类风湿关节炎贫血的中西医研究进展
摘要
贫血是类风湿关节炎最常见的关节外表现之一。目前认为,在病情活动期,T细胞、巨噬细胞产生的肿瘤坏死因子、干扰素、白细胞介素等细胞因子参与关节破坏时,干扰了造血过程,包括直接抑制骨髓对贫血的代偿,抑制促红细胞生成素的生成,干扰铁代谢,缩短红细胞寿命。中医学认为,痹证迁延不愈,正气渐虚,风寒湿热痰瘀痹阻于筋脉,亦影响气血运行,加之久服药物,耗伤精气,更加重气血亏虚。本病以正虚邪实,虚实夹杂为病机特点,治宜补中兼散,寓散于补。随着研究的进展,中西医结合将成为主要的治疗方法。
引文
[1]姚血明,马武开,黄颖,等.类风湿关节炎患者贫血情况及其对疾病影响的研究[J].风湿病与关节炎,2014,3(11):20-22.
[2]Young A,Koduri G.Extra-articular manifestations andcomplications of rheumatoid arthritis[J].Best PractRes Clin Rheumatol,2007,21(5):907-927.
[3]Singh H,Arya S,Talapatra P,et al.Assessment of fatiguein rheumatoid arthritis(by Functional Assessment ofChronic Illness Therapy-Fatigue score)and its relationto disease activity and anemia[J].J Clin Rheumatol,2014,20(2):87-90.
[4]朱芳晓,周润华,覃泱,等.类风湿关节炎血液系统受累的诊治分析[J].临床合理用药杂志,2013,6(9):93-94.
[5]Ganna S.The prevalence of anemia in rheumatoid arthritis[J].Rev Bras Reumatol,2014,54(4):257-259.
[6]李春萍,卫苏转.免疫抑制剂致风湿病患者急性造血功能停滞9例报告[J].基层医学论坛,2013,17(8):971-972.
[7]王银山,刘柏炎,周兵,等.类风湿性关节炎患者贫血类型及其相关因素的研究[J].中国现代医生,2008,46(33):1-3,19.
[8]Toyokawa Y,Kingetsu I,Yasuda C,et al.Pancytopenia,including macrocytic anemia,associated with leflunomide in a rheumatoid arthritis patient[J].Mod Rheumatol,2007,17(5):436-440.
[9]蔡家宇,沈思钰,蔡辉.类风湿关节炎伴自身免疫性溶血性贫血1例[J].现代中西医结合杂志,2009,18(33):4142-4143.
[10]Leung MH,Hughes M,Lane J,et al.Severe Disabilityin a Patient With Rheumatoid Arthritis and Sickle CellAnemia:An Underreported,But Yet a Potentially Treatable Combination of Diseases[J].J Clin Rheumatol,2015,21(8):458-459.
[11]任传永,徐亮.血清铁蛋白在风湿性疾病中的研究进展[J].安徽医学,2009,30(8):980-982.
[12]罗福东,吴新忠,陈富,等.可溶性转铁蛋白受体对类风湿性关节炎伴贫血疾病的诊断价值[J].广东医学,2008,29(1):64-65.
[13]陈波斌,林果为,倪赞明,等.血清转铁蛋白受体和血清铁蛋白在鉴别慢性病贫血和缺铁性贫血价值的评价[J].中华血液学杂志,2000,21(1):44.
[14]Fitzsimons EJ,Houston T,Munro R,et al.Erythroblastiron metabolism and serum soluble transferrin receptorvalues in the anemia of rheumatoid arthritis[J].Arthritis Rheum,2002,47(2):166-171.
[15]Bultink IE,Lems WF,van de Stadt RJ,et al.Ferritin andserum transferrin receptor predict iron deficiency inanemic patients with rheumatoid arthritis[J].ArthritisRheum,2001,44(4):979-981.
[16]李振玲.类风湿性关节炎贫血机制研究进展[J].中日友好医院学报,2005,19(3):175-178.
[17]吴志美,喻海忠,袁建芬,等.RA伴贫血患者治疗前、后网织红细胞参数变化[J].重庆医学,2013,42(18):2101-2102,2106.
[18]王敏,李晓兰,赵成艳,等.检测血清铁蛋白、骨髓铁染色对慢性病贫血及缺铁性贫血鉴别诊断的临床价值[J].放射免疫学杂志,2013,26(4):542-543.
[19]钱超,余建华,汤巧.类风湿关节炎伴慢性贫血患者相关细胞因子检测分析[J].检验医学与临床,2011,8(23):2819-2821.
[20]肖卫国,欧凤荣,张丽君,等.肿瘤坏死因子α对红系祖细胞造血影响的实验研究[J].中华血液学杂志,2003,25(8):438-439.
