输血传播病毒(transfusion transmitted virus,TTV)是一种新的DNA病毒,通常由输血途径传播,其基因组变异率与RNA病毒相似,但是很难预测其致病力是否会朝着增强的方向发展.本研究探讨了TTV病毒与类风湿关节炎患者之间的关系.研究发现类风湿性关节炎患者存在TTV感染,其感染率显著高于正常人群,性别上无明显差异,不存在某种特定基因型感染,初步明确了类风湿性关节炎患者和正常人群对TTV的感染率,并进一步探讨了该病毒基因分型对类风湿性关节炎患者和正常人群两组人群的影响.

探讨RA并肺间质纤维化患者中TGF-β、KL-6的水平变化及其临床意义.选取确诊RA并肺间质纤维化患者30例作为研究组,同期单纯RA患者60例作为对照组,检测并比较两组血清TGF-β、KL-6水平,并分析TGF-β、KL-6与肺间质纤维化相关指标的关系以及与HRCT的相关性.结果显示,研究组的血清TGF-β、KL-6水平显著的高于对照组,研究组的RF、CRP、中性粒细胞检测值显著的高于对照组,研究组和对照组的血沉检测值差异无统计学意义;并且研究组TGF-β、KL-6水平与患者RF、CRP呈显著的正相关,与血沉及外周血中性粒细胞水平无显著相关性;研究组HRCT评分为(1 1.6±3.6)分,研究组患者TGF-β、KL-6水平与HRCT评分均呈显著的正相关.说明除血沉和外周血中性粒细胞水平外,其余指标都可作为RA合并肺间质纤维化的判定依据,为RA合并肺间质纤维化的早期诊断提供了参考依据,具有重要的临床意义.

Objective To explore the characteristics of transfusion transmitted virus molecular epidemiology in the fourth and five groups in Kunming District of Yunnan through the examination of blood transfusion transmission.Methods the detection of serum transfusion transmitted virus by polymerase chain was analyzed,and the homology and phylogenetic analysis were analyzed after the positive samples were sequenced.Results the study of 223 sera to be detected,and according to the sequence determination and comparison,the clear 150 positive samples,the HIV infection rate of 64.38％,the fourth group detection out of 47,the transfusion transmitted virus infection rate of 21.08％;the fifth group detection out of 77,the transfusion transmitted virus infection rate of 34.53％;mixed infection of nine infection rate of 4.04％.Conclusion the data about the epidemiology of transfusion transmitted virus in fourth and five groups were obtained,which could prevent the transmission of transfusion transmitted virus.

Objective:To investigate the expression of ADAMTS-4 and ADAMTS-5 in different stages of knee osteoarthritis. Methods:121 cases of patients with knee osteoarthritis included 45 cases of early knee osteoarthritis,42 cases of mid-term knee osteoarthritis and 37 cases of advance knee osteoarthritis.The expression of ADAMTS-4 and ADAMTS-5 of knee joint fluid in patients were detected.Results:The expression levels of ADAMTS-5 in the early knee osteoarthritis group and advance knee osteoarthritis group were higher than that in the mid-term knee osteoarthritis group,and the differences were statistically significant(P<0.05).The expression level of ADAMTS-4 in the early knee osteoarthritis group was significantly higher than that in the mid-term knee osteoarthritis group and advance knee osteoarthritis group(P<0.01).Conclusion:The expression levels of ADAMTS-4 and ADAMTS-5 in joint fluid were helpful to the diagnosis of early knee osteoarthritis.

目的：探索鹿瓜多肽注射液治疗老年类风湿关节炎继发骨质疏松症的临床疗效。方法100例老年类风湿关节炎继发骨质疏松症患者，动态随机分为观察组和对照组，每组50例。对照组采用常规治疗，观察组在常规治疗的基础上加用鹿瓜多肽注射液治疗。对比两组患者的关节疼痛数、晨僵时间、C反应蛋白(CRP)、血沉(ESR)、血清IL-18指及治疗1、2、3周后的视觉模拟评分法(VAS)评分情况。结果治疗后，观察组患者的关节疼痛数、晨僵时间、CRP、ESR、血清IL-18指标显著优于对照组，两组比较差异均具有统计学意义(P<0.05)。治疗1、2、3周后，观察组VAS评分分别为(2.25±1.71)、(1.41±1.06)、(0.74±0.21)分，均显著优于对照组的(6.43±1.31)、(5.97±0.51)、(4.84±1.79)分，差异均有统计学意义(P<0.05)。结论鹿瓜多肽注射液治疗老年类风湿关节炎继发骨质疏松症患者效果显著。

