CDFI血流信号分级、抗CCP抗体、G6PI、RF对类风湿性关节炎的诊断价值

目的分析彩色多普勒血流显像(CDFI)血流信号分级、抗环瓜氨酸肽抗体(CCP)、葡萄糖6磷酸异构酶(G6PI)、类风湿因子(RF)对类风湿性关节炎(RA)的诊断价值。方法回顾性选取2022年4月至2023年10月新疆医科大学附属中医医院收治的100例RA患者纳入观察组,根据病情分为RA活动期组(n=50)和RA非活动期组(n=50);依据血流信号CDFI分级分为0~1级组(n=20)、2级组(n=17)、3级组(n=13)。选取同期本院收治的100例其他自身免疫性疾病患者纳入对照组。比较观察组、对照组一般临床资料(性别、病程、年龄、RA家族史、体重指数、吸烟史、饮酒史、居住地、职业等),比较不同活动期患者抗CCP抗体、G6PI及RF水平;比较不同血流信号分级组患者抗CCP抗体、G6PI及RF水平;采用受试者工作特征(ROC)曲线评估CDFI血流信号分级、抗CCP抗体、G6PI、RF联合检测对RA的诊断价值。结果两组患者性别构成比、病程、年龄、RA家族史、体重指数、吸烟史、饮酒史、居住地、职业比较,差异均无统计学意义(P>0.05);观察组患者抗CCP抗体、G6PI及RF水平均高于对照组,差异均有统计学意义(P<0.05)。RA活动期组患者抗CCP抗体、G6PI及RF水平均高于RA非活动期组患者,差异均有统计学意义(P<0.05)。血流信号3级组患者抗CCP抗体、G6PI及RF水平均高于血流信号0-1级组、2级组患者,差异均有统计学意义(P<0.05)。CDFI血流信号分级、抗CCP抗体、G6PI、RF单独检测RA的敏感度分别为79.57%、86.45%、82.14%、77.89%,特异度分别为83.89%、79.28%、83.67%、84.15%,AUC分别为0.855(0.804~0.907)、0.940(905~0.976)、0.893(0.852~0.935)、0.800(0.736~0.864),CDFI血流信号分级、抗CCP抗体、G6PI、RF联合检测RA的敏感度为89.36%,特异度为77.24%,AUC为0.957(0.933~0.980)。结论RA患者血清CCP抗体、G6PI、RF水平升高,随着CDFI血流信号分级增大,升高愈加明显,CDFI血流信号分级、抗CCP抗体、G6PI、RF联合检测RA诊断价值较高,对判断RA进展具有意义。

类风湿关节炎检查与诊断中RF、抗CCP、AKA单独或联合检验的作用

目的 探究类风湿关节炎检查与诊断中RF(类风湿因子)、抗CCP(抗环瓜氨酸多肽抗体)、AKA(抗角蛋白抗体)单独或联合检验的作用。方法 选取2019年1月—2021年12月本院收治的类风湿关节炎患者47例(试验组)与非类风湿关节炎的自身免疫性疾病患者47例(对照组)作为研究对象,分析单独检验及联合检验的检出率,判断临床诊断价值。结果 试验组RF、抗CCP抗体、AKA阳性率均高于对照组,差异有统计学意义(P<0.05)。单独RF、抗CCP抗体、AKA对比灵敏度无差异(P>0.05);AKA、抗CCP抗体特异度高于RF,差异显著有统计学意义(P<0.05)。RF+抗CCP抗体+AKA诊断效能最高,差异有统计学意义(P<0.05)。结论RF、抗CCP、AKA联合应用于类风湿关节炎诊断效能显著,应用价值高。

