Withdrawal of anti-tumour necrosis factor α therapy in inflammatory bowel disease

Anti-tumour necrosis factor α(anti-TNFα) therapy is an established treatment in inflammatory bowel disease.However, this treatment is associated with high costs and the possibility of severe adverse events representing a true challenge for patients, clinicians and health care systems.Consequently, a crucial question is raised namely if therapy can be stopped once remission is achieved and if so, how and in whom.Additionally, in a real-life clinical setting, discontinuation may also be considered for other reasons such as the patient's preference, pregnancy, social reasons as moving to countries or continents with less access, or different local policy or reimbursement.In contrast to initiation of anti-TNFα therapy guidelines regarding stopping of this treatment are missing.As a result, the decision of discontinuation is still a challenging aspect in the use of anti-TNFα therapy.Currently this is typically based on an estimated, case-by-case, benefit-risk ratio.This editorial is intended to provide an overview of recent data on this topic and shed light on the proposed drug withdrawal strategies.

Experimental Study of Vascular Endothelial Growth Factor Gene Therapy for Avascular Necrosis of the Femoral Head

To explore a new method for the therapy of the avascular necrosis of the femoral head, the recombinant plasmid pCD-hVEGF 165 was mixed with collagen and was implanted in the necrotic femoral head The expression of vascular endothelial growth factor (VEGF) was detected by RNA dot hybridization and immunohistochemical method The repair of the femoral head was observed by histological method The results showed that the expression of VEGF was detectable in the femoral head treated with VEGF gene Angiogenesis in these femoral heads was more abundant than the control Bone repairing was augmented in the femoral head treated with VEGF gene The results suggest that angiogenesis in bone tissue could be augmented by gene transfection of VEGF and bone repairing would be accelerated accordingly

Dysregulation of innate immunity in ulcerative colitis patients who fail anti-tumor necrosis factor therapy

AIM To study the innate immune function in ulcerative colitis(UC) patients who fail to respond to anti-tumor necrosis factor(TNF) therapy.METHODS Effects of anti-TNF therapy, inflammation and medications on innate immune function were assessed by measuring peripheral blood mononuclear cell(PBMC) cytokine expression from 18 inflammatory bowel disease patients pre- and 3 mo post-anti-TNF therapy. Toll-like receptor(TLR) expression and cytokine production post TLR stimulation was assessed in UC "responders"(n = 12) and "non-responders"(n = 12) and compared to healthy controls(n = 12). Erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) levels were measured in blood to assess disease severity/activity and inflammation. Pro-inflammatory(TNF, IL-1β, IL-6), immuno-regulatory(IL-10), Th1(IL-12, IFNγ) and Th2(IL-9, IL-13, IL-17A) cytokine expression was measured with enzyme-linked immunosorbent assay while TLR cellular composition and intracellular signalling was assessed with FACS.RESULTS Prior to anti-TNF therapy, responders and nonresponders had similar level of disease severity and activity. PBMC's ability to respond to TLR stimulation was not affected by TNF therapy, patient's severity of the disease and inflammation or their medication use. At baseline, non-responders had elevated innate but not adaptive immune responses compared to responders(P < 0.05). Following TLR stimulation, nonresponders had consistently reduced innate cytokine responses to all TLRs compared to healthy controls(P < 0.01) and diminished TNF(P < 0.001) and IL-1β(P < 0.01) production compared to responders. This innate immune dysfunction was associated with reduced number of circulating plasmacytoid dendritic cells(p DCs)(P < 0.01) but increased number of CD4+ regulatory T cells(Tregs)(P = 0.03) as well as intracellular accumulation of IRAK4 in non-responders following TLR-2,-4 and-7 activation(P < 0.001). CONCLUSION Reduced innate immunity in non-responders may explain reduced efficacy to anti-TNF therapy. These serological markers may prove useful in predicting the outcome of costly anti-TNF therapy.