Objective To compare the three kinds of methods for in vitro primary culturing of rheumatoid arthritis synovial fibroblast-like cells (RASFs), in order to get fast and effective culture methods. Methods Synovial tissue from RA synovial arthroscopic resection were treated by collagenase digestion method, modified tissue culture method, double enzyme digestion method respectively. By using an inverted phase contrast microscope, cell morphology and growth characteristics were observed and identified with vimentin staining. Trypan blue was used to count the number of living cells after culturing for 14d. Results The three primary methods could successfully isolate and culture RASFs, and RASFs met the morphological characteristics of vimentin-positive cells>95%, namely, the proportion of RASFs cell confluence was 70% after 16-20days by the collagenase digestion method,whose cell confluence proportion reached 95%after 4 weeks;and the cell confluence proportion was above 70%after 10-14days by modified tissue culture method,and the cell confluence proportion reached 85%after 4 weeks by the double enzyme digestion method. The comparison of the viable cells number cultured same number of synovial tissue by the three methods show the viable cells number cultured by the modified tissue culture&nbsp;method were (1.60±0.08) ×106, those by the collagenase digestion method were (1.41±0.08) ×106, those by the double enzyme digestion method were (1.19 ±0.05) ×106, which were with significant difference among them (P<0.05) .The comparison of incubation time of RASFs primary cells showed it took (267.50±16.58) mins by the collagenase digestion method, (183.75 ±11.08) mins by the double enzyme digestion method, and 149.10 ±13.71mins by the modified tissue culture method, with significant differences (P<0.05) .Conclusion Modified tissue culture for RASFs is an efficient and fast culture method, the number and purity of RASFs can meet the requirements for biology experiments.

类风湿关节炎（rheumatoid arthritis ，RA ）是一种常见的全身性自身免疫性疾病，以滑膜的异常增生和血管翳形成并侵入关节软骨造成骨和关节软骨破坏为特征［1］。关于 R A发病机制的探究一直处在不断的发展中，近年来对RA患者的滑膜组织异常增生做相应分析，表明 RA滑膜细胞具有凋亡不足的特点［2］，滑膜细胞异常凋亡及病理性血管新生可能在RA的发生和发展过程中起着关键的作用［3］。Survivin作为迄今发现的最强的凋亡抑制因子，通过抑制滑膜细胞凋亡和促进血管新生在RA的发生和发展中发挥重要作用。血管内皮生长因子（VEGF）作为血管新生的关键细胞因子通过多重途径促进RA的发生及发展。

Objective To explore the relationship between the levels of β-catenin in synovial fluid and knee osteoarthritis in serum as well as the degree of pathological change. Methods 65 cases of patients with knee osteoarthritis were chosen,30 of those suffered from early-stage knee osteoarthritis,and 35 from medium-later-stage knee osteoarthritis. The control group was 30 healthy volunteers. The levels of β-catenin in both synovial fluid and serum were detected by ELISA. Results The levels of β-catenin in both synovial fluid and serum in patients with osteoarthritis were higher than those of the control group. Additionally,the levels of β-catenin became higher as the degree of pathological change increasing seriously. The differences were statistically significant(P 0.05). Conclusion The elevated levels of β-catenin in both synovial fluid and serum in patients with osteoarthritis was closely associated with the degrees of pathological change. In summary,higher expression of β-catenin in both synovial fluid and serum was might closely paralled with the serious degree of osteoarthritis.

Objective To study the targeting survivin small interfering RNA ( siRNA ) to inhibit proliferation and apoptosis survivin gene expression in rheumatoid arthritis synovial fibroblasts ( RASFs) .Methods RA patients were isolated and cultured in vitro synovial fibroblasts ( RASFs) , designed and synthesized siRNA targeting survivin and negative control, by liposome transfection RASFs cell; real-time quantitative polymerase chain reaction (PCR) and Western blot RASFs detect mRNA expression and protein levels of survivin.Tetrazolium blue (MTT) assay of cell proliferation;TUNEL assay apoptosis.Results The experimental group compared with the negative control siRNA group and control group, 48h after transfection of synovial fibroblasts survivin mRNA and protein expression levels were significantly decreased ( P<0.05 ) .The experimental group compared with the negative control siRNA group and control group, synovial fibroblast proliferation after transfection significantly decreased ( P<0.05 ) . After the experimental group transfected 24h, 48h, 72h growth inhibition rates were (11.5 ±2.6)%, (26.2 ±3.4)%, (47.6 ±4.1)%, at 72 hours after transfection most significant.The rate of apoptosis in experimental group (23.87 ±1.6)%, significantly higher than the negative control group (9.72 ± 1.15)% and the control group (8.70 ±1.09)% (all P<0.05).Conclusion siRNA targeting survivin expression levels through reducing survivin, inhibit synovial fibroblast proliferation and promotes apoptosis.

