目的 探讨寒湿痹颗粒联合塞来昔布治疗强直性脊柱炎的效果.方法 选取2020年1月至2023年8月西安交通大学附属红会医院收治的128例强直性脊柱炎患者,按照随机数字表法将患者分为对照组和观察组,每组各64例.对照组给予塞来昔布胶囊治疗,观察组在对照组基础上给予寒湿痹颗粒治疗.2组患者均连续治疗6周.比较2组患者的治疗效果、视觉模拟量表(VAS)评分和Bath强直性脊柱炎功能指数(BASFI)评分、血清炎症指标、不良反应发生情况.结果 对照组好转54例,无效10例;观察组好转61例,无效3例;观察组的总有效率高于对照组[95.3％(61/64)比84.4％(54/64)](x2=4.195,P=0.041).治疗后,2组患者VAS和BASFI评分均低于治疗前,且观察组均低于对照组(均P＜0.05).治疗后,2组患者C反应蛋白、白细胞介素17、肿瘤坏死因子α水平均低于治疗前,且观察组均低于对照组(均P＜0.05).2组患者不良反应发生情况比较差异无统计学意义(x2=0.175,P=0.676).结论 在塞来昔布的基础上联用寒湿痹颗粒治疗强直性脊柱炎可获得较为满意的效果,能快速改善腰背痛、晨僵、关节痛等临床症状,降低VAS、BASFI评分和体内炎症反应,不良反应发生率较低,且症状轻微.

炎症性肠病常合并强直性脊柱炎有肠外病变表现,现代医学目前对于该共病发病机制尚不明确,临床缺乏有效防治方法,无法从根本上改善疾病的预后和减少复发.中医学认为该共病发病多为脾肾失司,二者制化失常为其主要病机表现.临床表现或以脾胃升降失司为主,或以肾虚温煦不足为主.治疗从脾肾论治出发,在炎症性肠病合并强直性脊柱炎共病的临床诊断和治疗中具有良好的临床效果.通过探讨从脾肾论治炎症性肠病及其肠外表现强直性脊柱炎共病的中医治疗经验,并附临床验案一则,以供临床参考借鉴.

强直性脊柱炎是临床上一种高致残、高致畸率的慢性炎症性骨病,发病早期常因腰背部疼痛、僵硬感等非特异性症状被忽视."阳病治阴"乃阴阳失调状态的治法之一.卢敏教授认为,强直性脊柱炎常督弱肾亏,内生阴邪,阴缠督阳,阳不胜阴,故阴阳失调,发病常兼糅寒、瘀、痰、湿阴之实邪.治则治法上,标实为盛除阴邪,本虚为主培督肾,同时辨阴证施以散寒、通瘀、蠲痰、逐湿之法化散阴毒,临证每获良效,可谓驱散阴邪以复督回阳以达"阳病治阴"之意.附验案 1则以当参阅.

Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease related to psoriasis involving bone and cartilage. It is a heterogeneous disorder with a variety of clinical manifestations, which can include peripheral arthritis, axial spondylitis, enthesitis, skin and nail disease, dactylitis, uveitis, osteitis, inflammatory bowel disease. The distinctive feature of PsA is enthesitis. The characteristic bone erosion at the bone-pannus junction in PsA is mediated by osteoclasts, which are multinucleated giant cells derived from hematopoietic stem cells. Although the pathological mechanism of osteoclasts in PsA is mainly related to the destruction of the diseased joint, the exact pathogenesis of PsA is complex and the factors involved in initiation and termination of osteoclast need to be further explored. Much attention has been paid to the importance of osteoclast in psoriasis arthritis for decades. Based on the role of osteoclasts in PsA, our review discusses the formation and characteristics of multinucleated osteoclasts in PsA, summarizes current developments in osteoclast-related pathways in PsA including classical receptor activator of nuclear factor-κB-receptor activator of nuclear factor-κB ligand-osteoprotegerin pathway and immunomodulatory factors, as well as their advances and corresponding treatment. At present, the molecular and signal pathway that interacts with osteoclasts in the pathogenesis of PSA has not been fully elucidated, therefore more detailed studies are expected in the near future.