[21]Kheansaard W,Mas-Oo-di S,Nilganuwong S,et al.Interferon-gamma induced nitric oxide-mediated apoptosisof anemia of chronic disease in rheumatoid arthritis[J].Rheumatol Int,2013,33(1):151-156.
[22]Dai CH,Price JO,Brunner T,et al.Fas ligand is present inhuman erythroid colony-forming cells and interacts withFas induced by interferon gamma to produce erythroidcell apoptosis[J].Blood,1998,91(4):1235-1242.
[23]Rokicka-Piotrowicz M,Paszkowska M,Król M,et al.Analysis of causes for anemia in patients with multiple myeloma[J].Pol Arch Med Wewn,2000,104(6):843-851.
[24]安燕.研究风湿免疫系统疾病相关性贫血血清红细胞生成素水平[J].中国继续医学教育,2015,7(19):30-31.
[25]余丽君.类风湿关节炎伴慢性疾病性贫血患者血清白介素1和促红细胞生成素水平及其意义[J].中国全科医学,2012,15(20):2265-2267.
[26]Laftah AH,Sharma N,Brookes MJ,et al.Tumour necrosisfactor alpha causes hypoferraemia and reduced intestinal iron absorption in mice[J].Biochem J,2006,397(1):61-67.
[27]李芳,刘宗印,李忠培,等.类风湿关节炎伴贫血病人血清s IL-1β水平的变化[J].齐鲁医学杂志,2000,15(2):99-100.
[28]Galushko EA.The clinical significance of hepcidindetection in the patients with anemia and rheumatoidarthritis[J].Klin Med(Mosk),2014,92(6):21-27.
[29]Le Petitcorps H,Monti A,Pautas E.Hepcidin:a new biomarker of the iron deficiency anemia in elderly patients?[J].Ann Biol Clin(Paris),2015,73(Suppl 1):24-25.
[30]邬秀娣,张振,陈勇,等.类风湿关节炎患者血清铁调素与贫血及疾病活动性的关系[J].中华临床免疫和变态反应杂志,2013,7(3):228-233.
[31]赵建治,周建尧,侯韬,等.Hepcidin与类风湿关节炎合并慢性病贫血、疾病活动度的关系[J].现代实用医学,2015,27(8):996-998.
[32]王强,董巍.一氧化氮对慢性病贫血大鼠转铁蛋白受体及铁蛋白的影响[J].实用医院临床杂志,2007,4(6):45-47.
[33]刘儒曦,杨娉婷,方芳,等.肿瘤坏死因子-α拮抗剂治疗类风湿关节炎并发慢性疾病性贫血疗效研究[J].中国实用内科杂志,2013,33(1):49-51.
[34]Rom?o VC,Santos MJ,Polido-Pereira J,et al.Comparative Effectiveness of Tocilizumab and TNF Inhibitors inRheumatoid Arthritis Patients:Data from the RheumaticDiseases Portuguese Register,Reuma.pt[J].BiomedRes Int,2015,2015:279890.
[35]李华,陈林囡,胡兵,等.基因重组人红细胞生成素治疗类风湿性关节炎贫血[J].江苏医药杂志,2000,26(12):946-947.
[36]Chen WS,Liu CY,Lee HT,et al.Effects of intravenousiron saccharate on improving severe anemia in rheumatoid arthritis patients[J].Clin Rheumatol,2012,31(3):469-477.
[37]冯艳广,魏琴,刘小军,等.间充质干细胞治疗类风湿关节炎贫血的临床研究[J].中国现代药物应用,2016,10(2):170-171.
[38]温伟强,黄胜光,谭宁,等.独活寄生汤和归脾汤分别联合西药治疗类风湿关节炎贫血的对照研究[J].中医杂志,2012,53(14):1219-1222.
[39]宋科.加味薏苡仁汤治疗类风湿关节炎贫血的临床观察[J].中国保健营养(中旬刊),2012(7):234.
[40]李燕,巫婷婷.类风湿关节炎慢性病贫血从肝脾肾论治[J].中医杂志,2007,48(增刊):78-79.
[41]邱明山,许正锦,陈进春.从痰瘀论治类风湿关节炎[J].光明中医,2011,26(6):1116-1118.
[42]余学芳,陆学丹,汪海静.益气养血口服液对老年类风湿关节炎患者贫血的影响[J].中国临床保健杂志,2013,16(1):65-67.
[43]沈玉杰,瞿群威,王大军.风湿仙丹治疗类风湿性关节炎53例临床观察[J].中医杂志,2002,43(1):33-35.
[44]阮崇洁.隔物温和灸对类风湿关节炎贫血影响的临床观察[D].武汉:湖北中医药大学,2011.