Objective To investigate the effect of short hairpin RNA(shRNA) eukaryotic expression vector‐mediated silen‐cing of the survivin‐gene on proliferation and apoptosis of human umbilical vein endothelial cells(HUVEC) .Methods The shRNA vector targeting the survivin gene and negative control vector were transfected into human umbilical vein endothelial cells(HUVEC) incubated with 50 ng/mL of recombinant VEGF in vitro by lipofectamine 2000 .Transfection after 48 h ,the expression of survivin mRNA and protein was detected by quantitative real‐time PCR and Western blot ,respectively .HUVEC proliferation was assayed by four methylthiazolyl tetrazolium(MTT) and cell apoptosis was detected by TUNEL .Results (1)Transfection with survivin‐shR‐NA vector significantly down‐regulated the expression of survivin mRNA and protein as compared with the control group ,after transfection of 48 h(P<0 .05) .(2)After survivin‐shRNA vector transfected ,the proliferation of HUVEC decreased significantly . After transfection 24 ,48 ,72 h ,the growth inhibition rate were (13 .53 ± 3 .91)% ,(38 .97 ± 1 .82)% ,(65 .75 ± 1 .83)% respective‐ly ,at 72 hours after transfection was the most significant .(3)The apoptosis rate of experimental group was (28 .07 ± 1 .71)% , which was higher than the negative control group (11 .45 ± 1 .52)% and blank control group (10 .04 ± 1 .46)% (P<0 .05) .Conclu‐sion The shRNA‐mediated mediated silencing of the survivin‐gene could significantly inhibit proliferation and promote the apopto‐sis of rheumatoid arthritis synovial fibroblasts by regulating survivin expression .

Objective To investigate the effect of arthroscopic synovectomy treating rheumatoid arthritis of knee joint cartilage.Methods One hundred and fourty three patients were divided into two groups:the control group (74 cases) and the treatment group (69 cases).The control group was only given conventional antirheumatoid drug therapy; treatment group (69 cases) were given surgical therapy for knee joint synovium resection under arthroscopy.Health assessment survey questions (HAQ scores),arthritis affecting measurement scale (AIMS scores),Joint function Ishikawa efficacy score and MRI of the knee joint cartilage injury Recht standard score were analyzed.Results The HAQ and AIMS scores of the treatment group after treatment of 6,12 months were significantly lower than those of the control group[after 6 months of treatment:HAQ scores (7 ± 6) vs (13 ± 11),AIMS scores(10 ±5) vs (18 ± 10) ;after 12 months of treatment:HAQ scores (6 ±5) vs (14 ± 11),AIMS scores (8 ± 6) vs (18 ± 10),P ＜ 0.05] ; the difference was statistically significant.The Recht scores of the treatment group after 6,12 months of treatment were significantly lower than those in the control group,the difference had statistical significance[after 6 months of treatment:(2.8 ± 0.7) vs (3.4 ± 0.8) ; after 12 months of treatment:(2.7 ± 0.6) vs (3.5 ± 0.9),P ＜ 0.05].The patients in the treatment group were evaluated by knee function after treatment of 6,12 months,the results showed that the excellent and good rate of first and second stage patients were significantly higher than those of the third stage patients,the difference had statistical significance [after treatment of 6 months:100.0％ (17/17),90.2％ (37/41) vs 80.0％ (12/15) ;after treatment of 12 months:94.1％ (16/17),92.4％(38/41) vs 73.3％ (11/15),P＜0.05].Conclusion The effect of arthroscopic synovectomy treating rheumatoid arthritis of knee joint cartilage is optimistic,it can significantly retard the destruction of articular cartilage,improve the function of joint and the quality of life.

目的 探讨类风湿性关节炎合并肺间质纤维化患者疾病活动程度和肺功能与TGF-β的相关性.方法 选取2010年1月-2012年12月云南省第一人民医院收治的类风湿性关节炎合并肺间质纤维化患者36例为观察组,并以同期就诊的类风湿性关节炎无肺间质纤维化患者30例为对照组,比较两组疾病活动情况和TGF-β含量,并对疾病活动度、肺功能与TGF-β相关性进行统计学分析.结果 两组患者在DAS28、ESR、CRP和TGF-β比较差异均有统计学(P＜0.05);疾病活动程度DAS28、ESR、CPR与TGF-β之间存在相关性(r分别为0.68,0.74,0.71,P＜0.05);肺功能指标最大通气量、血氧饱和度、指脉氧饱和度、呼吸频率和第1秒肺活量与TGF-β之间存在相关性(r分别为0.81,0.77,0.76,0.82,0.69,P＜0.05).结论 TGF-β与疾病活动度和肺功能存在明显相关关系,不仅可以作为类风湿性关节炎的活动标志,还可以作为类风湿性关节炎合并肺间质纤维化病情观察的指标.