Background::There are an increasing number of patients with oral sensory complaints (OSCs) presenting to our dental clinic. For most dentists, it is difficult to distinguish burning mouth syndrome (BMS) from other oral mucosal diseases that may cause symptoms such as burning mouth. It is beneficial to effectively distinguish OSC patients to reduce misdiagnosis and eliminate burning symptoms as much as possible.Methods::Patients with oral burning sensations in the oral mucosal disease clinic were collected from the Peking University Hospital of Stomatology between September 1, 2014 and December 31, 2018. After excluding oral candidiasis, anemic stomatitis, dental material allergy, and other diseases from patients with oral sensory complaints, basic conditions such as gender, age, education level, job status, hyperglycemia, hypertension, hyperlipidemia, history of brain abnormalities, history of cervical spondylitis, history of thyroid disease, history of thyroid disease and insomnia were obtained. The BMS patients were compared with the control group. The t test and Chi-square test were used for statistical analysis to compare the clinical symptoms of these diseases and explore the risk factors for BMS. Results::In this case-control study, 395 patients (321 females and 74 males, mean age 55.26 ± 10.51 years) with oral sensory complaints and 391 healthy controls (281 females and 110 males, mean age 47.11 ± 13.10 years) were enrolled, among which, 8.4% (33/395) had oral candidiasis, 1.3% (5/395) had dental material allergy, 0.8% (3/395) had anemic stomatitis and 0.5% (2/395) had lichen planus. A total of 352 patients were eventually diagnosed with BMS. Anxiety and depression were more severe in BMS patients, as were the incidences of sleep disorders and brain abnormalities. Logistic regression analysis showed that age (odds ratio [OR]= 2.79, 95% confidence interval [CI]: 1.61-4.83, P < 0.001), total cholesterol level (OR= 2.92, 95% CI: 1.32-6.50, P = 0.009) and anxiety score (OR = 1.75, 95% CI: 1.01-2.77, P = 0.017) significantly increased the incidence of BMS. Patients with hyperglycemia (OR = 0.46, 95% CI: 0.23-0.89, P = 0.022), low body mass index (BMI: OR = 0.57, 95% CI: 0.34-0.93, P = 0.026) and low education level (OR = 3.43, 95% CI: 1.91-6.15, P < 0.001) were more likely to suffer from BMS. Conclusions::Oral candidiasis, anemic stomatitis, and dental material allergy with burning symptoms should be excluded from patients with BMS. It is recommended to conduct a questionnaire survey (including anxiety and depression), blood cell analysis, and salivary fungus culture for all patients with an oral burning sensation. It is necessary to conduct a patch test on patients with oral burning sensations and metal restorations.

目的:探究高压氧联合温针灸治疗对强直性脊柱炎(AS)患者躯体功能、关节活动度改善及对炎性因子水平的影响。方法:选取2017年6月至2018年12月烟台市烟台山医院收治的128例AS患者作为研究对象，采用随机数字表法将患者分为对照组( n＝64)和观察组( n＝64)。2组患者均给予常规治疗，在常规治疗的基础上，对照组给予温针灸治疗，观察组给予温针灸联合高压氧治疗。采用Bath AS功能指数量表(BASFI)评估患者躯体功能及关节活动度，同时结合视觉模拟量表(VAS)评分评价腰骶脊背疼痛及关节疼痛情况；采用酶联免疫吸附法(ELISA)检测炎性因子水平的变化。 结果:2组患者治疗后躯体功能及疼痛情况较治疗前有明显改善，且观察组患者BASFI和VAS评分均显著低于对照组，差异均有统计学意义( P<0.05)。2组患者胸廓活动度、Schober试验、指地距、腰椎侧屈、腰椎后仰度及枕墙距较治疗前明显好转，且观察组患者改善情况优于对照组，差异均有统计学意义( P<0.05)。炎性因子红细胞沉降率(ESR)、C-反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)水平也明显降低，且观察组显著低于对照组，差异均有统计学意义( P<0.05)。观察组治疗总有效率(92.19%)显著高于对照组(78.13%)，差异有统计学意义( P<0.05)。 结论:高压氧联合温针灸治疗能提高AS的疗效，有效降低患者炎性因子水平，减轻患者疼痛，改善躯体功能及关节活动能力。