[45]刘健,陈瑞莲,朱怀敏,等.新风胶囊对类风湿关节炎贫血的疗效及机制研究[J].中国临床保健杂志,2010,13(3):225-229.
[46]唐志宇,梁江.昆山合剂对类风湿关节炎合并贫血患者滑膜成纤维细胞增殖及My D88、IL-6表达的研究[J].世界科学技术-中医药现代化,2014,16(3):582-586.
[2]Young A,Koduri G.Extra-articular manifestations andcomplications of rheumatoid arthritis[J].Best PractRes Clin Rheumatol,2007,21(5):907-927.
[3]Singh H,Arya S,Talapatra P,et al.Assessment of fatiguein rheumatoid arthritis(by Functional Assessment ofChronic Illness Therapy-Fatigue score)and its relationto disease activity and anemia[J].J Clin Rheumatol,2014,20(2):87-90.
[4]朱芳晓,周润华,覃泱,等.类风湿关节炎血液系统受累的诊治分析[J].临床合理用药杂志,2013,6(9):93-94.
[5]Ganna S.The prevalence of anemia in rheumatoid arthritis[J].Rev Bras Reumatol,2014,54(4):257-259.
[6]李春萍,卫苏转.免疫抑制剂致风湿病患者急性造血功能停滞9例报告[J].基层医学论坛,2013,17(8):971-972.
[7]王银山,刘柏炎,周兵,等.类风湿性关节炎患者贫血类型及其相关因素的研究[J].中国现代医生,2008,46(33):1-3,19.
[8]Toyokawa Y,Kingetsu I,Yasuda C,et al.Pancytopenia,including macrocytic anemia,associated with leflunomide in a rheumatoid arthritis patient[J].Mod Rheumatol,2007,17(5):436-440.
[9]蔡家宇,沈思钰,蔡辉.类风湿关节炎伴自身免疫性溶血性贫血1例[J].现代中西医结合杂志,2009,18(33):4142-4143.
[10]Leung MH,Hughes M,Lane J,et al.Severe Disabilityin a Patient With Rheumatoid Arthritis and Sickle CellAnemia:An Underreported,But Yet a Potentially Treatable Combination of Diseases[J].J Clin Rheumatol,2015,21(8):458-459.
[11]任传永,徐亮.血清铁蛋白在风湿性疾病中的研究进展[J].安徽医学,2009,30(8):980-982.
[12]罗福东,吴新忠,陈富,等.可溶性转铁蛋白受体对类风湿性关节炎伴贫血疾病的诊断价值[J].广东医学,2008,29(1):64-65.
[13]陈波斌,林果为,倪赞明,等.血清转铁蛋白受体和血清铁蛋白在鉴别慢性病贫血和缺铁性贫血价值的评价[J].中华血液学杂志,2000,21(1):44.
[14]Fitzsimons EJ,Houston T,Munro R,et al.Erythroblastiron metabolism and serum soluble transferrin receptorvalues in the anemia of rheumatoid arthritis[J].Arthritis Rheum,2002,47(2):166-171.
[15]Bultink IE,Lems WF,van de Stadt RJ,et al.Ferritin andserum transferrin receptor predict iron deficiency inanemic patients with rheumatoid arthritis[J].ArthritisRheum,2001,44(4):979-981.
[16]李振玲.类风湿性关节炎贫血机制研究进展[J].中日友好医院学报,2005,19(3):175-178.
[17]吴志美,喻海忠,袁建芬,等.RA伴贫血患者治疗前、后网织红细胞参数变化[J].重庆医学,2013,42(18):2101-2102,2106.
[18]王敏,李晓兰,赵成艳,等.检测血清铁蛋白、骨髓铁染色对慢性病贫血及缺铁性贫血鉴别诊断的临床价值[J].放射免疫学杂志,2013,26(4):542-543.
[19]钱超,余建华,汤巧.类风湿关节炎伴慢性贫血患者相关细胞因子检测分析[J].检验医学与临床,2011,8(23):2819-2821.
[20]肖卫国,欧凤荣,张丽君,等.肿瘤坏死因子α对红系祖细胞造血影响的实验研究[J].中华血液学杂志,2003,25(8):438-439.
[21]Kheansaard W,Mas-Oo-di S,Nilganuwong S,et al.Interferon-gamma induced nitric oxide-mediated apoptosisof anemia of chronic disease in rheumatoid arthritis[J].Rheumatol Int,2013,33(1):151-156.
[22]Dai CH,Price JO,Brunner T,et al.Fas ligand is present inhuman erythroid colony-forming cells and interacts withFas induced by interferon gamma to produce erythroidcell apoptosis[J].Blood,1998,91(4):1235-1242.