Objective To study the association between single nucleotide polymorphisms (SNPs) of PSMB8 and PSMB9 genes with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in Han Chinese female from Yunnan.Methods A case-control study was carried out including 209 female RA patients,178 female SLE patients and 216 healthy female controls.Genotypes of rs2071543 loci of PSMB8 gene,and rs17587 loci of PSMB9 gene were determined with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).SHEsis software was used to calculate the genotypic and allelic frequencies,construct haplotype,and also to calculate the linkage disequilibrium between the two SNPs.x2 test was used for statistical analysis.Results Genotypic frequencies of GG of rs17587 locus were significantly higher in the RA group (0.646) and SLE group (0.635) compared with the control group (0.533) (x2=5.652,P=0.017; x2=4.199,P=0.040).The hap-lotype C (rs2071543)-A (rs17587) frequency was significantly lower in the RA group (0.201) compared with the control group (0.264) (x2=4.495,P=0.034).Conclusion Genetic polymorphism of rs17587 maybe asso-ciated with both RA and SLE in femke Han Chinese from Yunnan.

Objective To investigate the role of survivin in the pathogenesis of rheumatoid arthritis (RA) by detecting of expression levels of survivin in synovial tissue of patients with rheumatoid arthritis and analyze its relationship with clinical features of RA patients.Methods The expression levels of survivin in synovial tissue of patients with RA were detected by immunohistochemistry method in 65 cases of RA,9 cases of osteoarthritis,21 normal controls.According to the disease activity score (DAS28),RA patients were divided into active disease group and remission group.Clinical data of these patients were recorded,including gender,age,course of disease,erythrocyte sedimentation rate (ESR),C reactive protein (CRP),rheumatoid factor (RF),anti-cyclic citrullinated peptide antibodies (CCP) and DAS28 score.Comparison of means of above parameters in multiple groups was conducted with variance analysis.Pair-wise comparisons among groups were conducted with one-way ANOVA.The expression of survivin was examined and compared among the three groups,the relationship between survivin and the clinical pathological features of the active group of RA were analyzed.The likelihood ratio chi-square test or Pearson chi-square test was used in the comparison of rates,Spearman's correlation analysis was used among parameters in the study.Results ① The expression of survivin in synovial tissue of patients with RA was significantly higher than that in OA group and normal control group (P=0.001).② The expression of survivin in synovial tissue of active RA group was significantly higher than in the remission group (x2=41.62,P=0.001).③ The survivin expression level was positively correlated with ESR,CRP,DAS28 score (r=0.297,0.411,0.416 respectively,P＜0.05),but not correlated with anti-CCP,RF,sex,patients' age and course of disease in RA patients (r=0.004,-0.1 14.,-0.074,-0.035,-0.188 respectively,P＞0.05).Conclusion The increased expression of survivin in RA synovial tissue has shown that the synovial fibroblast abnormal apoptosis is associated with survivin,and the increasing of survivin is involved in the pathogenesis of RA.Detection of survivin level is helpful for evaluation of RA disease activity.

Objective To observe the effect of the combination treatment of bosentan and simvastatin in medium-severe pulmonary arterial hypertension(PAH).Methods 61 patients with PAH were allocated into three groups:a combination of bosentan and simvastatin group,bosentan group and simvastatin group.WHO heart functional classification,right ventricular systolic pressure(RVSP),right ventricle diameter(RVd),Borg dyspnea index(BDI),6 minute walk distance(6MWD),Minnesota Living with Heart Failure Questionnaire(MLHFQ) scoring and plasma NT-Pro-BNP concentration were recorded at baseline and after 12 weeks under treatment.Results Compared to baseline,RVSP(62.16±3.42 vs.87.28±5.30),RVd(2.50±0.33 vs.2.83±0.64),BDI(3.1±1.5 vs.4.1±1.2),NT-Pro-BNP level(289.1±50.7 vs.399.7±48.2) and MLHFQ scoring(42.21±4.25 vs.55.14±3.48)(P<0.05) were decreased significantly(P<0.01),6MWD(340.72±9.06 vs.291.22±4.14) was increased significantly in combination group(P<0.01);combination group had the greater effect in decreasing RVSP(23.15±6.25 vs.18.71±4.23),RVd(0.32±0.26 vs.0.39±0.28),MLHFQ scoring(15.11±4.23 vs.11.72±5.12),NT-Pro-BNP level(104.35±32.40 vs.82.15±61.02) and increasing 6MWD(52.33±3.15 vs.37.82±7.41)(P<0.01)compared with bosentan group(P<0.05).Conclusion Bosentan combined with simvastatin was more effective for patients with medium-severe PAH than single medicine treatment.

