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   探讨免疫及靶向药物联合肝动脉灌注化学治疗（化疗）治疗晚期肝癌的临床疗效。方法   选取甘肃省武威市人民医院2021年1月—2024年1月收治的78例晚期肝癌患者进行回顾性分析，其中20例患者采取单纯肝动脉灌注化疗（HAIC）治疗为单化疗组，30例患者采取HAIC联合程序性细胞死亡受体-1（PD-1）抗体治疗为免疫组，28例患者采取HAIC联合PD-1抗体免疫治疗与甲磺酸仑伐替尼胶囊靶向治疗为联合组。对比三组临床疗效、治疗前后胚抗原（CEA）、糖类抗原125（CA125）、甲胎蛋白（AFP）表达水平，不良反应发生率，并采用Piper疲乏修正量表（PFS-R）、世界卫生组织生存质量量表简表（WHOQOL-BREF）对两组癌因性疲乏程度及生存质量进行评价。结果   单纯化疗组、免疫组、联合组客观缓解率分别为15.00%、40.00%、64.29%，疾病控制率为30.00%、66.67%、82.14%，联合组高于单纯化疗组与免疫组（χ ² =11.720，P=0.003；χ ² =13.890，P＜0.001）；治疗后三组患者CEA、CA125、AFP水平均降低，且联合组［CEA：（13.62±4.24）ng/mL、CA125：（31.62±13.66）U/mL、AFP：（35.21±5.93）ng/mL］低于免疫组［（17.85±3.32）ng/mL、（59.26±9.35）U/mL、（42.12±4.12）ng/mL］及单纯化疗组［（23.73±4.79）ng/mL、（64.57±5.23）U/mL、（47.46±5.32）ng/mL］，对比差异有统计学意义（F=7.698，P＜0.001；F=11.480，P＜0.001；F=14.952，P＜0.001；P＜0.05）；所有患者均无5级不良反应及严重肝功能损害出现，且三组血小板减少、白细胞减少、腹痛、呕吐、消化道出血、厌食等不良反应发生率对比差异无统计学意义（P＞0.05）；治疗后三组患者PFS-R评分均降低，联合组（3.85±1.13）分低于免疫组（5.39±1.25）分及单纯化疗组（6.33±1.26）分，WHOQOL-BREF评分均升高，联合组（348.58±66.12）分高于免疫组（297.24±72.21）分及单纯化疗组（256.35±41.67）分，对比差异有统计学意义（F=2.526，P=0.014；F=2.167，P=0.033）。结论   免疫及靶向药物联合肝动脉灌注化疗治疗晚期肝癌疗效显著，可有效控制疾病进展的同时，降低机体肿瘤标志物水平，安全性可控，同时可改善患者生存质量，减轻癌因性疲乏程度。

       Objective  To explore the clinical efficacy of immune and targeted drugs combined with hepatic artery infusion chemotherapy（HAIC）in the treatment of advanced liver cancer．Methods  A retrospective analysis was conducted on 78 patients with advanced liver cancer admitted to our hospital from January 2021 to January 2024．Among them，20 patients were treated with simple HAIC and divided into a single chemotherapy group．Thirty patients were treated with HAIC combined with PD-1 antibody，and divided into an immune group．Twenty-eight patients were treated with HAIC combined with PD-1 antibody immunotherapy and lenvatinib mesylate capsule targeted therapy，and divided into a combination group．The clinical efficacy of three groups，the expressionlevels of CEA，CA125，AFP，and incidence of adverse reactions before and after treatment were compared．Piper Fatigue Correction Scale（PFS-R）and the WHO QOL-BREF were used to assess cancer-related fatigue in both groups．The degree of fatigue and quality of life were assessed．Results  The objective response rates of the simple chemotherapy group，the immune group，and the combination group were 15.00%，40.00% and 64.29%，respectively．The disease control  rates were 30.00%，66.67% and 82.14%，respectively．The indicators above of the combination group was significantly higher than those in the simple chemotherapy group and the immune group（χ ² =11.720，P=0.003；χ ² =13.890，P＜0.001；P＜0.05）．After treatment，the levels of CEA，CA125 and AFP were all decreased in the three groups，and those in the combined group （CEA［13.62±4.24］ng/mL，CA125［31.62±13.66］U/mL，AFP：Ng/mL［35.21±5.93］）were lower than those in the immune group（17.85±3.32 ng/mL，59.26±9.35 U/mL，/ 42.12±4.12 ng/mL）and single chemotherapy group（23.73±4.79 ng/mL，64.57±5.23 U/mL47.46±5.32］ng/mL），the differences were statistically significant（F=7.698，P＜0.001；F=11.480，P＜0.001；F=14.952，P＜0.001；P＜0.05）．All patients had no grade 5 adverse reactions or severe liver function damage，and there was no statistically significant difference in the incidence adverse reactions such as thrombocytopenia，leukopenia，abdominal pain，vomiting，gastrointestinal bleeding，and anorexia among the three groups（P＞0.05）．After treatment，the PFS-R score of the three groups was decreased，and the combined group（3.85±1.13）score was lower than that of the immune group（5.39±1.25）and the chemotherapy group（6.33±1.26）．While the WHOQOL-BREF score was increased，the score of combination group（348.58±66.12）was higher than that of immune group（297.24±72.21）and chemotherapy group（256.35±41.67），and the difference was statistically significant（F=2.526，P=0.014；F=2.167，P=0.033；P＜0.05）．Conclusions  The combination of immune and targeted drugs with hepatic artery infusion chemotherapy has a significant therapeutic effect on advanced liver cancer．It can effectively control disease progression，reduce tumor marker levels in the body，improve patient quality of life，and alleviate cancer-related fatigue，with controllable safety