类风湿关节炎(rheumatoid arthritis,RA)是一种器官特异性自身免疫病,本病的免疫调节失衡可导致嗜酸粒细胞增多.现将我科诊治的1例报告如下. 临床资料 患者女,68岁,因“关节肿痛20余年,加重20 d”于2008年5月16日入住华中科技大学同济医学院附属同济医院.患者20余年前无明显诱因出现关节肿痛,主要累及双侧肩关节及膝关节,当地医院诊断为类风湿关节炎,给予泼尼松5 mg,2次/d,口服治疗,疼痛可缓解.20年来,上述症状反复发作.

Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a standard instrument regularly used to assess disease activity of patients with ankylosing spondylitis (AS). However, the well-being of a patient is also affected by impairment of function as well as psychological status and other factors. The objective of this study was to evaluate if psychological status, stressful life events, and sleep quality contribute significantly to BASDAI. Six hundred eighty-three AS patients satisfying the Modified New York Criteria for AS were recruited from the rheumatology clinics of seven hospitals in China. Patients with other concomitant disorders were excluded. Participants were requested to complete a set of clinical examinations and the following questionnaires: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index Questionnaire (PSQI), Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S), and Social Readjustment Rating Scale (SRRS). Spearman correlation analysis showed that BASDAI was highly associated with degree and duration of morning stiffness, overall pain, nocturnal back pain, overall back pain, anxiety, and BASFI (all P < 0.001), but were not associated with education, HAQ-S, and sleep medication in PSQI (P > 0.05). Multiple stepwise regression analysis indicated that overall pain was the maximal statistical contribution in predicting disease activity (standardized coefficient, 0.335). In hierarchic multiple regression analysis, psychological variables added an only additional 2.7 % to the overall R 2 beyond that accounted for by demographic and medical variables, resulting in a final R 2 of 53.5 %. Although BASDAI is a very good measurement of pain and stiffness and to a certain extent effect of functional impairment in AS, it barely takes into account psychological status, stress life events, and sleep quality These factors should be evaluated by other modalities.

Jieruo Gu, Jianjun Liu and colleagues report the results of a genome-wide association study of ankylosing spondylitis in Han Chinese. They identify two new susceptibility loci for this inflammatory disease and confirm strong associations with variants in the HLA-B region.

The objectives of this study were to evaluate the reliability of Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis disease activity index (BASDAI) in Chinese ankylosing spondylitis (AS) and undifferentiated spondyloarthropathy (USpA) patients. 664 AS patients by the revised New York criteria for AS and 252 USpA patients by the European Spondyloarthropathy Study Group criteria were enrolled. BASDAI and BASFI questionnaires were translated into Chinese. Participants were required to fill in BASFI and BASDAI questionnaires again after 24 h. Moreover, BASDAI and BASFI were compared in AS patients receiving Enbrel or infliximab before and after treatment. For AS group, BASDAI ICC: 0.9502 (95% CI: 0.9330-0.9502, α=0.9702), BASFI ICC: 0.9587 (95% CI: 0.9521-0.9645, α=0.9789). For USpA group, BASDAI ICC: 0.9530 (95% CI: 0.9402-0.9632, α=0.9760), BASFI ICC: 0.9900 (95% CI: 0.9871-0.9922, α=0.9950). In the AS group, disease duration, occipital wall distance, modified Schober test, chest expansion, ESR, and CRP showed significant correlation with BASDAI and BASFI (all P<0.01). In the USpA group, onset age, ESR, and CRP were significantly correlated with BASDAI (all P<0.05), while modified Schober test, ESR, and CRP were significantly associated with BASFI (all P<0.05). The change in BASDAI and BASFI via Enbrel or infliximab treatment showed a significant positive correlation (P<0.01). The two instruments have good reliability and reference value regarding the evaluation of patient's condition and anti-TNF-α treatment response.

目的 了解心肌肌钙蛋白Ⅰ升高常见的原因并分析其在各类疾病中的意义.方法 回顾性分析我院2007年1月～2007年12月收治的237例心肌肌钙蛋白Ⅰ明显升高患者的临床资料.结果 心肌肌钙蛋白Ⅰ升高的常见病因依次为急性冠脉综合征(73.4%)、脑血管意外(5.5%)、慢性阻塞性肺疾病合并呼吸衰竭(3.4%)、慢性肾功能不全(2.5%)、心肺复苏后(2.1%)、感染性休克(2.1%)、肥厚型心肌病(1.3%)和高血压性心脏病(1.3%),其他各种原因引起者占8.4%.结论 心肌肌钙蛋白Ⅰ的异常升高提示心肌损伤,急性冠脉综合征是心肌肌钙蛋白Ⅰ升高的主要原因,且多种原因可以引起心肌肌钙蛋白Ⅰ的异常升高,临床上需要注意鉴别.