基于RF和MLR的土壤重金属影响因素分析及生物有效性预测

为探究影响土壤中重金属累积和生物有效性的因素,以桂北地区某铅锌矿流域为研究对象,综合运用单因子指数法、风险评价编码法(RAC)、多元线性回归模型(MLR)和随机森林模型(RF)进行土壤重金属(Pb、Zn、Cu和Cr)累积影响因素分析及生物有效性预测。结果表明:研究区Cr含量无超标且空间分布相对均匀(变异系数为0.51);Cu、Pb和Zn的含量均值(分别为52.58、280.31 mg·kg^(-1)和654.71 mg·kg^(-1))均大于广西西江流域土壤重金属背景值,在思的河山前和地下河入口处全量和生物有效性均较大,对土壤生态环境具有一定风险;对于重金属全量分布和生物有效态的影响因素,阳离子交换量(CEC)、黏粒(Clay)、土壤有机质(SOM)和铁铝氧化物对Cr影响较大,SOM、Clay、pH和铁铝氧化物对Cu影响较大,pH、电导率(EC)和Clay对Pb影响较大,CEC、pH、土壤质地和铁铝氧化物对Zn影响较大;生物有效性预测结果显示RF和MLR均可较好地预测土壤重金属的全量与次生相,其中RF预测的R2区间为0.44~0.93,MLR预测的R2区间为0.30~0.72,RF预测结果表现更为准确。

基于PCA-RF组合模型的福建省空气负氧离子浓度预测研究

空气负氧离子(NOI)浓度是评价空气新鲜和清洁程度的重要指标。为了提高NOI浓度的监测能力,综合考虑气象要素和遥感因子,分析NOI浓度的关键影响因子,利用皮尔逊相关分析、PCA分析和随机森林机器学习方法(RF)构建了福建区域NOI浓度的PCA-RF预测模型。研究发现,(1)NOI浓度分布与风速(W_(air))、空气温度(T_(air))、大气压强(P_(air))、能见度(I_(VIS))、气溶胶光学厚度(h_(AOD))、植被指数(I_(NDVI))、湿度指数1(I_(NDMI1))、植被供水指数(I_(VSWI))和亮度指数(I_(NDSI))呈显著相关(均通过0.01显著性检验),其中W_(air)、I_(VIS)、I_(NDVI)和I_(VSWI)与NOI浓度呈正相关,T_(air)、P_(air)、h_(AOD)、I_(NDMI1)和I_(NDSI)与NOI浓度呈负相关。(2)主成分数量为7时,方差累计贡献率达到93.36%,能够代表所有因子的大部分信息。(3)PCA-RF模型最佳的ntree和mtry分别为400和7。对福建区域NOI浓度影响较大的前3个因子依次为P_(air)、I_(VIS)和I_(VSWI)。(4)PCA-RF模型在验证集上的RMSE为803.73 ions/cm^(3),R^(2)为0.44,MAE为548.79 ions/cm^(3)。

Comparative study for cardiovascular risk factors of rheumatoid arthritis and osteoarthritis

目的：比较类风湿关节炎和骨关节炎患者心血管危险因素的差异.方法：回顾性比较44例类风湿关节炎患者（RA）和36例骨关节炎患者（OA）的心血管疾病相关影响因素的差异.包括性别、年龄、身体质量指数、病程、颈动脉超声相关指标、同型半胱氨酸、血脂水平、炎症相关指标及超声心动相关指标等.结果：（1）一般情况：两组患者在性别、年龄方面无明显差异（P〉0.05）,在体重指数方面,OA组体重指数显著高于RA组（P=0.018）,在病程方面,RA组病程显著长于OA组（P=0.024）;（2）实验室指标：RA组患者同型半胱氨酸水平显著高于OA组（P=0.002）;两组患者总胆固醇、甘油三酯、低密度脂蛋白、载脂蛋白B、高密度脂蛋白比较均无明显差异（P〉0.05）,但RA组载脂蛋白A1水平显著低于OA组（P〈0.001）,脂蛋白α水平显著高于OA组（P〈0.001）;RA组患者的血沉、C反应蛋白较OA组水平显著升高（P〈0.001）;（3）超声评价：在心脏超声方面,RA组患者每搏输出量、射血分数明显低于OA组（P=0.022,P=0.009）;两组患者主动脉内径、左心房内径、左室舒张末期内径、左室收缩末期内径、左室后壁厚度、左室短轴缩短率、右心室内径、右心房内径、及室间隔厚度比较均无明显差异（P〉0.05）;两组患者颈动脉斑发生率无明显差异（P〉0.05）,但两组患者颈动脉增厚的发生率及颈动脉中层厚度比较均有明显差异（P〈0.001）.结论：RA患者发生心血管事件的概率比OA高,积极控制RA病情,可能降低心血管事件的发生.