目的:筛选AS患者PBMCs中差异表达的环状RNA（circRNA），分析其表达谱以探讨circRNAs在AS发病中的作用。方法:采用circRNA微阵列芯片技术检测3例AS活动期（ASA）患者，3例AS稳定期（ASS）患者和3名健康对照者（HC）PBMCs中circRNAs的表达并通过倍数变化（FC）和 P值进行筛选，找到差异表达的circRNAs；从差异表达靠前的circRNAs中随机选择4个circRNAs，采用实时荧光定量PCR（RT-qPCR）验证芯片结果；对差异表达的circRNAs进行基因本体论（GO）分析，京都基因与基因组百科全书（KEGG）分析，并通过微RNA（miRNA）靶标预测软件对circRNA/miRNA相互作用关系进行预测。采用 t检验和Mann-Whitney U检验等方法对数据进行统计分析。 结果:芯片结果显示，ASA组较HC组共有800个显著差异表达的circRNAs（FC>1.5， P<0.05），其中466种上调，334种下调；ASS组较HC组共有1 149个显著差异表达的circRNAs（FC>1.5， P<0.05），其中589种上调，560种下调；ASA组较ASS组间共有233个显著差异表达的circRNAs（FC>1.5， P<0.05），其中145种上调，88种下调。RT-qPCR验证结果提示，4个差异表达的circRNAs表达趋势与芯片结果一致。GO分析结果提示，这些差异表达的circRNAs主要参与无义介导的mRNA衰变、Rho GTPase酶结合等过程；KEGG分析结果在辅助性T细胞（Th）17细胞分化、趋化因子信号通路等处得到富集；miRNA靶标预测软件结果提示差异表达的circRNAs可能靶向结合miR-650、let-7b-5p等miRNAs发挥作用。 结论:和HC组相比AS患者PBMCs中存在差异表达的circRNAs，推测这些circRNAs可能参与AS的发病。

目的:探讨AS患者英夫利西单抗（IFX）谷浓度（TLs）与疗效的关系，了解抗IFX抗体（ATI）产生情况。方法:连续纳入2017年1月至2018年12月苏北人民医院接受IFX治疗的AS患者38例。在第8次应用IFX前空腹抽取检测血清IFX-TLs和ATI水平，在第1次、第6次、第8次应用IFX前进行AS病情活动度评分（ASDAS），采用单因素方差分析、秩和检验、 χ2检验、Logistic回归分析进行统计学分析。从而进行疗效评价。 结果:① 38例AS患者，其中6例（16%）出现了ATI。这6例患者第8次IFX给药（38周）时出现病情反弹。②以第8次IFX治疗相比第6次IFX治疗的ASDAS是否上升进行分组，绘制受试者工作曲线（ROC）曲线，计算出IFX-TLs维持在0.635 μg/ml以上时，患者病情不易反跳。③ Logistic回归分析结果显示IFX-TLs与BMI相关[ OR（95% CI）=1.536（1.023，2.308）， P=0.039]，与合并用药相关[ OR（95% CI）=0.218（0.06，0.797）， P=0.021]。 结论:ATI的产生以及IFX-TLs变化与IFX失应答密切相关，应定期监测，调整治疗方案。

