Objective:The current evidence suggests that tumor necrosis factor-inhibitor (TNFi) treatment can be used to achieve clinical remission or low disease activity in patients with ankylosing spondylitis (AS). After achieving remission / low disease activity, however, the follow-up treatment options are unclear. The purpose of this review is to conduct an extensive and systematic literature review of the studies conducted from September 2014 to July 2020 to assess the feasibility and effectiveness of tapering of biological agents.Methods:After searching for the related papers and abstracts and applying inclusion/exclusion criteria, a structured extraction process was used to include the studies into this study.Results:A total of 13/93 studies were included into the analysis of the tapering of biological agents in AS patients, in which 7/13 adopted the dose reduction regimen, 3/13 adopted the extended interval between doses regimen, and 5/13 did not provide or formulate the detailed reduction regimen. We summarized the feasibility of TNFi tapering schemes in the published studies and summarized the tapering rules. Only one study showed that reduced TNFi levels worsened the quality of life and resulted in a relapse within 12 months.Conclusion:More research is needed to understand the long-term effects of these strategies on efficacy, safety, and cost in the treatment of AS.

强直性脊柱炎(AS)是一种以骶髂关节和脊柱中轴关节病为主要病变的慢性进行性炎症性疾病.骨外组织异常钙化、骨赘形成是AS发展的根源,异位骨形成、骨量减少、骨质疏松目前被认为是AS的共同特征,其中关键的异位骨形成机制尚未明确.细胞核因子KB受体活化因子(RANK)/细胞核因子KB受体活化因子配体(RANKL)/骨保护素(OPG)通路、骨形态发生蛋白(BMPs)介导通路、Wnt信号通路及白细胞介素(IL)-23/IL-17轴是目前研究较多的影响AS骨代谢的通路,也有少数文献报道机械载荷(ML)介导信号通路影响AS骨形成.应用骨代谢标志物,包括骨形成标志物和骨吸收标志物在AS患者异常改变,以及双能X线(DXA),定量计算机断层扫描法(QCT)、MRI、骨小梁评分(TBS)等影像学检查可协助了解AS骨代谢情况,为目前有效的治疗方法提供随访的量化指标.该文从AS骨代谢通路、AS骨代谢标志物、AS骨代谢在影像学中表现等方面对AS骨代谢的研究进展进行综述.

Objective:To explore the effect of guided interventions on promoting physical and mental health of obese children.Method:180 children received by our clinic were divided into the observation group and the control group according to the order of hospitalization,90 cases in each group.The control group was given routine health guidance,while the observation group was given guide interventions of psychological and behavioral,nutritional,weight and social function on the basis of routine health guidance.The height,weight,mental health test (MHT) scores and proportions of overweight and obesity were compared between the two groups before and after the interventions.Result:After the intervention,the weight,BMI index, MHT score and rates of overweight and obesity of the observation group were significantly lower than those of the control group (P<0.05).Conclusion:Guide interventions can effectively promote children’s physical and mental health.

ObjectiveTo compare the clinical effects of budesonide combined with ribavirin and combivent in alternating aerosol, budesonide combined with ribavirin, and budesonide combined with combivent in the treatment of infantile capillary bronchitis.MethodsA total of 90 children with capillary bronchitis were randomly divided into groups A, B and C, with 30 cases in each group. Group A received alternating aerosol by budesonide combined with ribavirin and combivent for treatment, group B received budesonide combined with ribavirin through aerosol inhalation, and group C received budesonide combined with combivent. Comparisons were made on symptoms disappearance time, hospital stay and total effective rate of the three groups.ResultsThe disappearance times of cough, suffocation, stridor, and rale were respectively (4.3±0.4) d, (2.1±0.4) d, (2.2±0.4) d, (5.5±0.6) d, which were all shorter than those in group B and group C. The group A had hospital stay as (7.2±1.0)d, which was shorter than (9.7±1.3) d of group B and (9.9±1.5) d of group C. The differences had statistical significance (P<0.05). The total effective rate in group A was 96.7%, which was much higher than 76.7% of group B and 73.3% of group C, and the difference had statistical significance (P<0.05).ConclusionImplement of budesonide combined with ribavirin and combivent in alternating aerosol treatment for infantile capillary bronchitis can provide effectively anti-inflammatory action. This method can rehabilitate ventilatory function and improve clinical symptoms of cough, rale and suffocation with remarkable effect. This method contains high value for application.