Blood glucose changes surrounding initiation of tumor-necrosis factor inhibitors and conventional disease-modifying anti-rheumatic drugs in veterans with rheumatoid arthritis

AIM To determine the scope of acute hypoglycemic effects for certain anti-rheumatic medications in a large retrospective observational study. METHODS Patients enrolled in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were selected who, during follow-up, initiated treatment with tumor necrosis factor inhibitors (TNFi's, including etanercept, adalimumab, infliximab, golimumab, or certolizumab), prednisone, or conventional disease-modifying anti-rheumatic drugs(DMARDs), and for whom proximate random blood glucose (RBG) measurements were available within a window 2-wk prior to, and 6 mo following, medication initiation. Similar data were obtained for patients with proximate values available for glycosylated hemoglobin A1C values within a window 2 mo preceding, and 12 mo following, medication initiation. RBG and A1C measurements were compared before and after initiation events using paired t-tests, and multivariate regression analysis was performed including established comorbidities and demographics.RESULTS Two thousands one hundred and eleven patients contributed at least one proximate measurement surrounding the initiation of any examined medication. A significant decrease in RBG was noted surrounding 653 individual hydroxychloroquine-initiation events(-3.68 mg/dL, P = 0.04), while an increase was noted for RBG surrounding 665 prednisone-initiation events(+5.85 mg/d L, P < 0.01). A statistically significant decrease in A1C was noted for sulfasalazine initiation, as measured by 49 individual initiation events(-0.70%, P < 0.01). Multivariate regression analyses, using methotrexate as the referent, suggest sulfasalazine (β =-0.58, P = 0.01) and hydroxychloroquine(β =-5.78, P = 0.01) use as predictors of lower post-medicationinitiation RBG and A1C values, respectively. Analysis by drug class suggested prednisone (or glucocorticoids) as predictive of higher medication-initiation event RBG among all start events as compared to DMARDs, while this analysis did not show any drug class-level effect for TNFi. A diagnosis of congestive heart failure(β = 4.69, P = 0.03) was predictive for higher post-initiation RBG values among all medication-initiation events.CONCLUSION No statistically significant hypoglycemic effects surrounding TNFi initiation were observed in this large cohort. Sulfasalazine and hydroxychloroquine may have epidemiologically significant acute hypoglycemic effects.

Effect of tumor necrosis factor inhibitors on rheumatoid arthritis-induced peripheral neuropathy A cohort study

In this historical cohort study, 236 patients with primary rheumatoid arthritis were treated with the tumor necrosis factor inhibitors, etanercept or infliximab （n = 80）, or by conventional methods （n = 156）. Results revealed that 11 patients developed varying types of peripheral neuropathy at 1-2 years post-treatment （mean 16 months）. The incidence of peripheral neuropathy in the tumor necrosis factor inhibitors treatment group was 8.8% （7/80）, which was significantly higher than the conventional treatment group （2.6%; 4/156）. The relative risk of developing peripheral neuropathy in the tumor necrosis factor inhibitors treatment group was 3.41 （95% confidence interval： 1.03 11.31）. Comparison of the tumor necrosis factor inhibitors revealed that etanercept and infliximab had no significant difference in terms of inducing peripheral neuropathy. Experimental findings indicate that tumor necrosis factor inhibitors may increase the risk of peripheral neuropathy.