类风湿关节炎(rheumatoid arthritis,RA)是一种以关节炎为主要临床表现的慢性炎症性疾病,可引起关节破坏、畸形和功能障碍,以手、足的小关节受累为主,并可累及全身其他系统.早期使用缓解病情抗风湿药(DMARDs)对于延缓关节变形、改善预后起着至关重要的作用.

目的 调查系统性红斑狼疮(SLE)合并免疫性甲状腺疾病的年患病数,并探讨分析其临床特点.方法 回顾性调查2008年度武汉同济医院风湿免疫科住院的172例SLE病例,分析其中49例检测了甲状腺功能患者的临床资料,并分组比较SLE合并甲状腺疾病的临床特征.结果 SLE合并甲状腺功能减退症(甲减)组,17例;SLE合并甲状腺功能亢进症(甲亢)组,10例;病例对照组,22例.SLE合并甲状腺疾病的总体患病率约为15.7%,合并甲减和甲亢的患病率分别为9.89%和5.81%.多关节炎和抗ds-DNA抗体阳性检出率低是SLE合并甲减的主要特征,发热则在SLE合并甲亢的病人多见(P均＜0.05).结论 SLE合并甲状腺疾病临床并不少见,它具有独特的临床特征,应注意监测其甲状腺功能.

OBJECTIVETo assess the efficacy and safety of T-614 versus methotrexate (MTX) in patients with active rheumatoid arthritis (RA).METHODSIn this multicenter, double-blind trial, 489 patients randomly received either T-614 25 mg/day for the first 4 weeks and 50 mg/day for the subsequent 20 weeks (group 1, n = 163), T-614 50 mg/day for 24 weeks (group 2, n = 163), or MTX 10 mg/week for the first 4 weeks and 15 mg/week for the subsequent 20 weeks (n = 163). Clinical and laboratory parameters were analyzed at baseline and at 4, 10, 17, and 24 weeks.RESULTSAfter 24 weeks of treatment, the American College of Rheumatology 20% improvement criteria response rate for patients in T-614 group 2 (63.8%) was not statistically significantly different from that for patients receiving MTX treatment (62.0%), and was superior to that for patients in T-614 group 1 (50.9%). The result of the noninferiority analysis indicated that the efficacy of T-614 (50 mg/day) was not lower than that of MTX by <10%. Rheumatoid factor and IgA, IgG, and IgM demonstrated a statistically significant decrease in all groups. Frequently reported adverse events included hematologic disorder, skin reactions, gastrointestinal symptoms, and transient liver enzyme elevations in the T-614 therapy groups. Side effects in the T-614 groups were generally fewer and milder than in the MTX group, except for skin reactions. There were no prominent cardiovascular adverse events and gastrointestinal ulcers found in the T-614 groups.CONCLUSIONResults indicate that T-614 therapy 50 mg/day is effective and well tolerated, and represents a new option for the treatment of patients with active RA.

Objective To investigate the positive rate and concentrations of tumor marker CA125 in sera of patients with systemic lupus erythematosus(SLE),and to analyze the relationship between serum CA125 and SLE disease activity index (SLEDAI),and serous cavity effusion.Methods The tumor marker CA125 in sera of 37 patients with SLE was determined by means of chemiluminescent microparticle immunoassay.The clinical data and results of laboratory examination were collected.The positive rate of serum CA125,and the relationship between serum CA125 and SLEDAI,and serous cavity effusion was statistically analyzed.Results The positive rate of tumor marker CA125 in sera of SLE patients was 32.4% (33.3% in active stage,and 30.8% in remission stage,respectively,P>0.05).The concentration of CA125 in sera of patients with peritoneal effusion or pleural effusion was higher than in those without peritoneal effusion or pleural effusion(P<0.05).Conclusion The positive rate of CA125 in sera is high in SLE patients,which may be related to the serous cavity effusion,but not to the activity of the SLE.

目的 探讨系统性红斑狼疮(SLE)患者外周血单个核细胞表达神经颗粒素蛋白(Ng)的临床意义.方法 采用半定量RT-PCR和Western blot共检测72例SLE患者外周血单个核细胞Ng表达状态,依据RT-PCR电泳条带的灰度值或是否可见Western blot条带,将72例SLE患者分成病例研究组(53例)和病例对照组(19例),分别比较两组临床特征.结果病例研究组SLE疾病活动指数评分(SLEDM)明显高于对照组(P<0.05),具有较高的发生肾损害(P<0.05)的危险性.结论 SLE患者外周血单个核细胞过度表达Ng提示疾病活动性较高,可能与肾损害和血液学异常相关联.