Perioperative Use of Methotrexate and Tumor Necrosis Factor α Inhibitors Combination Therapy Is Not Likely to Increase Post-Operative Infection Rate in the National Veterans Health Administration Administrative Databases

Objective: The aim of the study is to assess the risk of post-operative outcome in rheumatoid arthritis (RA) patients continuing versus stopping combination therapy of methotrexate (MTX) and hydroxychloroquine (HCQ) or tumor necrosis factor α inhibitors (TNF) prior to surgery. Methods: Using the United States Veterans Affairs (VA) databases, we identified surgical procedures in a 17-year cohort of RA patients. Among those patients, those on MTX + HCQ or MTX + TNF were identified. Post-operative outcome variables include infection, length of post-operative hospital stay and death. Results: We identified a total of 29,708 surgeries in RA patients. Among them, we identified the most recent elective surgeries without pre-operative infection in 16,174 patients. There were 783 and 550 patients on MTX + HCQ and MTX + TNF, respectively. The rates of post-op infection were 5% and 4% for the MTX + HCQ and MTX + TNF continuing medication groups, respectively, similar to the general RA population (5%). Sensitivity analyses at various time points of discontinuation combination therapies prior to surgery did not show significant change in terms of infection. Conclusions: The prevalence of adverse outcome is low. The proportion of post-operative infection in continuing and discontinuing medicine groups is similar for both MTX + HCQ and MTX + TNF. While we were unable to formally compare proportions of post-operative infection among the two groups, these preliminary findings do not support the hypothesis that continuing either MTX + TNF or MTX + HCQ combination during perioperative period increases post-operative infection compared with discontinuation prior to therapy.

Therapeutic effect of neurogrowth factor in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy

Objective: To explore the clinical efficacy of neurogrowth factor in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy and the effect on the serum inflammatory cytokines. Methods: A total of 156 patients with gingival pain and swelling after root canal therapy due to dental pulp necrosis were included in the study and randomized into the control group (n=78) and teh treatment group (n=78). The patients in the control group were given metronidazole tablets. On the above basis, the patients in the treatment group were given local injection of neurogrowth factors. 10-day treatment was regarded as one course, and the patients were continuously treated for 2 courses. The improvement of clinical symptoms before and after treatment in the two groups was evaluated. Gingival sulcus index and serum inflammatory cytokines before and after treatment in the two groups were detected and compared. Results: When compared with before treatment, the periodontal soft tissue swelling, tooth mobility, and periapical pain scores after treatment in the two groups were significantly reduced, and those in the treatment group were significantly lower than those in the control group. When compared with before treatment, the gingival sulcus bleeding index 1 and 2 courses after treatment in the two groups was significantly reduced, and that 2 courses after treatment was significantly lower than that after 1 course treatment. The gingival sulcus bleeding index 1 and 2 courses after treatment in the treatment group was significantly lower than that in the control group. When compared with before treatment, the serum IL-8 and IL-6 levels after treatment in the two groups, and TNF-α level after treatment in the treatment group were significantly reduced, and the above indicators in the treatment group were significantly lower than those in the control group. Conclusions: The neurogrowth factors in the treatment of gingival pain and swelling in patients with dental pulp necrosis after root canal therapy can effectively improve the clinical symptoms, and inhibit the inflammatory reaction, with a significant efficacy.

Use of anti tumor necrosis factor-alpha monoclonal antibody for ulcerative jejunoileitis

Ulcerative jejunoileitis is an uncommon clinical syndrome consisting of abdominal pain,weight loss associated with diarrhea,and multiple inflammatory ulcerations and strictures of the small bowel.Ulcerative jejunoileitis can complicate established celiac disease or develop in patients de novo.Increased levels of tumor necrosis factor-alpha(TNF-α) in the small intestine of patients with untreated celiac disease are associated with a role in the immune pathogenesis of this disorder.No specific therapy has been shown to change the course of ulcerative jejunoileitis.We report a case of severe ulcerative jejunoileitis previously unresponsive to traditional therapies,including high dose corticosteroids and cyclosporine.The patient had a dramatic resolution of symptoms and a complete normalization of endoscopic findings after anti-TNF-α monoclonal antibody,infliximab(Remicade).