Distinct Expression of Chemokine-like Factor 1 in Synovium of Osteoarthritis, Rheumatoid Arthritis and Ankylosing Spondylitis

Chemokine-like factor 1（CKLF1） is a newly cloned chemotactic cytokine with CCR4 being its functional receptor. Recent evidence demonstrates a role of CKLF1 in arthritis. The aim of this study was to quantify the expression of CKLF1 as well as assess the correlation between CKLF1 and plasma acute-phase markers. Synovium was obtained from 16 osteoarthritis（OA）, 15 rheumatoid arthritis（RA） and 10 ankylosing spondylitis（AS） patients undergoing total joint arthroplasty, with other 11 patients treated for meniscal tears during sport accidents serving as normal controls. Levels of CKLF1 and CCR4 m RNA were detected by q RT-PCR, and the expression of CKLF1 was investigated by immunohistochemistry staining, subsequently analyzed with semiquantitative scores. Plasma acute-phase markers of inflammation were determined by ELISA. CKLF1 was found with a particularly up-regulated expression in synovim from AS and RA patients, and CCR4 m RNA levels increased in RA patients, not in OA or AS patients. Elevated levels of plasma markers of inflammation including CRP, ESR and Ddimer were observed in RA. Further, significantly positive correlations between relative expression levels of CKLF1 and CRP/ESR in RA patients and a positive correlation between CKLF1 and ESR in AS patients were found. There was no detectable correlation between CKLF1 and plasma D-dimer. This study confirms an increased but different level of CKLF1 in RA, OA and AS patients, all significantly higher than that in controls. Additionally, the significant positive correlations between CKLF1 levels and CRP/ESR in RA and between CKLF1 and ESR suggest that CKLF1 might contribute to the inflammation state and clinical symptoms in these rheumatic diseases. Further studies are required to investigate the utility of targeting specific CKLF1 for symptom control or disease modification in RA and AS.

Simulation of higher order modes and loss factor of a new type of 500-MHz single cell superconducting cavity at SSRF

In this paper,higher order modes(HOMs) and loss factor of a new type of 500-MHz superconducting cavity is studied,by simulating its broadband HOMs damping at different positions of the ferrite HOM-absorber and different lengths of the ferrite.The results show that the impedance and Q value of the HOMs in transverse and longitudinal modes could be greatly reduced.The HOM longitudinal impedance could be damped to meet the requirement of SSRF beam instability threshold.The calculated loss factor of the new SC cavity was compared with cavities at SSRF.It was estimated that the HOM absorber could absorb a total power of 3.16 kW at 4-mm beam bunch length.

Inhibition of rheumatoid arthritis by blocking connective tissue growth factor

The pathogenesis of rheumatoid arthritis(RA) remains to be completely elucidated so far; however, it is known that proinflammatory cytokines play a pivotal role in the induction of RA. Tumor necrosis factor(TNF-α), in particular, is considered to play a central role in bone destruction by mediating the abnormal activation of osteoclasts or the production of proteolytic enzymes through direct or indirect mechanisms. The use of TNF-α blocking agents has a significant impact on RA therapy. Anti-TNF-α blocking agents such as infliximab are very effective for treatment of RA, especially for the prevention of articular destruction. We have previously shown that several proteins exhibited extensive changes in their expression after amelioration of RA with infliximab treatment. Among the proteins, connective tissue growth factor(CTGF) has a significantrole for the development of RA. Herein, we review the function of CTGF in the pathogenesis of RA and discuss the possibility of a novel treatment for RA. We propose that CTGF is a potentially novel effector molecule in the pathogenesis of RA. Blocking the CTGF pathways by biological agents may have great beneficial effect in patients with RA.