目的:探讨经椎弓根椎体截骨矫形术（PSO）中选择不同的下端融合椎（LIV）对强直性脊柱炎（AS）胸腰椎后凸畸形患者术后骨盆投射角（PI）的影响。方法:回顾性队列研究。纳入2006年3月—2014年9月南京大学医学院附属鼓楼医院94例AS胸腰椎后凸畸形患者的临床资料，其中男83例、女11例，年龄19～59（34.7±8.5）岁。患者均行后路PSO，依据LIV的选择将患者分为2组：A组69例，LIV选择L 4或L 5，其中20例远端固定至L 4、49例远端固定至L 5；B组25例，LIV选择S 1，远端均固定至S 1。比较2组患者术前、术后第10天及术后2年时全脊柱最大后凸角（GK）、矢状面垂直轴（SVA）、PI、骨盆倾斜角（PT）、骶骨倾斜角（SS）的变化情况。 结果:（1）2组患者性别、年龄、体质量指数等基线资料比较，差异均无统计学意义（ P值均>0.05）。所有患者均顺利完成手术，术后恢复良好，无手术相关并发症发生。（2）组间各项指标比较：术前除SVA差异有统计学意义（ t=-3.46， P=0.001），GK、PI、PT、SS差异均无统计学意义（ P值均>0.05）；术后第10天2组间GK、SVA、PI、PT、SS比较差异均无统计学意义（ P值均>0.05）；术后2年，A组PT小于B组，SS大于B组，差异均有统计学意义（ t=2.81、0.01， P值均<0.05），而GK、SVA、PI差异均无统计学意义（ P值均>0.05）。（3）组内各项指标比较：A组、B组内不同时间点PI差异均无统计学意义（ P值均>0.05），GK、SVA、PT、SS差异均有统计学意义（ P值均<0.05）。与术前比较，A组、B组内术后第10天和2年的GK、SVA、PT均减小，SS均增大，差异均有统计学意义（ P值均<0.05）；与术后第10天比较，术后2年A组、B组内PT均增大，SS均减小，差异均有统计学意义（ P值均<0.05），而GK、SVA差异均无统计学意义（ P值均>0.05）。 结论:对于行PSO治疗的AS胸腰椎后凸畸形患者，不论LIV是否固定至S 1，PI均无显著性变化，且对患者术后PI无影响。

Background::The clinical features of enthesitis in patients with psoriatic arthritis (PsA) have been reported in some Western countries, but data in China are very limited. This study aimed to describe the characteristics of enthesitis in Chinese patients with PsA and compared them with those in other cohorts.Methods::Patients with PsA enrolled in the Chinese Registry of Psoriatic Arthritis (CREPAR) (December 2018 to June 2021) were included. Data including demographics, clinical characteristics, disease activity measures, and treatment were collected at enrollment. Enthesitis was assessed by the Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis enthesitis score (MASES), and Leeds enthesitis index (LEI) indices. A multivariable logistic model was used to identify factors related to enthesitis. We also compared our results with those of other cohorts.Results::In total, 1074 PsA patients were included, 308 (28.7%) of whom had enthesitis. The average number of enthesitis was 3.3 ± 2.8 (range: 1.0–18.0). More than half of the patients (165, 53.6%) had one or two tender entheseal sites. Patients with enthesitis had an earlier age of onset for both psoriasis and arthritis, reported a higher proportion of PsA duration over 5 years, and had a higher percentage of axial involvement and greater disease activity. Multivariable logistic regression showed that axial involvement (odds ratio [OR] 2.21, 95% confidence interval [CI], 1.59–3.08; P <0.001), psoriasis area and severity index (PASI) (OR: 1.03, 95% CI: 1.01–1.04; P = 0.002), and disease activity score 28-C reactive protein (DAS28-CRP) (OR: 1.25, 95% CI: 1.01–1.55; P = 0.037) were associated with enthesitis. Compared with the results of other studies, Chinese patients with enthesitis had a younger age, lower body mass index (BMI), a higher rate of positive human leukocyte antigen (HLA)-B27, more frequent dactylitis, and a higher proportion of conventional synthetic disease-modifying antirheumatic drugs’ (csDMARDs) use. Conclusions::Enthesitis is a common condition among Chinese patients with PsA. It is important to evaluate entheses in both peripheral and axial sites.