探讨外周血CD4^+、CD8^+T细胞CD69在小儿类风湿关节炎发生过程中的免疫病理作用

目的:对小儿类风湿关节炎(RA)在发生过程中外周血中CD4+、CD8+T细胞CD69的表达水平与免疫病理作用进行探讨。方法:选取本院在2011年7月-2012年9月间采集的30例类风湿关节炎患儿与30例健康儿童的外周血标本,将前者定为观察组,后者定为对照组。对这两组儿童外周血中的CD4+、CD8+T细胞CD69采用流式细胞仪进行检测;观察组患儿采用药物治疗后,检测CD4+、CD8+T细胞CD69的表达水平情况。结果:观察组患儿的CD4+、CD8+T细胞CD69的表达水平明显高于对照组(P<0.05);且观察组患儿经过药物治疗后,RA症状明显有了改善,重新抽取其外周血进行检测,发现患儿CD4+、CD8+T细胞CD69的表达水平明显比治疗前要下降(P<0.05)。结论:CD4+、CD8+T细胞CD69在疾病的发生过程中是起着一种激活、增殖的作用,通过控制CD4+、CD8+T细胞CD69能够达到缓解病情的作用。

基于真实世界温针灸治疗类风湿性关节炎的疗效分析

目的探讨基于临床数据的真实世界中温针灸治疗类风湿性关节炎的临床疗效。方法用前瞻性队列研究方法,分析2017年9月—2019年12月经该院治疗的300例类风湿性关节炎患者;按是否接受温针灸治疗,分为温针灸组和非温针灸组。计算治疗4周后的中医整体疗效、简化的临床疾病活动指数(SDAI)及临床的疾病活动指数(CDAI),判定疗效。采用倾向评分法(PS)来平衡混杂因素,使用倾向评分匹配法评价其疗效,并分别采用分层回归法、PS逆处理概率加权法(IPTW)、倾向评分标准化加权法对评价结果进行敏感性分析。结果温针灸组与非温针灸组总有效率匹配前分别为93%(93/100)、85%(170/200),组间比较OR=2.34,P=0.020<0.05;匹配后,有效率分别为93%(93/100)、83%(83/100),OR=2.72,P=0.002<0.05;CPR、CDAI、SDAI治疗后都有明显降低,且均为温针灸组优于非温针灸,P<0.05。敏感性分析,倾向评分分层法和加权法均P<0.05,提示温针灸有治疗类风湿性关节炎作用,研究的结果具有较强稳定性。结论在真实世界临床实践中温针灸对于有类风湿性关节炎有治疗作用,值得临床上推广应用。

Arthroscopic Debridement and Synovium Resection for Inflammatory Hip Arthritis

Objective To evaluate the efficacy of arthroscopic surgery in inflammatory hip arthritis.Methods A retrospective clinical study was conducted inspecting 40 hips in 36 patients of inflammatory arthritis.There were 17 cases of ankylosing spondylitis,11 cases of rheumatoid arthritis,and 8 cases of psoriatic arthritis.The joints were irrigated and the inflamed tissues were debrided with anthroscopy.The patients were followed up with Harris hip score,Oxford hip score,Visual Analog Scale(VAS),and magnetic resonance imaging(MRI).Statistical analysis was performed using Student t test.Results All of the 36 cases were followed up for 46-103 months,averaging 67.2±8.4 months.Harris and Oxford scores increased from 66.9±12.1 and 69.4±16.4 before operation to 78.4±19.3 and 80.2±18.8 after operation,respectively(P<0.05).VAS score decreased from pre-operative 8.5±2.5 to post-operative 7.2±2.5(P<0.05).All the patients showed improved joint range of motion.MRI revealed alleviation of hip synovitis.The results were classified as excellent in 8 patients,good in 17 patients,fair in 8 patient,and poor in 3 according to Harris hip score.Twenty-seven patients were satisfied with the operative outcomes as they regained normal daily activities.Conclusions Arthroscopy-assisted joint debridement and synovium resection is an effective procedure for hip lesion in inflammatory arthritis.The inflammatory lesion might be thereby controlled and the symptoms be relieved.

