目的 探讨加味骨洗方外治法用于治疗类风湿关节炎的疗效以及类风湿因子等临床指标的变化。方法 选取100例类风湿关节炎患者,随机分为治疗组和对照组各50例。治疗组给予加味骨洗方及TDP特定电磁疗灯导入的外治,对照组给予TDP特定电磁疗灯磁疗。结果 在缓解症状和恢复功能方面治疗组总有效率为84%,对照组总有效率为58%,治疗组各临床指标与对照组相比均有差异(P<0.05)。结论 加味骨洗方治疗类风湿关节炎疗效显著,能有效降低类风湿因子等炎性指标,值得临床推广。

Objective To discuss curative effects of rheumatoid arthritis treatment and clinical indicators transformation including rheumatoid factor by additional Guxi prescription external therapy. Methods We selected 100 patients who were suffered from rheumatoid arthritis, divided randomly into two groups. 50 patients for the treatment group and another 50 for the control group. The treatment group was treated by the additional Guxi prescription external therapy. While the control group was treated by the infrared magnetic therapy. Results The effective proportion of the treatment group was 84%, while the control group total was 58% in the aspect of relieve the symptoms and recovery of functions. Besides, all clinical indicators of the treatment group were inferior to the control group(P<0.05). Conclusion There are effects for treating rheumatoid arthritis by utilizing additional Guxi prescription external therapy. This therapy which can effectively reduce the inflammatory indexes of the rheumatoid factor is worth promoting clinically.

目的 对比观察海桐皮汤熏洗应用于膝骨性关节炎关节镜清理术后的临床疗效。方法 于2012年1月—2014年1月,从我院骨科住院患者中选取因膝骨性关节炎行关节镜清理术病例60例,随机分为两组,对照组术后给予常规康复治疗措施,治疗组在常规康复治疗的基础上于术后2周拆线后配合海桐皮汤熏洗治疗,治疗周期4周。对比两组患者治疗前后的WOMAC评分,分析其疗效差异。结果 两组患者WOMAC评分术后2周比较无差异P＞0.5;治疗4周后,两组患者较术后2周有所降低(P＜0.5),但治疗组疗效优于对照组(P＜0.5)。结论 海桐皮汤熏洗疗法可改善膝骨性关节炎关节镜清理术后膝关节功能,操作简便,成本低廉,无副作用,值得临床推广应用。

KOA是临床上最常见,发病起源于关节软骨的慢性退行性关节疾病。近年来,应用黄芪治疗KOA的报道不断增多,并且开展了大量的机制研究。本文综述了黄芪在KOA治疗中的应用现状及研究进展,同时指出从PPAR-γ信号通路探索黄芪干预KOA的具体分子机制具有积极的理论和实践意义。

目的 评估重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白（rhTNRF：Fc）治疗难治性慢性痛风性关节炎的临床疗效及安全性。方法 选取2022年1月一2023年12月广州中医药大学顺德医院风湿科门诊收治的46例难治性痛风性关节炎患者,分为观察组和对照组两组,对照组规范使用降尿酸药物治疗,观察组在对照组治疗的基础上联合使用rhTNRF：Fc至少12周,在0、12、24、48周观察两组的血尿酸（sUA）、肿瘤坏死因子-α（TNF-α）、关节肌肉骨骼超声变化、痛风发作例数、肝肾功能等指标。结果 观察组与对照组sUA无明显差别（P>0.05）,TNF-α水平明显下降（P<0.05）,滑膜炎、关节积液影像表现减少（P<0.05）,痛风发作例数明显减少（P<0.05）,观察期间肝肾功能正常,无患者因不良反应退出研究。结论 rhTNRF：Fc对难治性慢性痛风性关节炎安全有效。

Objective To explore the efficacy and safety of recombinant human type II tumor necrosis factor receptor-antibody fusion protein（rhTNRF：Fc）in refractory chronic gouty arthritis. Methods From January 2022 to December 2023, 46 cases of refractory chronic gouty arthritis in the Rheumatology Outpatient Department,Shunde Hospital Guangzhou University of Chinese Medicine were selected and divided into an observation group and a control group. The control group received routine treatment,while the observation group received rhTNRF：Fc treatment additionally for at least 12 weeks, two groups of indicators such as serum urine acid（sUA）, TNF-α, changes in musculoskeletal ultrasound,number of gout attacks,hepatic and renal function at 0, 12, 24, and 48 weeks were observed. Results There was no significant difference in sUA between the observation group and the control group（P>0. 05）, TNF-α significantly decreased（P<0. 05）, synovitis and joint effusion imaging manifestations reduced（P<0. 05）, number of gout attacks decreased（P<0. 05）. During the observation period, liver and kidney function were normal, and no patients withdrew from the study due to adverse reactions. Conclusions Using rhTNRF：Fc is safe and effective in treating refractory chronic gouty arthritis.