目的 探讨结缔组织病合并感染的病原学特征,以期为临床诊治提供依据.方法 回顾性分析我科体液培养阳性的102例结缔组织病合并感染患者的病原学资料.结果 本组疾病感染的病原体中,G-杆菌感染已占绝对优势达62.75%,G+球菌感染率仅为37.25%.在菌种构成方面,大肠埃希氏菌占16.67%,铜绿假单胞菌占14.72%,肺炎克雷伯杆菌占9.80%,金黄色葡萄球菌占9.80%,凝固阴性葡萄球菌占6.86%,表皮葡萄球菌占5.88%.感染的部位以呼吸道和泌尿道居多,分别为57.84%、16.66%,全身感染引起的败血症也占有较高的比率,为17.64%.对27株大肠埃希菌及肺炎克雷伯菌属进行ESBLs检测,阳性率为59.26%.结论 G-杆菌是结缔组织病合并感染的主要致病菌,感染菌株中ESBLs阳性率较高,全身感染引起的败血症的比率较高.

类风湿性关节炎(Rheumatoid,RA)是一种慢性炎症性疾病,全球范围内一般人群发病率约为0.5%～1%,病变主要造成患者关节破坏及生活质量严重下降.

目的 探讨99锝[99Tc]亚甲基二膦酸盐(99Tc-MDP)对胶原诱导性关节炎(CIA)大鼠的治疗作用.方法 设立正常组大鼠10只,建立CIA大鼠模型18只,分为模型组和99Tc-MDP组各9只.99Tc-MDP组CIA大鼠予以尾静脉注射99Te-MDP,相当于99TC 0.04ug·kg-1·d-1共21 d .测量各组大鼠体重、关节肿胀程度和关节炎指数(AI),观察滑膜病理组织形态学变化,并用ELISA法检测血清肿瘤坏死因子(TNFα)水平.结果 ①与正常组大鼠比较,模型组CIA大鼠体重明显减轻.关节肿胀程度严重,AI评分明显升高,滑膜组织病理评分也明显升高(均P＜0.01);②99Tc-MDP干预治疗可明显缓解CIA大鼠体重下降,改善关节肿胀程度,降低AI评分和滑膜组织病理评分;③正常对照组和99Tc-MDP组大鼠血清TNFα水平显著性低于模型组大鼠(均P＜0.01).结论 CIA大鼠关节炎症状明显,99Tc-MDP可明显改善CIA大鼠一般状况,减轻关节炎症状及滑膜组织的病理评分,降低血清TNF-α水平,对CIA有显著治疗效果.

Objective To investigate the therapeutic effect of 99Tc-MDP on collagen-induced arthritis(CIA) in rats. Methods CIA was established by subcutaneous injection with type Ⅱ collagen and incomplete Freud's adjuvant in rats.Three groups were designed including the control group,CIA model group and 99Tc-MDP treatment group.Rats of the treatment group were given 0.04 μg·kg-1·d-1 99Tc of Tc-MDP by caudal vein injection for 21 days.Arthritis were evaluated by measuring the body weight,joint swelling degree,arthritis index(AI) and synovium histopathologic index.ELISA was used to assay the TNF-α level in serum. Results ①The degree of weight loss,joint swelling,AI and synovium histopathologic index in the rats of CIA model group were significantly higher than those of 99Tc-MDP treatment group and the control group(P0.01);②Post-treatment with 99Tc-MDP obviously attenuated the weight lost,inhibited the degree of joint swelling,AI and synovium histopathologic index;③Compared with the CIA model group,the level of TNF-α was significant decreased in control group and 99Tc-MDP treatment group(P0.01). Conclusion The CIA rats suffered serious polyarthritis,however the clinical symptoms and the synovium histopathologic index were markedly improved and the level of TNF-α in serum was reduced after treated with 99Tc-MDP.99Tc-MDP could inhibit the progress of CIA.