目的：探讨甲泼尼龙冲击递减疗法联合小剂量免疫球蛋白治疗重症过敏性紫癜患者的临床效果。方法对普宁市人民医院收治的80例重症过敏性紫癜患者资料进行分析，根据治疗方案不同将患者分为对照组和实验组，对照组采用甲泼尼龙冲击治疗，实验组采用甲泼尼龙冲击递减疗法联合小剂量免疫球蛋白治疗，比较两组疗效。结果实验组皮疹消失时间为（6．86±3．25）d、腹痛缓解时间为（3．07±1．97）d、消化道出血停止时间为（3．76±2．56）d，肾损害恢复时间为（7．81±1．83）d，显著短于对照组（P ＜0．05）。结论重症过敏性紫癜患者采用甲泼尼龙冲击递减疗法联合小剂量免疫球蛋白治疗效果确切，值得推广使用。

目的 分析影响儿童反复性发作过敏性紫癜疗效的相关因素.方法 回顾性分析我院收治的544例反复发作的过敏性紫癜患儿的临床资料,所有患儿均进行常规的补液、抗感染、抗炎,抗血小板凝聚、抗过敏及孟鲁司特钠治疗,观察疗程1个月,按照疗效情况分为观察组与对照组,观察组患儿为经治疗后无效患儿,对照组患儿为显效+有效患儿,对影响疗效的相关因素进行单因素及多元logistic分析.结果 单因素分析结果表明影响小儿反复发作过敏性紫癜的疗效相关因素主要有:发病年龄、发病季节、过敏性紫癜家族史、肾型、复发次数、诱发因素及饮食干预;多元logistic分析结果表明影响儿童反复发作的过敏性紫癜的相关因素有:发病年龄,EXP(B)=-1.511,95％CI:0.119-0.408,过敏性紫癜家族史,EXP (B) =-1.562,95％CI:0.115-0.382,饮食干预,EXP(B)=1.246,95％CI:1.909-6.326,P＜0.001.结论 患儿年龄偏大、有家族过敏性紫癜史是儿童反复性发作过敏性紫癜的危险因素,而饮食干预是保护性因素.

Objective To study the effect of 3%NaCl combined with Xiyanping in the treatment of 50 cases of severe Hand-foot-mouth disease(HFMD) with encephalitis. Methods Divided 100 cases of severe HFMD with encephalitis into study group and control group, 50 cases in each group, control group was given Xiyanping, study group was given 3% NaCl combined with Xiyanping, the efficacy, cooling time, awareness recovery time and hospitalization between the two groups were compared. Results The clinical effective rate of the study group was 92.0%(46/50), significantly higher than 80.0%(40/50) of the control group, difference between the two groups had statistically significant(P<0.05). The efficacy, cooling time, awareness recovery time and hospitalization of the study group were shorter than of the control group, difference between the two groups had statistically significant(P<0.05). Conclusion 3%NaCl combined with Xiyanping has a better effect in the treatment of severe HFMD with encephalitis.

目的：探讨静脉注射免疫球蛋白联合地塞米松在重症手足口病的疗效。方法将261例重症手足口病患儿作为研究对象，分为丙种球蛋白组（n=84，A组）、地塞米松组（n=68，B组）及联合组（n=109，C组）。3组患儿均进行常规治疗，A组患儿采用丙种球蛋白治疗，B组采用地塞米松治疗， C组采用丙种球蛋白联合地塞米松治疗，观察3组患儿的疗效及主要临床指标情况。结果 A组、C组患儿在发热时间、危重症例数、机械通气例数、住院时间及神经系统受累时间均显著低于B组（P<0.05）；A、B、C组患儿治疗有效率分别为89.2%、73.5%、93.6%，A、C组患儿治疗有效率均显著高于B组（P<0.05），A组及C组进入3期危重症病的患者比例显著低于B组，需要进行机械通气的患者比例低于B组（P<0.05）。结论静脉注射免疫球蛋白联合地塞米松与单独采用丙种球蛋白的疗效比较无明显差异无统计学意义，临床治疗可倾向于单独采用丙种球蛋白进行治疗。

<正>小儿肺炎是儿科临床最常见的感染性疾病之一,发病率较高,一年四季均可发病,尤以冬、春季较多,具有病情严重、病程长及易反复的特点,严重威胁患儿的身体健康[1]。小儿肺炎的临床表现主要有咳嗽、发热、气喘等症状,患儿肺部可闻及湿罗音,甚至出现心力衰竭及昏迷,严重者可导致患儿死亡,目前小儿肺炎已成为婴幼儿死亡的主要原因之一[2-3]。本研究选取我院2010年10月至2013年2月收治的257例肺炎患儿,采用肺俞穴位微波照射联合布地奈德与万托林雾化吸入的疗法,取得良好的临床效果,现将研究结果报道如下。

Objective To observe the effect of early application of high dose ambroxol on early prevention and treatment of premature children with hyaline membrane disease(HMD).Methods 86 patients were randomly divided into treatment group(B group,n=46) and control group(A group,n=40),on the base of same comprehensive treatment of the two groups,the treatment group was given the high-dose ambroxol(trade name ambroxol),30mg/(kg?d),twice with 5% glucose intravenous infusion diluted 20mL,to analyse and compare the incidence of HMD in preterm children,mortality,complication rate,admission 12-hour monitoring of blood gas between the two groups.Results ①There was signifi cant difference the incidence of HMD between treatment group and control group.②The results of admission`s 12-hour blood gas analysis was significantly different between the two groups(P0.05).③The incidence of complications in treatment group was signif icantly lower than that of control group(P0.05).Conclusion High-dose ambroxol has a good effect on preventing neonatal HDM and protecting the lungs function of premature children after childbirth.