Low rates of adherence for tumor necrosis factor-α inhibitors in Crohn's disease and rheumatoid arthritis: Results of a systematic review

AIM:To investigate adherence rates in tumor necrosis factor-α (TNF-α)-inhibitors in Crohn's disease (CD) and rheumatoid arthritis (RA) by systematic review of medical literature. METHODS:A structured search of PubMed between 2001 and 2011 was conducted to identify publications that assessed treatment with TNF-α inhibitors providing data about adherence in CD and RA. Therapeutic agents of interest where adalimumab, infliximab and etanercept, since these are most commonly used for both diseases. Studies assessing only drug survival or continuation rates were excluded. Data describing adherence with TNF-α inhibitors were extracted for each selected study. Given the large variation between definitions of measurement of adherence, the definitions as used by the authors where used in our calculations. Data were tabulated and also presented descriptively. Sample size-weighted pooled proportions of patients adherent to therapy and their 95%CI were calculated.To compare adherence between infliximab, adalimumab and etanercept, the adherence rates where graphed alongside two axes. Possible determinants of adherence were extracted from the selected studies and tabulated using the presented OR. RESULTS:Three studies on CD and three on RA were identified, involving a total of 8147 patients (953 CD and 7194 RA). We identified considerable variation in the definitions and methodologies of measuring adherence between studies. The calculated overall sample size-weighted pooled proportion for adherence to TNF-α inhibitors in CD was 70% (95%CI:67%-73%) and 59% in RA (95%CI:58%-60%). In CD the adherence rate for infliximab (72%) was highercompared to adalimumab (55%), with a relative risk of 1.61 (95%CI:1.27-2.03), whereas in RA adherence for adalimumab (67%) was higher compared to both infliximab (48%) and etanercept (59%), with a relative risk of 1.41 (95%CI:1.3-1.52) and 1.13 (95%CI:1.10-1.18) respectively. In comparative studies in RA adherence to infliximab was better than etanercept and etanercept did better than adalimumab. In three studies, the most consistent factor associated with lower adherence was female gender. Results for age, immunomodulator use and prior TNF-α inhibitors use were conflicting. CONCLUSION:One-third of both CD and RA patients treated with TNF-α inhibitors are non-adherent. Female gender was consistently identified as a negative determinant of adherence.

Increased IgG Rheumatoid Factor-Positivity in the Asian Rheumatoid Arthritis Patients Irrespective of Ethnicity

Aim of Work: Initial observations implied IgG rheumatoid factor (RF) to be common among Malaysian rheumatoid arthritis (RA) patients. We tested this hypothesis and used a multiethnic RA cohort (Malays, Chinese and Indians) to investigate whether the IgG RF predominance might be genetically or environmentally determined. Patients and Methods: 556 serum samples comprising 171 patients classified as RA according to the 1987 ACR criteria, 60 patients with other rheumatic diseases and 325 non-rheumatic controls were tested for IgG RF, IgM RF and anti-CCP by ELISA. The findings were then tested in a larger RA case-control cohort (n = 1844). Results: IgG RF predominated over IgM RF in all the investigated ethnic groups. The sensitivity, specificity, and diagnostic accuracy of IgG RF (55.6%, 91.2% and 80.2%, respectively) were superior compared to IgM RF, but comparable to anti-CCP. IgG RF was however, also increased in the Malaysian controls, but the IgG RF superiority over IgM RF was still apparent after cutoff adjustment according to the 1987 ACR criteria. Autoantibody levels did not differ between the three ethnic groups. The Receiver Operating Characteristics (ROC) curves showed larger areas under the curves for IgG RF (0.826) and for anti-CCP (0.867) than for IgM RF (0.737). Review of the literature showed consistently higher sensitivity for IgG RF in studies of Asian RA patients as compared to Caucasian and African-American studies. Conclusion: Increased frequency of IgG RF-positive in RA populations with different genetic background living in Malaysia argues for an environmental factor selectively amplifying the IgG RF response.