Exceptionally rare cause of a total stomach resection

The first-ever case of a 54-year-old woman who overdosed on non-steroidal anti-inflammatory drugs in an attempt at suicide.Before that incident,she had not been treated for coexisting diseases such as rheumatoid arthritis or depression.At the time of admission to the General Surgery Department,the patient reported pains in the epigastric region with accompanying nausea and vomiting with mucous content as well as the inability to ingest food orally.Despite parenteral and enteral feeding,the patient exhibited a drop in body mass.The histopathologic examination of a sample taken from the stomach during gastroscopy showed some non-specific necrotic and inflammatory masses with granulation.Intraoperatively,a very small,infiltrated stomach with an initial section of duodenum was identified.A total stomach resection together with the reconstruction of digestive tract continuity was performed using the Roux-Y method.Histopathologic examination of the stomach revealed a deep,chronic and exacerbated inflammatory condition with an extensive ulceration over the entire length of the stomach,reaching up to the pylorus.Additionally,numerous lymphatic glands with inflammatory reaction changes were observed.

The Extraarticular Symptoms Influence ACR Response in the Treatment of Rheumatoid Arthritis with Biomedicine: A Single-blind, Randomized, Controlled, Multicenter Trial in 194 patients

Objective: The extraarticular symptoms are important in the pattern differentiation of traditional Chinese medicine (TCM), and the present study is designed in an attempt to find the associations between the extraarticular symptoms and American College of Rheumatology (ACR) Response in 194 cases of rheumatoid arthritis (RA) treated with biomedicine. Methods: The data were obtained from a randomized clinical trial. One hundred ninety-four RA patients were treated with the biomedical therapy (diclofenec, methotrexate and sulfasalazine). ACR20 response in 24 weeks was used for the efficacy evaluation. Eighteen symptoms (including 13 extraarticular symptoms) that TCM practitioners focus on were collected for exploration on the association between the symptoms and the efficacy of the biomedical therapy with association rules method. Results: After 24 weeks, a total of 135 patients receiving biomedicine had achieved an ACR20 response. The association rules analysis on each symptom showed that soreness in the waist was more associated with ACR20 response, but with lower support (selected sample size based, 20.10% and 14.95% respectively); cold intolerance and cold joint were found to be associated with ACR20 response with higher support (48.97% and 53.61% respectively), and the confidences (predicted effective rate) were 73.08% and 71.23% respectively. The associations between combination of symptoms (among them, there was at least one extraarticular symptom) and ACR20 response indicated that cold intolerance or cold joint with higher confidence and support were the most important extraarticular symptoms. Conclusion: The RA patients with "cold intolerance" and "cold joints", which are the extraarticular symptoms that TCM practitioners focus on, may show higher ACR20 response when treated with the biomedical approach.

Assessing the therapeutic impact of Qianjinba polysaccharide in a rheumatoid arthritis murine model

Qianjinba is primarily cultivated in the southern regions of China and finds extensive use in traditional Chinese medicine(TCM)for conditions such as rheumatism,arthralgia,and gynecological ailments.It has been officially recognized as a protected variety of TCM by the state.The aim of this study was to investigate the therapeutic potential of Qianjinba polysaccharide(QJBDT)in treating rheumatoid arthritis(RA)in mice,along with a preliminary exploration of its mechanisms for inhibiting RA in these animals.Kunming mice(KM)were randomly divided into several groups,including a normal group,a model group(LPS group),low-dose,medium-dose,and high-dose QJBDT groups,as well as a positive control group(TGP group),each consisting of 10 mice.To induce inflammation and create an RA model,type II collagen was injected into the right hind foot joint.Following a 7-day modeling period,various concentrations of QJBDT and the positive control drug total glycoside of peony were administered via gavage once a day for 21 consecutive days.Throughout the study,we monitored and recorded the mice's weight,measured foot swelling,and assessed the arthritis index on a weekly basis.We also conducted pathological examinations of joint tissues and analyzed the signal pathway of p38 mitogen-activated protein kinase(MAPK)as well as the protein expression of nuclear factor NF-κB in the mice’s right foot joint tissues.Additionally,we employed ELISA to detect the levels of interleukin-β(IL-β),IL-17,and tumor necrosis factor-α(TNF-α)in the mice’s serum.The results of this study revealed that QJBDT effectively reduced the degree of foot swelling and the arthritis index in collagen-induced arthritis mice while improving their weight loss(P<0.05).Furthermore,it alleviated the pathological damage observed in the mice’s joints.Notably,the expression of transcription factors p38 and NF-κB proteins was down-regulated(P<0.05),and the levels of inflammatory cytokines IL-β,IL-17,and TNF-αin the mice’s serum were decreased(P<0.05).In conclusion,this study demonstrated that polysaccharides could inhibit the expression of transcription factors p38 and NF-κB,reduce the production of inflammatory factors,and alleviate the progression of RA to a certain extent.