Correlations between skin lesions induced by anti-tumor necrosis factor-α and selected cytokines in Crohn's disease patients

AIM:To investigate the correlation between the appearance of skin lesions and concentration of interleukin(IL)-17A,IL-23 and interferon-γ(IFN-γ)in Crohn’s disease(CD)patients during anti-tumor necrosis factor-α(TNF-α)therapy METHODS:A prospective study included 30 adult patients with CD of Caucasian origin(19 men and 11women;mean age±SD 32.0±8.6 years)during biological therapy with anti-TNF-αantibodies from January2012 to March 2013.Eighteen patients were treated with infliximab,seven with adalimumab and five withcertolizumab.Inclusion criteria were exacerbation of the underlying disease,Crohn’s Disease Activity Index over 300 and the ineffectiveness of previously used non-biological therapies.Patients with a history of psoriasis,atopic dermatitis and other autoimmune skin lesions were excluded from the study.The control group consisted of 12 healthy subjects.A diagnostic survey was carried out,blood tests and careful skin examination were performed,and the serum levels of IL-17,IL-23 and IFN-γwere measured using an enzyme-linked immunosorbent assays technique.Dermatoses that have developed in the course of biological therapy in patients who had no pre-existing skin lesions of similar character were qualified as skin lesions induced by antiTNF-αtherapy.RESULTS:Skin manifestations occurred in 18 of CD patients during the anti-TNF-αtherapy(60%),in the average time of 10.16±3.42 mo following the beginning of the 52-wk treatment cycle.Skin lesions observed in CD patients during biological therapy included psoriasiform lesions(44.4%),and eczema forms lesions(22.2%).In CD patients with drug induced skin lesions significantly higher levels of hemoglobin(13.3±1.5 g/dL vs 10.8±1.9 g/dL,P=0.018)and hematocrit(39.9%±4.5%vs 34.3%±5.4%,P=0.01),as well as a significantly lower level of platelets(268±62×103/μL vs 408±239×103/μL,P=0.046)was observed compared with CD patients without skin manifestations.The concentrations of IL-17A and IL-23in CD patients with skin lesions developed under antiTNF-αtherapy were significantly higher compared to those in patients without lesions(IL-17A:39.01±7.03pg/mL vs 25.71±4.90 pg/mL,P=0.00004;IL-23:408.78±94.13 pg/mL vs 312.15±76.24 pg/mL,P=0.00556).CONCLUSION:Skin lesions in CD patients during bio-logical therapy may result from significantly increased concentrations of IL-17A and IL-23,which are strongly associated with TNF-α/Th1 immune pathways.

针刺配合翁沥通胶囊治疗良性前列腺增生的疗效观察

目的观察针刺配合翁沥通胶囊治疗良性前列腺增生的临床疗效及其对血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、前列腺特异性抗原(prostate specific antigen,PSA)水平的影响。方法将119例良性前列腺增生患者随机分为A组40例、B组38例及C组41例。A组采用针刺治疗,B组采用口服翁沥通胶囊治疗,C组采用针刺配合口服翁沥通胶囊治疗。观察3组治疗前后尿动力学各项指标[排尿后残余尿量(postvoid residual urine,PVR)、最大尿流率(maximum urine flow,Qmax)、最大逼尿肌压力]、国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量(quality of life,QOL)评分、中医证候(排尿困难、夜尿频数、腰膝酸软、小腹胀满)积分及实验室指标[血清TNF-α、PSA、白细胞介素-6(interleukin-6,IL-6)、表皮细胞生长因子(epidermal growth factor,EGF)水平]的变化情况,比较3组临床疗效。结果3组治疗后PVR、最大逼尿肌压力、I-PSS、QOL评分、各项实验室指标及中医证候积分均较同组治疗前显著降低,Qmax均显著升高,差异均具有统计学意义(P<0.05)。C组治疗后PVR、最大逼尿肌压力、I-PSS、QOL评分、各项实验室指标及中医证候积分均明显低于A组和B组,Qmax均明显高于A组和B组,差异均具有统计学意义(P<0.05)。A组治疗后各项指标与B组比较,差异均无统计学意义(P>0.05)。C组总有效率为92.7%,明显高于A组的70.0%和B组的73.7%,差异均具有统计学意义(P<0.05)。结论针刺配合翁沥通胶囊治疗良性前列腺增生疗效确切,能降低患者TNF-α、PSA水平,改善其临床症状。

