treatment in PNS group were significantly decreased ( P<0. 05 ) , and the differences in hs-CRP, BASDAI and night pain VAS were statistically significant compared with those in control group (P<0. 05). Be-fore and after the treatment, the differences in BASFI, ASDAS and PG scores were statistically significant in the two groups (P<0. 05). Compared with that in the control group after treatment, ASDAS value in PNS group was statistically significant (P<0. 05);ASAS 20 compliance rates between the two groups had statistically significant difference (P<0. 05). Conclusion Administration of promoting blood circulation drugs of Panax Notoginsenosidum combined with con-ventional treatment may improve the curative effect in treatment of AS.