       目的   分析类风湿因子（RF）、T淋巴细胞亚群（CD3⁺ 、CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ ）与类风湿关节炎病情程度的关系。方法   选取2023年1月—2024年4月收治的90例类风湿关节炎患者作为观察组，同期到院的90例健康体检者为对照组，均接受RF、CD3⁺ 、CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ 检测，并按照类风湿关节炎患者病情评价（DAS28）判定观察组患者病情的严重程度，应用Pearson相关性分析RF、CD3⁺ 、CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ 与患者病情严重程度的关系。结果   与对照组比较，观察组RF及CD8⁺ 水平较高，CD3⁺ 、CD4⁺ 及CD4⁺ /CD8⁺ 水平较低（P＜0.05）；不同病情的RF及CD8⁺ 水平比较，重度患者最高，其次为中度、轻度，而CD3⁺ 、CD4⁺ 及CD4⁺ /CD8⁺ 水平比较，轻度患者最高，其次为中度、重度，两两比较均有差异统计学意义（P＜0.05）；经Pearson相关性分析，RF及CD8⁺ 水平与病情程度呈正相关，CD3⁺ 、CD4⁺ 及CD4⁺ /CD8⁺ 水平与病情程度呈负相关（P＜0.05）。结论  RF、T淋巴细胞亚群指标与类风湿关节炎发生、发展有密切关系，可为医师准确评估患者病情严重程度提供可靠参考。

       Objective  To analyze the relationship between rheumatoid factor（RF），T lymphocyte subsets（CD3⁺ ，CD4⁺ ，CD8⁺ ，CD4⁺ /CD8⁺ ）and the severity of rheumatoid arthritis．Methods  A total of 90 patients with rheumatoid arthritis from January 2023 to April 2024 were selected as the observation group，and 90 healthy checkup individuals who came to the hospital during the same period were selected as the control group．All patients underwent RF，CD3⁺ ，CD4⁺ ，CD8⁺ ，and CD4⁺ /CD8⁺  tests，and the severity of their condition was determined based on the evaluation of rheumatoid arthritis patient condition（DAS28）．Pearson Correlation analysis was used to analyze the relationship between RF，CD3⁺ ，CD4⁺ ，CD8⁺ ，CD4⁺ /CD8⁺  and the disease severity of the patients．Results  Compared with the control group，RF and CD8⁺  levels in the observation group were higher，while the levels of CD3⁺ ，CD4⁺  and CD4⁺ /CD8⁺  were low（P＜0.05）．Comparison of RF and CD8⁺  levels for different conditions，the RF and CD8⁺  levels of the severe patients was highest，followed by moderate and mild．However，the CD3⁺ ，CD4⁺  and CD4⁺ /CD8⁺levels were highest in mild patients，followed by the moderate and sereve patients．Statistical significance was found in both pairwise comparisons（P＜0.05）．After the Pearson correlation analysis，RF and CD8⁺  levels were positively correlated with the degree of disease，while CD3⁺ ，CD4⁺ ，and CD4⁺ /CD8⁺  levels were inversely associated with the degree of disease condition（P＜0.05）．Conclusions  RF and T lymphocyte subsets are closely related to the occurrence and development of rheumatoid arthritis，and can provide reliable references for physicians to accurately evaluate the severity of patients’ conditions．

       目的   基于Nomogram初步构建膝骨关节炎（KOA）患者术前衰弱的风险预测模型。方法   便利选取172例于2021年12月—2022年8月在广州市某三甲医院关节外科接受择期膝关节置换术的KOA患者为研究对象，依据衰弱的发生与否分为衰弱组（n=111）和非衰弱组（n=61），通过单因素分析筛选变量，纳入Logistic回归分析，并构建列线图模型。结果   单因素分析结果显示年龄、BMI、膝关节疼痛年限、合并症、抑郁、焦虑、疼痛、睡眠障碍、营养状况等在不同组间比较差异存在统计学的意义（P＜0.05）。多因素Logistic回归分析表明，BMI异常（OR=3.360）、膝关节疼痛年限＞5年（OR=14.188）、抑郁（OR=5.608）、睡眠障碍（OR=25.480）是KOA患者术前衰弱的独立危险因素（P＜0.05）。基于此，建立了预测膝骨关节炎患者术前衰弱风险的列线图预测模型。结果显示C-index为0.915，校正曲线接近理想曲线，ROC曲线下面积（AUC）为0.919（95%CI：0.878~0.961），可见该预测模型具有较好的区分度和准确度。结论   根据BMI、膝关节疼痛年限、抑郁以及睡眠障碍这四个独立危险因素，可以准确地预测膝骨关节炎患者术前衰弱的风险。

    Objective  To develop a nomogram for predicting the risk of preoperative frailty in knee osteoarthritis patients．Methods  A convenience sample of 172 patients who underwent elective knee arthroplasty at a Grade-A hospital in Guangzhou from December 2021 to August 2022 was selected．The patients were divided into two groups based on the presence of preoperative frailty：frailty group（n=111）and non-frailty group（n=61）．The variables with statistical differences were screened by univariate analysis for multivariate logistic regression analysis，and the nomogram prediction model was established．Results  Univariate analysis identified significant differences between the groups in age，BMI，years of knee pain，complications，depression，anxiety，pain，sleep disturbance，and nutrition（P＜0.05）．Multivariate logistic regression showed that abnormal BMI（OR=3.360），years of knee pain ＞ 5（OR=14.188），depression（OR=5.608），and sleep disorders（OR=25.480）were independent  risk factors for preoperative frailty in knee osteoarthritis patients（P＜0.05）．Based on these findings，a nomogram prediction model was established．Model verification results demonstrated that the nomogram had good differentiation and accuracy in predicting the risk of preoperative frailty，with a C-index of 0.915，an area under the ROC curve of 0.919（95% CI：0.878~0.961），and a calibration curve slope close to 1．Conclusions  The nomogram，based on four independent risk factors（BMI，years of knee pain，depression，and sleep disturbance），effectively predicts the risk of preoperative frailty in knee osteoarthritis patients．