康复疗法在部队高脂血症患者中的应用及其对巨噬细胞肿瘤坏死因子-α、白细胞介素-6的影响

目的探讨康复疗法在部队高脂血症患者中的应用及其对巨噬细胞肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)的影响。方法选取2021年5月至2023年1月武警重庆总队医院门诊及体检中心的部队高脂血症患者124例进行研究,依据不同的治疗方式分为对照组和研究组两组,各62例。对照组常规干预,研究组在此基础上应用康复疗法,观察对比两组依从性及干预前后血脂水平[三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)]、炎性因子水平(IL-6、TNF-α)变化以及心理状态[抑郁自评量表(SDS)、焦虑自评量表(SAS)]、生活质量评分[生活质量综合评定问卷(GQOLI-74评分)]。结果研究组情绪控制、按时用药、坚持运动、合理饮食依从性比对照组高(P<0.05);研究组干预后HDL-C比对照组高(P<0.05),TG、LDL-C、TC、IL-6、TNF-α水平均比对照组低(P<0.05);研究组干预后GQOLI-74评分比对照组高,SDS、SAS评分比对照组低(P<0.05)。结论部队高脂血症患者应用康复疗法不仅可以降低机体中的炎症因子和血脂水平,还可以改善患者负性心理状态,提高其依从性和生活质量,值得推广应用。

体外冲击波疗法对膝关节骨性关节炎大鼠滑膜和软骨组织炎症因子的影响及机制

目的 探讨体外冲击波疗法(ESWT)对膝关节骨性关节炎(KOA)大鼠滑膜及软骨组织炎症因子的影响及机制。方法 30只雄性Sprague Dawley(SD)大鼠随机均分为对照组、模型组及冲击波组,对照组大鼠右侧关节腔注射50μL生理盐水,模型组与冲击波组大鼠右侧膝关节腔注射碘乙酸钠(MIA)2 mg/50μL构建KOA模型,均干预14 d;干预结束后对照组、模型组大鼠行冲击波声音刺激,冲击波组大鼠予ESWT治疗,1次/周、共4周;分别于术前和术后第3、7、14、21、28、35及42天,采用热刺痛仪和足底刺痛仪检测各组大鼠右后爪的热缩爪潜伏期(PWTL)和足底机械刺激缩足阈值(MWT);术后第42天,各组大鼠给予10%水合氯醛腹腔注射麻醉,行右膝关节X线检查,然后处死、取右侧膝关节,采用免疫组织化学法(IHC)检测各组大鼠膝关节滑膜和软骨组织白细胞介素-1β (IL-1β)、IL-6及肿瘤坏死因子-α(TNF-α)的表达水平。结果 模型组和冲击波组大鼠术后第3~42天的PWTL均较对照组缩短(P<0.05),冲击波组大鼠术后第28~42天的PWTL较模型组延长(P<0.05);模型组与冲击波组大鼠术后第3~42天的MWT均较对照组降低(P<0.05),冲击波组大鼠术后第21~42天MWT较模型组升高(P<0.05);与对照组比较,模型组与冲击波组大鼠关节间隙变窄,关节面粗糙变形程度较重,膝关节对线不齐,关节边缘有骨赘形成,且冲击波组上述X线表现轻于模型组;3组大鼠膝关节滑膜组织、软骨组织TNF-α、IL-1β及IL-6水平比较,对照组<冲击波组<模型组(P<0.05)。结论 ESWT可缓解KOA大鼠痛觉敏化症状及KOA疾病进展,其机制可能与减少滑膜和软骨组织中IL-1β、IL-6及TNF-α的表达有关。

Treatment revisited and factors affecting prognosis of severe acute pancreatitis

INTRODUCTIONAs stated in the author’s previous articles,severe acute pancreatitis is a multifacetted diseasewith rapid and sometimes fulminating onset and mayresult in many serious complications or even death iftreatment is improper or delayed.Therapeuticmeasures must be directed against these