基于慢病毒介导的NLRP3过表达对艾灸调控实验性RA家兔关节滑膜液anti-CCP、RF水平的影响

目的观察艾灸对实验性类风湿性关节炎(RA)家兔的抗炎消肿作用,通过在RA家兔实验模型过表达由慢病毒载体介导的NOD样受体相关蛋白3(NLRP3),研究艾灸对其膝关节滑膜液中抗环瓜氨酸多肽抗体(anti-CCP)、类风湿因子(RF)、白细胞介素-18(IL-18)含量的影响及其NLRP3调控机制。方法日本大耳白兔30只,随机分为空白组、模型组、艾灸组、NLRP3过表达组、NLRP3阴性对照组,每组各6只动物。福氏完全佐剂(FCA)平均注入家兔双膝关节腔(0.5 mL·kg^(-1))。RA模型塑造后第3天及治疗后第10天,将NLRP3过表达慢病毒载体(Lv-NLRP3-GFP)10μL注入NLRP3过表达组兔双后膝关节腔,NLRP3阴性对照组家兔同法注入等量携带GFP的慢病毒载体(LvGFP)作对照。艾柱灸艾灸各组家兔双侧“肾俞”、“足三里”穴(5壮/穴/天,6天1疗程,疗程间间隔1天,3个疗程)。治疗后观测各家兔左、右后膝关节周长,ELISA法检测关节滑膜液中anti-CCP、RF、IL-18的含量。结果与空白组比较,模型组左、右膝关节周长增大,膝关节滑膜液anti-CCP、RF、IL-18含量显著升高(P<0.01);与模型组比较,艾灸组左、右膝关节周长缩小,膝关节滑膜液anti-CCP、RF、IL-18含量显著降低(P<0.01);与艾灸组相比,NLRP3过表达组左、右膝关节周长增大(P<0.05),膝关节滑膜液anti-CCP、RF、IL-18含量升高(P<0.05)。结论艾灸对实验性RA家兔具有抗炎效应,艾灸“肾俞”、“足三里”穴可显著降低RA家兔膝关节滑膜液中免疫效应因子anti-CCP、RF以及炎性细胞因子IL-18的含量,在NLRP3过表达的情况下其作用显著降低,提示艾灸抑制实验性RA家兔异常免疫功能,从而实现其抗炎调节作用可能与NLRP3的表达情况有密切关联。

Determination of IgA,IgG,IgM Class-Specific Rheumatoid Factor and Its Clinical Evaluation

Solid Phase enzyme-linked Immunosorbent assay（ELISA） for detectingclass-specific rheumatoid factor （RF） was established.Aggregated rabbit lgG was used ascoating antigen and the presence of RF was demonstrated by F（ab’）2 fragment of anti-humanIg conjugated to horseradish peroxidase（HRP）.The results showed that high levels ofIgM-RF,IgG-RF and IgA-RF were found in patients with rheumatoid arthritis.A positive cor-relation existed between IgM-,IgG-,IgA-RF and disease activity.The presence of vasculitis al-so correlated positively with the levels of 3 class-specific RFs.

Gene Expression of Tumor Necrosis Factor-Alpha in Etanercept-Treated Rheumatoid Arthritis Patients

Fifty-one rheumatoid arthritis (RA) patients were enrolled to assess the gene expression of tumor necrosis factor-alpha (TNF-α) by reverse transcription quantitative polymerase chain reaction (qRT-PCR) in etanercept-treated RA patients, with some emphasis on clinical and biological markers of disease. The results revealed that the ΔCt mean range in total, male and female RA patients and controls was 1.286 ± 1.226 - 4.023 ± 0.856 and the differences were not. Laboratory and clinical findings in subgroups of patients also showed no significant variations in the distribution of 2-ΔΔCt means, with the exception of anti-cyclic citrullinated peptide (ACCP) antibodies. The lowest expression was observed in moderate positive patients (1.566 ± 1.104) compared to low and high positive patients (4.061 ± 1.366 and 9.668 ± 3.518, respectively) for ACCP antibodies, and the difference was significant (p = 0.043). Inspecting the 2-ΔΔCt means in duration of disease and gender revealed that male patients recorded a lower mean than female patients (0.827 ± 0.550 vs. 4.143 ± 1.317) at 10 years duration of disease, female patients showed a lower mean than male patients (1.242 ± 0.372 vs. 5.607 ± 3.334). However, both differences were not significant. It is concluded that etanercept was effective in normalizing the TNF gene expression, but variations that were related to gender, duration of disease and some biological markers of disease, were observed.