痛风石是痛风的特征性病变,痛风石形成的典型部位在耳轮,也常见于第一跖趾、指间、踝、腕、膝、肘等处,发生在脊柱部位的痛风石极为少见,我院近期收治1例腰椎痛风石患者,现报道如下:

【Objective】 To explore the clinical presentations and pathologic features of the subcutaneous panniculitis like T-cell lymphoma(SPTCL) in order to improve its diagnosis.【Methods】 Five patients treated as SPTCL in our hospital from January 2005 to January 2009 were included in this study,and the clinical, pathologic,and immunohistochemical features were analyzed.【Results】 There were 2 males and 3 females with the median age 23.8 years(range: 14～38 years).The period from the onset of symptom to the diagnosis as SPTCL was 8 months on average(range: 14～38 years).The 5 patients had been misdiagnosed as rheumatic diseases at beginning,such as polymyositis,nodular panniculitis,antiphospholipid syndrome.All the patients presented with multiple subcutaneous nodules or deeply seated plaques at different sites,most commonly on the extremities and trunk,as well as on face and neck.Ulceration of nodules occurred in 2 cases.2 patients had lymphadenopathy involvement,1 patient had breast involvement.5 cases all had fevered and abnormal liver function with higher level of lactate dehydrogenase(LDH).4 cases had smaller amount of white blood cell.2 patients had hemophagocytic syndrome(HPS),and the pathologic features may consist of infiltrations of atypical lymphocytes,infiltrated subcutaneous lipid tissue as panniculitis pattern.CD3 and CD45RO were expressed in the tumor cells of all 5 cases.CD 20 was not expressed.Loss of the follow-up was in 3 cases, one patient was died,and the other patient was alive with a followed-up of 21 months and 3 months respectively.【Conclusion】 SPTCL is often misdiagnosed as rheumatic disease at initial stage.SPTCL should be watched out once the anti-rheumatic therapy does not work well,especially accompanied by high level LDH in serum,HPS and lower WBC.Immunophenotype and gene rearrangement data are considered important in confirming a diagnosis of SPTCL.

Objective To investigate expression and significance of ADAMTS-4 in synovial fluid of knee osteoarthritis.Method Among 87 patients with single-side knee osteoarthritis,45 of them suffered from early-stage knee osteoarthritis,and 42 of them from medium-later-stage knee osteoarthritis.The levels of ADAMTSs in synovial fluid of patitents were determined.30 healthy volunteers were selected into the control group.Results ADAMTSs-4 in synovial fluid had higher expression in the early stage OA group than in the late stage OA group(P0.05).Only a few ADAMTS-4 in synovial fluid were expressed in the control group.Conclusion ADAMTS-4 in synovial fluid have high expression in the early stage and late stage OA groups,and ADAMTS-4 has value in the early diagnosis of OA.

<正>本文旨在研究绝经前女性SLE患者血清sCD40L浓度与动脉粥样硬化的关系,探讨系统性红斑狼疮(SLE)患者早发动脉粥样硬化病变的机制。1资料与方法1.1标本来源纳入2008年11月至2009年12月在我院住院的女性SLE患者59例,符合美国风湿病协会(ACR)1997年修订的诊断标准。参照SLEDAI评分标准,

目的:探讨抗SSA抗体阳性SLE患者的临床特点。方法:对抗SSA抗体阳性的157例和抗SSA抗体阴性的221例SLE患者进行回顾性分析比较。结果:抗SSA抗体(+)患者出现口腔溃疡、雷诺现象、肺动脉高压、肢端坏死、肌痛/肌炎、神经系统受累和继发干燥综合征的发生率显著高于抗SSA抗体(-)的患者,而光过敏则显著低于抗SSA抗体(-)的患者,两组差异有统计学意义(P<0.05或P<0.01)。结论:抗SSA抗体阳性的SLE患者易出现肺动脉高压、肢端坏死、神经精神等重症表现,并多处于狼疮活动期。