Genetic factors determining the host response to Helicobacter pylori

INTRODUCTIONThe strongest evidence that H.pylori infection isthe cause of peptic ulcer is that treatment withantibiotics as the only regimen,is not only effectivefor the clearance and eradication of the infection,but more importantly for the healing of the ulcer orthe remission of gastric lymphoma.However,it isstill a matter of controversy and research as to

Establishment and expression of recombinant human glial cell linederived neurotrophic factor and TNF α receptor in human neural stem cells

Objective:To investigate the interference and expression of human glial cell line-derived neurotrophic factor(hCDNF) and soluble TNF alpha(sTMFRⅠ) receptor genes in neural stem cells and to evaluate the roles of these proteins in the genetic treatment of spinal cord injury.Methods:Full-length of GDNF cDNA(538 bp) and sTMFRⅠcDNA(504 bp) were inserted into the early 1 region of adenovirus genomic DNA respectively and were immediated by the human cytomegalovirus(gene promoter/enhancer). These adenoviruses were propagated in HEK293 cells via homologous recombination for 7-10 days in vivo,then they were used to infect human neural stem ceils.The infection and expression of gene were tested under immunofluorescence.ELISA and Westem-blot after 48 hours.Results:Almost all the cultured cells showed the nestin immunofluorescence positive staining,which was the characteristics of neural stem cell.A great quantity of EGFP and KFP were observed in neural stem cells,which indicated the expression of GDNF and sTMFRⅠ.After transfection of GDNF and sTMFRⅠgenes,many neural stem cells show GFAP and tubulin immunofluorescence positive staining,which meant that most neural stem cells differentiated into neuron at that condition.Conclusions:The infective efficiency of adenovirus is greatly acceptable to neural stem cell,thus adenovirus provide a useful vector for exogenous GDNF and sTMFRⅠgenes expressing in neural stem cells,which is useful for differentiation of neural stem cell.

Pyloric stenosis associated Crohn's disease responding to adalimumab therapy

Gastroduodenal Crohn’s disease (CD) is rare and the response to standard medical therapy is often poor. Anti-tumor necrosis factor therapy has revolutionised the treatment of CD. We present a patient with pyloric stenosis associated with CD which improved with Adalimumab therapy. We recommend considering antitumor necrosis factor therapy in symptomatic gastroduodenal CD.

EXPERIMENTAL STUDIES ON RADIATION-INDUCIBLE HUMAN TNF GENE THERAPY FOR CANCER

Tumor necrosis factor (TNF) has certain radioprotective effect on host tissue and is capable of enhancing the antitumor effect of radiotherapy. In addition, the transcriptional regulation of the promoter region of Egr 1 gene is activated by ionizing radiation. So we fused Egr 1 promoter with hTNF α cDNA, and resultantly constructed a double copy and radiationin ducible retroviral vector named as pETDC. After packaged with Psi 2 and Crip cells in vitro, the hTNF recombinant retroviruses were in the titers of 4×10 5 CFU/ml. By infection of murine fibroblast cell line NIH3T3 and murine melanoma cell line B16.F10 with the recombinant retroviruses and followed by G418 resistant selection, two positive clones secreting TNF at the levels of 2.1 ng/ml and 1.1 ng/ml respectively were generated. After exposure to 20 Gy ionizing radiation, TNF secre tions from the two positive clones were elevated to 13.8 ng/ml (6.6 fold) and 5.7 ng/ml (5.2 fold) respectively. Furthermore, hTNF α expression in pETDC transfected cells was confirmed by RT PCR. These data provide an experimental bases for the application of TNF gene therapy combined with local radiotherapy in cancer patients.