Rheumatoid Factor and Anti Citrulinated Peptide. Relation with Remission and Progression in Rheumatoid Arthritis with Biologic Agent Therapy, during a One-Year Follow-Up

The aim of this study is to assess the variations of the RF and ACCP in RA patients treated with biologics in actual clinical practice (real) conditions for a one-year follow-up from the first biologic medication. The evaluated patients with a diagnosis of RA, according to the American College of Rheumatology (ACR) 1987 were selected from the outpatient consult of Rheumatology of the “Hospital de Sant Pau” during one month (November 2012). We collected and analyzed data from 41 patients with RA and positivity for RF and/or ACCP. Of the 41 patients had given FR and ACCP at 3, 6 and 12 months respectively in 18 and 10 patients. In 22 patients had given DAS 28 at 3, 6 and 12 months respectively. The mean age of the sample is 55 years (range 29-79), with a mean disease progression 9 years (4 months to 32 years). 70% are women. 33 patients (80.5%) initiated treatment with anti-TNF and 8 (19.5%) with other no anti-TNF mechanism of action. There was a statistically significant (p = 0.001, ANOVA) decrease in DAS 28 (average decrease of 1.6 points) at 3 months is maintained at 6 and 12 m and no significant differences in their evolution by separating anti-TNF drugs vs. other biological agents (different mechanisms of action (p = 0.285). So we have not detected a correlation between DAS 28 and FR or ACCP along the first 12 months of biological treatment. In our experience we did not find a correlation between DAS 28 and RF or ACCP, thus RF and ACCP do not appear to predict the response to treatment.

Efficacy of Infliximab Therapy for a Patient with Superficial Thrombophlebitis and Rheumatoid Arthritis

Superficial thrombophlebitis is known as a frequent complication of Beh?et’s disease. Infliximab may promote healing of superficial thrombophlebitis in patients with Beh?et’s disease. However, thrombophlebitis as a complication of rheumatoid arthritis (RA) is rare and treatments have not been reported. We describe the case of a 47-year-old man with RA with complications of superficial thrombophlebitis who was treated using methotrexate and infliximab. Erythema nodosum and cord-like induration with pain in the extremities completely disappeared following a single infusion of infliximab and oral acetylsalicylic acid was not needed. This case suggests that infliximab might offer effective treatment for patients showing superficial thrombophlebitis with RA.

Acquired coagulation dysfunction resulting from vitamin Kdependent coagulation factor deficiency associated with rheumatoid arthritis: A case report

BACKGROUND Rheumatoid arthritis(RA)is a common chronic inflammatory autoimmune disease with the main clinical feature of progressive joint synovial inflammation,which can lead to joint deformities as well as disability.RA often causes damage to multiple organs and systems within the body,including the blood hemostasis system.Few reports have focused on acquired coagulation dysfunction resulting from vitamin K-dependent coagulation factor deficiency associated with RA.CASE SUMMARY A 64-year-old woman with a history of RA presented to our hospital,complaining of painless gross hematuria for 2 wk.Blood coagulation function tests showed increased prothrombin time,international normalized ratio,and activated partial thromboplastin time.Abnormal blood coagulation factor(F)activity was detected(FII,7.0%;FV,122.0%;and FX,6.0%),indicating vitamin K-dependent coagulation factor deficiency.Thromboelastography and an activated partial thromboplastin time mixed correction experiment also suggested decreased coagulation factor activity.Clinically,the patient was initially diagnosed with hematuria,RA,and vitamin K-dependent coagulation factor deficiency.The patient received daily intravenous administration of vitamin K120 mg,etamsylate 3 g,and vitamin C 3000 mg for 10 d.Concurrently,oral leflunomide tablets and prednisone were administered for treatment of RA.After the treatment,the patient's symptoms improved markedly and she was discharged on day 12.There were no hemorrhagic events during 18 mo of follow-up.CONCLUSION RA can result in vitamin K-dependent coagulation factor deficiency,which leads to acquired coagulation dysfunction.Vitamin K1 supplementation has an obvious effect on coagulation dysfunction under these circumstances.

