目的:观察类风湿关节炎(rheumatoid arthritis,RA)患者血清Ⅱ型胶原 C 端肽(type Ⅱcollagen C-terminal peptide,CTX-Ⅱ)、组蛋白去乙酰化酶 3(histone deacetylase 3,HDAC3)水平变化,分析其与免疫功能、疾病活动度的关系.方法:选取本院收治的 84 例RA患者(RA 组)和 84 例体检健康者(NC组).分析血清CTX-Ⅱ、HDAC3(酶联免疫吸附法)及免疫功能指标[免疫球蛋白(immunoglobu-lin,Ig)A、IgG、IgM、CD3+、CD4+、CD8+T 细胞比例]、疾病活动度相关指标[C 反应蛋白(C-reactive pro-tein,CRP)、血沉(erythrocyte sedimentation rate,ESR)]水平变化情况.Pearson 法分析血清 CTX-Ⅱ、HDAC3 分别与免疫指标、疾病活动度相关指标的相关性.结果:RA组CTX-Ⅱ(9.26±1.84 vs 4.59±0.62)、HDAC3(83.72±13.51 vs 20.15±4.90)水平高于NC组(t=22.044、40.542,P＜0.05).缓解组CTX-Ⅱ(7.37±1.71 vs 10.75±1.94)、HDAC3(72.97±12.10 vs 92.18±14.62)水平低于活动组(t=8.347、7.940,P＜0.05).RA组CD3+(64.42±6.91 vs 70.42±7.34)、CD4+(34.80±5.96 vs 39.74±5.80)T细胞比例低于NC组,而CD8+T细胞(31.68±6.15 vs 29.62±7.15)、IgM(2.06±0.39 vs 1.47±0.30)、IgA(2.96±0.50 vs 1.51±0.36)、IgG(15.49±3.05 vs 11.83±2.19)、ESR(28.32±7.60 vs 13.75±2.18)、CRP(10.94±2.02 vs 6.08±0.73)水平显著高于 NC 组(P＜0.05).活动组患者 CD3+(62.94±6.60 vs 66.30±7.30)、CD4+T(33.57±5.74 vs 36.36±6.24)细胞低于缓解组,IgM(2.19±0.41 vs 1.89±0.36)、IgA(3.08±0.54 vs 2.81±0.45)、IgG(16.16±3.27 vs 14.64±2.77)、ESR(30.06±8.15 vs 26.11±6.90)、CRP(12.37±2.24 vs 9.12±1.74)水平高于缓解组(P＜0.05).相关性分析显示,血清CTX-Ⅱ与ESR、CRP、28 个关节疾病活动(disease activity score in 28 joints,DAS28)呈正相关(r=0.572、0.495、0.809,P 均=0.000);血清HDAC3 分别与CD3+、CD4+T细胞比例存在负相关(r=-0.529、-0.464,P 均= 0.000),而与 IgM、IgA、IgG、ESR、CRP、DAS28 评分呈正相关(r= 0.460、0.491、0.445、0.540、0.519、0.864,P 均＜0.05).结论:类风湿关节炎患者血清 CTX-Ⅱ、HDAC3 水平均高于体检健康者,CTX-Ⅱ与 RA 疾病活动度有关,HDAC3 与RA免疫功能紊乱以及疾病活动度有关.

艾拉莫德是一种具有抗炎、抗骨吸收及免疫调节作用的新型小分子改善病情抗风湿药,多用于治疗类风湿关节炎.原发性干燥综合征目前尚无满意的治疗措施,临床上使用的药物多为经验性治疗.多项临床研究将艾拉莫德单药或与甲泼尼龙、硫酸羟氯喹、白芍总苷中的1种或2种药物联合应用于干燥综合征患者,可提高治疗总有效率、改善干燥症状、降低球蛋白、降低炎症水平及抗体水平、升高血小板、改善肺功能且不良反应发生率低.艾拉莫德可通过减轻腺体炎症及病理损伤、抑制B淋巴细胞及抗肺纤维化等多种机制发挥治疗干燥综合征的作用.

Objective:To investigate the expression of serum matrix metalloproteinase 3 (MMP-3) in patients with rheumatoid arthritis (RA) and analyze its correlation with bone erosion and disease activity.Methods:100 RA patients diagnosed in the First People's Hospital of Changde from July 2018 to December 2019 were selected as the RA group, and 35 healthy volunteers who came to the hospital for physical examination at the same time were selected as the control group. The clinical data of the patients were collected, and the serum MMP-3 levels of the patients and healthy volunteers were detected by enzyme-linked immunosorbent assay (ELISA). The serum MMP3 levels of RA patients with different disease activity, different imaging stages and different bone mineral density were compared, and the correlation with clinical indicators were analyzed.Results:⑴ RA patients were grouped according to the Disease Activity Score (DAS) 28. Serum MMP-3 levels in the highly active group (300.87±15.93)ng/ml and in the moderately active group (213.78±12.79)ng/ml were higher than those in the clinical remission group (82.87±8.19)ng/ml increased significantly. ⑵ The serum MMP3 level in the RA group (190.98±13.43)ng/ml was significantly higher than that in the healthy control group (69.97±10.63)ng/ml. ⑶ There were significant differences in serum MMP-3 levels among RA patients with different imaging stages ( P<0.05). The level of MMP-3 in stage Ⅲ (206.18±13.58)ng/ml and stage Ⅳ (301.72±13.43)ng/ml were significantly higher than those in stage Ⅰ (89.16±10.13)ng/ml. ⑷ RA patients were divided into normal group, osteopenia group, and osteoporosis group according to bone mineral density. The serum MMP-3 level in the osteopenia group (180.87±12.69)ng/ml and osteoporosis group (289.54±13.28)ng/ml were significantly higher than that in the normal group (121.05±8.45)ng/ml. ⑸ Serum MMP-3 levels were positively correlated with C-reaction (CRP), erythrocyte sedimentation rate (ESR), DSA 28, rheumatoid factor (RF), joint swelling index, joint tenderness index, and platelet count in the RA group ( P<0.05). Conclusions:The serum MMP-3 plays an important role in the progression of RA, and is closely related to RA disease activity and bone erosion. It is expected to become a serological indicator for predicting RA bone erosion and radiological progress.

目的:观察艾拉莫德、来氟米特联合云克治疗类风湿关节炎(RA)的效果.方法:2016年5月-2017年5月收治RA患者100例,随机分为两组,各50例.对照组给予艾拉莫德、来氟米特口服治疗,观察组在艾拉莫德、来氟米特基础上联合使用云克注射液治疗.比较两组治疗效果.结果:观察组临床疗效高于对照组,DAS28评分及炎性因子水平均显著低于对照组,差异均有统计学意义(P＜0.05).结论:艾拉莫德、来氟米特联合云克治疗RA,可明显减轻患者临床症状,有效性和安全性高.

目的:探讨双醋瑞因联合白芍总苷治疗膝骨关节炎的临床疗效及安全性.方法:2017年6月-2018年6月收治膝骨关节炎患者112例,随机分为两组,各56例.对照组服用双醋瑞因治疗;观察组服用双醋瑞因联合白芍总苷治疗.比较两组治疗效果.结果:观察组治疗总有效率、Lequesne评分、膝关节VAS评分和15 m行走时间均显著优于对照组,差异有统计学意义(P＜0.05),结论:双醋瑞因联合白芍总苷治疗膝骨关节炎疗效明显,安全性高.