Antitumor and radiosensitization effect of 12C6+heavy-ion irradiation mediated by radiation-inducible gene therapy

Radio genetic therapy which combines gene therapy with radiotherapy has shown promising results in cancer treatment. In this study, an oncolytic adenovirusbased gene therapy system regulated by radiation was constructed to improve the cancer curative effect. This gene therapy system incorporated the radiation-inducible early growth response gene(Egr-1) promoter and the anticancer gene tumor necrosis factor-related apoptosis-inducing ligand(TRAIL). To confirm the antitumor effect of Ad-ET combined with^12C^(6+)tion irradiation, the survival and apoptosis fraction of tumor cells HT1080 and normal cells MRC-5 in combination treatment were detected by CCK-8 assay and FACS analysis. Then the expression levels of TRAIL gene and protein were tested by real-time PCR and western blotting. The results show that^12C^(6+)tion irradiation could induce cell growth inhibition and apoptosis by activating the TRAIL gene expression in tumor cells, while exhibiting no obvious toxicity to the normal lung cell line MRC-5. Theresults also demonstrate that use of an oncolytic adenovirusbased radiation-inducible gene therapy system together with^12C^(6+)tion irradiation could cause synergistic antitumor effect specifically in tumor cells but not in normal cells. The results indicate that the novel radio genetic therapy could potentiate radiation treatment by improving the safety and efficiency of monotherapy, and provide theoretical support for clinical application of combination treatment.

Interrupted Etanercept Therapy: A New Case Report

Psoriasis is a chronic, immune-mediated, inflammatory disease with a high prevalence in the general population (2%). The anti-tumor necrosis factor receptor etanercept is Food and Drug Administration (FDA) approved for the treatment of moderate-to-severe plaque psoriasis. Both continuous and interrupted etanercept therapy is effective and well-tolerated. This report aims to document a new case presentation of psoriasis on intermittent etanercept injection throughout 36 weeks with long-lasting sustained efficacy and no risk factor. Case Report: A 39-year-old adult male patient with long-standing chronic plaque psoriasis for 15 years duration without joint involvement started loading dose treatment of etanercept injection in whom due to his work circumstances not taken maintenance therapy and showed-up at the clinic after 36 weeks from first induction therapy when partial relapse of psoriatic lesions appear in last week with continued improvement when reintroducing loading treatment on followed-up over the next 36 weeks. Conclusion: Intermittent etanercept therapy considers effective for 36 weeks with prolonging sustained efficacy and without adverse effect.

不同运动方式联合氟比洛芬凝胶贴膏在膝骨关节炎中的应用效果比较

目的比较不同运动方式联合氟比洛芬凝胶贴膏在膝骨关节炎(KOA)中的应用效果。方法选取2021年9月至2022年1月深圳市罗湖区人民医院收治的50例KOA患者,按照随机数字表法分为五组,每组各10例。A组为常规干预,采用氟比洛芬凝胶贴膏。其余4组为运动干预,均在使用氟比洛芬凝胶贴膏基础上,每周运动3次。其中B组:步行30 min/次;C组:步行45 min/次;D组:跑步30 min/次;E组:跑步45 min/次;比较五组患者干预前后的视觉模拟评分(VAS)、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分及检测血清脂氧素A4(LXA4)、白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)的浓度。结果各组患者干预后的VAS、WOMAC评分均低于本组干预前,差异有统计学意义(P<0.05);B、C、D、E组患者干预后的VAS、WOMAC评分均低于A组,差异有统计学意义(P<0.05);B、C、E组患者干预后的VAS、WOMAC评分均高于D组,差异有统计学意义(P<0.05)。五组患者干预后的血清LXA4、IL-1β、TNF-α水平比较,差异有统计学意义(P<0.05);A组干预后的血清LXA4低于D组,差异有统计学意义(P<0.05);A组干预后的血清IL-1β、TNF-α高于B、C、D、E组,差异有统计学意义(P<0.05);D组干预后的血清TNF-α低于A、B、C、E组,差异有统计学意义(P<0.05);B、C、D、E组干预后的血清LXA4高于本组干预前,差异有统计学意义(P<0.05);B、C、D、E组干预后血清IL-1β、TNF-α低于本组干预前,差异有统计学意义(P<0.05)。结论运动联合氟比洛芬凝胶贴膏治疗KOA比单用外用药的疗效和抗炎效果更佳,且每周3次跑步30 min作用更佳。运动可升高LXA4水平,降低IL-1β、TNF-α水平。