血清IgG-RF、IL-1β和生存素对通痹胶囊联合托法替布治疗类风湿关节炎疗效的预测价值

目的探讨血清人类风湿因子(IgG-RF)、人白介素1β(IL-1β)和生存素对通痹胶囊联合托法替布治疗类风湿关节炎(RA)疗效的预测价值。方法选取2019年6月至2022年5月于山东省东营市东营区人民医院122例接受通痹胶囊联合托法替布治疗的RA患者作为研究对象,观察并记录患者治疗3个月后的临床疗效,根据疗效分为有效组(n=86)和无效组(n=36),调查两组患者一般资料及入组时两组血清IgG-RF、IL-1β和生存素水平,分析类RA患者血清IgG-RF、IL-1β、生存素水平对对通痹胶囊联合托法替布治疗RA炎疗效的预测价值。结果有效组与无效组患者关节功能、X线分期、年龄、IgG-RF、IL-1β、生存素差异具有统计学意义(χ^(2)=4.871、4.484、t=2.158、5.646、8.091、6.183,P<0.05);多因素logistic回归分析结果显示,患者IgG-RF、IL-1β与生存素的高水平均为通痹胶囊联合托法替布治疗类风湿关节炎治疗无效的独立危险因素(P<0.05);患者IgG-RF、IL-1β、生存素水平级三项联合预测对通痹胶囊联合托法替布治疗类风湿关节炎疗效预测曲线下面积(AUC)分别为0.853、0.847、0761、0.947,均有良好的预测效能(P<0.05),其中联合预测效能高于单项。结论血清IgG-RF、IL-1β和生存素水平对通痹胶囊联合托法替布治疗RA疗效具有良好的预测价值,三项联合检测预测效能更高。

类风湿关节炎患者血清RF、ACCP、CD4^(+)/CD8^(+)水平及相关性分析

目的探讨类风湿关节炎(RA)患者血清类风湿因子(RF)、抗环瓜氨酸肽抗体(ACCP)、CD4^(+)/CD8^(+)水平及其相关性。方法选取2020年10月至2022年6月该院收治的96例RA患者作为RA组,另选取同期96例健康体检者作为对照组。比较两组入组时、不同活动度RA患者及治疗前、治疗1个月后、治疗3个月后RA患者血清RF、ACCP、CD4^(+)/CD8^(+)水平,分析血清ACCP、CD4^(+)/CD8^(+)水平与28处关节疾病活动度(DAS28)评分及RF水平的相关性。结果与对照组比较,RA组入组时血清RF、ACCP、CD4^(+)/CD8^(+)水平均高于对照组,差异均有统计学意义(P<0.05);轻度活动度组RA患者RF、ACCP、CD4^(+)/CD8^(+)水平均低于中度活动度组,中度活动度组RA患者RF、ACCP、CD4^(+)/CD8^(+)水平均低于重度活动度组,差异均有统计学意义(P<0.05);治疗前RA患者RF、ACCP、CD4^(+)/CD8^(+)水平均高于治疗1个月后,治疗后1个月后RA患者RF、ACCP、CD4^(+)/CD8^(+)水平均高于治疗3个月后,差异均有统计学意义(P<0.05)。血清ACCP水平、CD4^(+)/CD8^(+)水平与DAS28评分及RF水平均呈正相关(P<0.05)。结论血清RF、ACCP、CD4^(+)/CD8^(+)水平在RA患者中呈异常表达,动态监测其水平可评估RA的病情变化,可为临床治疗方案的制订提供参考依据。