[23]Rokicka-Piotrowicz M,Paszkowska M,Król M,et al.Analysis of causes for anemia in patients with multiple myeloma[J].Pol Arch Med Wewn,2000,104(6):843-851.
[24]安燕.研究风湿免疫系统疾病相关性贫血血清红细胞生成素水平[J].中国继续医学教育,2015,7(19):30-31.
[25]余丽君.类风湿关节炎伴慢性疾病性贫血患者血清白介素1和促红细胞生成素水平及其意义[J].中国全科医学,2012,15(20):2265-2267.
[26]Laftah AH,Sharma N,Brookes MJ,et al.Tumour necrosisfactor alpha causes hypoferraemia and reduced intestinal iron absorption in mice[J].Biochem J,2006,397(1):61-67.
[27]李芳,刘宗印,李忠培,等.类风湿关节炎伴贫血病人血清s IL-1β水平的变化[J].齐鲁医学杂志,2000,15(2):99-100.
[28]Galushko EA.The clinical significance of hepcidindetection in the patients with anemia and rheumatoidarthritis[J].Klin Med(Mosk),2014,92(6):21-27.
[29]Le Petitcorps H,Monti A,Pautas E.Hepcidin:a new biomarker of the iron deficiency anemia in elderly patients?[J].Ann Biol Clin(Paris),2015,73(Suppl 1):24-25.
[30]邬秀娣,张振,陈勇,等.类风湿关节炎患者血清铁调素与贫血及疾病活动性的关系[J].中华临床免疫和变态反应杂志,2013,7(3):228-233.
[31]赵建治,周建尧,侯韬,等.Hepcidin与类风湿关节炎合并慢性病贫血、疾病活动度的关系[J].现代实用医学,2015,27(8):996-998.
[32]王强,董巍.一氧化氮对慢性病贫血大鼠转铁蛋白受体及铁蛋白的影响[J].实用医院临床杂志,2007,4(6):45-47.
[33]刘儒曦,杨娉婷,方芳,等.肿瘤坏死因子-α拮抗剂治疗类风湿关节炎并发慢性疾病性贫血疗效研究[J].中国实用内科杂志,2013,33(1):49-51.
[34]Rom?o VC,Santos MJ,Polido-Pereira J,et al.Comparative Effectiveness of Tocilizumab and TNF Inhibitors inRheumatoid Arthritis Patients:Data from the RheumaticDiseases Portuguese Register,Reuma.pt[J].BiomedRes Int,2015,2015:279890.
[35]李华,陈林囡,胡兵,等.基因重组人红细胞生成素治疗类风湿性关节炎贫血[J].江苏医药杂志,2000,26(12):946-947.
[36]Chen WS,Liu CY,Lee HT,et al.Effects of intravenousiron saccharate on improving severe anemia in rheumatoid arthritis patients[J].Clin Rheumatol,2012,31(3):469-477.
[37]冯艳广,魏琴,刘小军,等.间充质干细胞治疗类风湿关节炎贫血的临床研究[J].中国现代药物应用,2016,10(2):170-171.
[38]温伟强,黄胜光,谭宁,等.独活寄生汤和归脾汤分别联合西药治疗类风湿关节炎贫血的对照研究[J].中医杂志,2012,53(14):1219-1222.
[39]宋科.加味薏苡仁汤治疗类风湿关节炎贫血的临床观察[J].中国保健营养(中旬刊),2012(7):234.
[40]李燕,巫婷婷.类风湿关节炎慢性病贫血从肝脾肾论治[J].中医杂志,2007,48(增刊):78-79.
[41]邱明山,许正锦,陈进春.从痰瘀论治类风湿关节炎[J].光明中医,2011,26(6):1116-1118.
[42]余学芳,陆学丹,汪海静.益气养血口服液对老年类风湿关节炎患者贫血的影响[J].中国临床保健杂志,2013,16(1):65-67.
[43]沈玉杰,瞿群威,王大军.风湿仙丹治疗类风湿性关节炎53例临床观察[J].中医杂志,2002,43(1):33-35.
[44]阮崇洁.隔物温和灸对类风湿关节炎贫血影响的临床观察[D].武汉:湖北中医药大学,2011.
[45]刘健,陈瑞莲,朱怀敏,等.新风胶囊对类风湿关节炎贫血的疗效及机制研究[J].中国临床保健杂志,2010,13(3):225-229.
[46]唐志宇,梁江.昆山合剂对类风湿关节炎合并贫血患者滑膜成纤维细胞增殖及My D88、IL-6表达的研究[J].世界科学技术-中医药现代化,2014,16(3):582-586.