浮针疗法联合中药治疗股骨头缺血性坏死的疗效观察及对髋关节功能和血清TGF-β、BMP、VEGF水平的影响

目的 观察浮针疗法联合中药治疗股骨头缺血性坏死(avascular necrosis of the femoral head,ANFH)的临床疗效及对髋关节功能和血清转化生长因子-β(transforming growth factor-β, TGF-β)、骨形态发生蛋白(bone morphogenetic protein, BMP)、血管内皮生长因子(vascular endothelial growth factor, VEGF)水平的影响。方法 将127例ANFH患者随机分为对照组(63例)和浮针组(64例)。两组患者均给予抗凝、扩血管、降脂等基础治疗,对照组给予仙灵骨葆胶囊治疗,浮针组在对照组治疗基础上给予浮针。观察两组治疗前后髋关节疼痛分级和活动度、血清相关因子(TGF-β、BMP和VEGF)及影像学指标(骨坏死区灰度、骨坏死区体积和股骨头灰度)的变化,并比较两组临床疗效。结果 浮针组总有效率为93.8%(60/64)高于对照组79.4%(50/63),差异有统计学意义(P<0.05)。浮针组治疗后疼痛分级水平优于对照组,差异有统计学意义(P<0.05)。两组治疗后屈曲、外展和外旋角度较治疗前升高,且浮针组高于对照组,差异有统计学意义(P<0.05)。两组治疗后血清TGF-β、BMP和VEGF水平较治疗前升高,且浮针组高于对照组,差异有统计学意义(P<0.05)。两组治疗后骨坏死区灰度和股骨头灰度水平较治疗前升高,且浮针组高于对照组;骨坏死区体积水平较治疗前降低,且浮针组低于对照组,差异有统计学意义(P<0.05)。结论 在基础治疗的基础上,浮针疗法联合中药治疗ANFH疗效优于中药治疗,可改善影像学指标,调节血清相关因子水平,改善髋关节功能。

根管治疗术改善牙髓炎患者外周血炎性细胞因子水平及焦虑抑郁状态的研究

目的探讨根管治疗术对牙髓炎患者外周血炎性因子的改善及焦虑抑郁情绪的影响。方法选取2021年6月至2022年6月在第四军医大学口腔医院牙体牙髓病科收治的155例牙髓炎患者为试验组,采用根管治疗术治疗;另选同期接受健康体检且口腔健康的155例人员为对照组,比较两组的广泛性焦虑障碍量表(Generalized Anxiety Disorder⁃7,GAD⁃7)评分、抑郁症筛查量表(Patien Health Questionnare⁃9,PHQ⁃9)评分;同时观察试验组治疗前与治疗第3、6周后的GAD⁃7评分、PHQ⁃9评分与疼痛评分,其中疼痛用视觉模拟量表(visu⁃al analogue scale,VAS)评定;比较试验组治疗前与治疗第3、6周后外周血的炎性细胞因子白细胞介素⁃8(inter⁃leukin⁃8,IL⁃8)、白细胞介素⁃1β(interleukin⁃1β,IL⁃1β)、肿瘤坏死因子⁃α(tumor necrosis factor⁃α,TNF⁃α)、C反应蛋白(C⁃reactive protein,CRP)水平。结果试验组治疗前GAD⁃7评分、PHQ⁃9评分均高于对照组(P<0.05);试验组治疗第3、6周后的GAD⁃7评分、PHQ⁃9评分均低于治疗前(P<0.05),治疗第3周后与治疗第6周后的GAD⁃7评分以及PHQ⁃9评分差异无统计学意义(P>0.05);试验组治疗第3、6周后的疼痛评分均低于治疗前(P<0.05),治疗第6周的疼痛评分比治疗第3周低(P<0.05);试验组治疗第3、6周后外周血的IL⁃8、IL⁃1β、TNF⁃α、CRP水平均低于治疗前(P<0.05),治疗第6周后外周血的IL⁃8、IL⁃1β水平低于治疗第3周后(P<0.05),治疗第6周后外周血的TNF⁃α、CRP水平与治疗第3周后差异无统计学意义(P>0.05)。结论牙髓炎患者外周血存在较高的炎症水平与明显的焦虑、抑郁情绪,根管治疗术能降低牙髓炎患者的炎症水平,改善焦虑、抑郁情绪。