目的 探讨干扰素诱导蛋白(IFI 16、IFI 27、IFI 30)mRNA表达与系统性红斑狼疮(SLE)的关系.方法 以前期构建SLE患者外周血单个核细胞(PBMCs)基因表达系列分析(SAGE)文库为基础,分析该文库中出现的3个干扰素相关基因标签(tag),并采用反转录-聚合酶链反应(RT-PCR)方法,临床检测IFI16、IFI27、IFI30在43例SLE患者和25名正常对照人群PBMCs中的mRNA表达水平.结果 分别约有88%、98%、58%的SLE个体其IFI16、IFI27、IFI30 mRNA表达增加,高于正常对照组总体均数95%可信区间的上限.与正常对照组比较,SLE活动组和缓解IFI16、IFI27、IFI30的表达水平均增加(P值均＜0.01).活动组与缓解组间比较,活动组SLE患者高表达IFI16和IFI27(P=0.003,P=0.001),IFI30的表达差异无统计学意义(P=0.227). SLE患者IFI16、IFI27、IFI30间的表达水平互不相关.IFI16、IFI27表达与狼疮疾病活动指数(SLEDAI)呈正相关,相关系数分别为0.557、0.414,P直分别为0.000,0.006.IFI30表达与SLEDAI无相关(r=-0.102,P=0.514).结论 SLE患者IFI16、IFI27、IFI30表达增高,揭示其在SLE发病中的重要作用.

Objective To investigate the mRNA expression of a proliferation inducing ligand (APRIL) and its receptors including B cell maturation antigen (BCMA),transmembrane activator.calcium modulator and cyclophilin ligand interactor (TACI) in the peripheral blood mononuclear cells (PBMCs) of patients with systemic lupus erythematosus (SEE).Methods APRIL mRNA、BCMA mRNA and TACI mRNA in PBMCs were detected by real-time quantitative PCR in 66 SLE patients and 25 normal controls.Gene expression level was measured as 2-AACT.Results The expression levels of APRIL mRNA、BCMA mRNA and TACI-mRNA were significantly increased in both active SLE group and stable SLE group compared with those in the normal controls(P<0.01 for all).The expression levels of APRIL mRNA and TACI mRNA in active SLE group were significantly higher than those in stable SLE group(P<0.01,P<0.05,respectively).But there was no significant difierence in the expression levels of BCMA mRNA between the SLE stable and active groups-Beside,the expression levels of APRIL mRNA and TACI mRNA were significantly increased in patients with lupus nephritis (LN) compared to patients with non-LN (P<0.01 for all).Conclusion The expression levels of APRIL and its receptors are significantly elevated in SLE patients.It may suggest that APRIL and its receptors play an important role in the pathogenesis of SLE.

Objective To investigate the mRNA expression level of neurogranin on peripheral blood mononuclear cells(PBMCs)from patients with systemic lupus erythematosus(SLE).Methods Top 20 tags of SLE PBMCs SAGE library were searched from normal lymphocytes SAGE library including navie-T,Th1,Th2, CD8+T, NK and B cells,and their abundance was compared.The mRNA expression level of neuro-granin,a differential over-expressed tag,was detected in 35 cases of SLE and 15 normal controls by reversetranscription-polymerase chain reaction (RT-PCR).Results Neurogranin tag could only be detected in SLE PBMCs SAGE library,but was hardly found in normal lymphocyte SAGE library.However,either SLE pa-tients or normal controls showed a detectable mRNA level of neurogranin on PBMCs by RT-PCR.The mRNA level of neurogranin in active SLE patients was significantly increased than those in controls(P＜0.001).but only slightly increased in inactive SLE patients (P＞0.05).Conclusion Neurogranin,as a novel proapototic factor,is overexpressed on PBMCs of SLE patients.It may be involved in the regulation of abnormal immune responses in lupus.

系统性红斑狼疮(SLE)是一种病因和发病机制尚不完全清楚的自身免疫性疾病(AID),目前认为是多种内外因素共同作用,导致SLE患者免疫功能紊乱,大量致病性自身抗体和免疫复合物产生,造成多系统和多器官的损害.随着诊断和治疗水平的不断提高,SLE的预后已明显改善.然而,部分SLE患者虽然经过糖皮质激素和免疫抑制剂等药物治疗,仍然难以控制疾病活动,病情进展性加重,生活质量差,甚至死亡.

系统性红斑狼疮(SLE)是内科疾病中病变损伤范围最为广泛的疾病之一.但皮肤黏膜病变程度多较轻,罕见严重的皮肤黏膜损害.我们成功救治1例SLE合并中毒性表皮坏死松解症(TEN),伴有重度消化道出血的病例,兹将临床资料报道如下.

糖皮质激素(glucocorticoids)是治疗慢性炎症性疾病的常用药物,可以引起多种不良反应,其中糖皮质激素所致骨质疏松(glucocorticiod induced osteoporosis,GIOP)是继发性骨质疏松中最常见的一种,可导致椎体、肋骨、髋部等多部位骨折,严重影响患者生活质量并增加社会负担,是糖皮质激素治疗的严重并发症之一.