本文選題：女性 + 類風(fēng)濕關(guān)節(jié)炎��； 參考：《第三軍醫(yī)大學(xué)》2015年碩士論文

【摘要】：類風(fēng)濕關(guān)節(jié)炎(Rheumatoid arthritis,RA)是一種慢性、全身性的自身免疫性疾病,其病理改變以全身的關(guān)節(jié)滑膜炎癥為主,以人體四肢小關(guān)節(jié)(如手、腕等)反復(fù)出現(xiàn)慢性、對(duì)稱性、多關(guān)節(jié)的炎癥性改變?yōu)橹饕R床表現(xiàn),能夠刺激血管翳形成,從而導(dǎo)致關(guān)節(jié)內(nèi)軟骨及骨的破壞,關(guān)節(jié)出現(xiàn)功能障礙,甚則致殘。同時(shí),可出現(xiàn)關(guān)節(jié)外病變,如可能出現(xiàn)心臟、肺臟、腎臟病變,以及胃腸道、神經(jīng)系統(tǒng)等病變。RA是多種因素共同作用所致的疾病,其可能與遺傳、環(huán)境因素、心理因素、社會(huì)因素,以及與吸煙、飲酒等多種因素相關(guān)。陰道內(nèi)支原體作為環(huán)境因素之一,對(duì)類風(fēng)濕關(guān)節(jié)炎的發(fā)病產(chǎn)生影響。陰道內(nèi)支原體是條件致病菌,支原體寄生于女性陰道內(nèi),若免疫力低下或粘膜損害等因素破壞了陰道微生態(tài)平衡,即可導(dǎo)致疾病的發(fā)生。目前,鮮有針對(duì)女性RA患者陰道內(nèi)支原體感染情況、藥物敏感性研究及血清學(xué)變化分析,我們的工作彌補(bǔ)了這方面研究的空白,有利于揭示女性類風(fēng)濕關(guān)節(jié)炎與陰道支原體的關(guān)系,指導(dǎo)臨床治療方案的擬定;同時(shí),關(guān)注了女性RA患者支原體感染后造成血清學(xué)變化情況、臨床意義,從而預(yù)知潛在風(fēng)險(xiǎn)防患于未然。方法:1.研究女性RA與陰道支原體的關(guān)系。本研究將女性人群分為三組,分別為女性RA患者(RA組)、女性非RA其它疾病患者(非RA組)及女性健康體檢者(健康組),通過支原體培養(yǎng)及分型技術(shù),將取自女性RA患者、女性非RA其它疾病患者及女性健康體檢者的宮頸管口上皮細(xì)胞及分泌物標(biāo)本進(jìn)行支原體檢測(cè)及分型,然后,統(tǒng)計(jì)分析這三組的陰道支原體感染及分型的構(gòu)成情況,從而揭示女性RA與陰道支原體的關(guān)系。2.研究女性RA患者陰道支原體感染藥物敏感性情況。將第一部分試驗(yàn)篩選的女性RA患者陰道支原體感染者的宮頸上皮細(xì)胞及分泌物拭子,從-70℃冰箱中取出,復(fù)溫后對(duì)其進(jìn)行藥物敏感性試驗(yàn)。3.研究女性RA患者陰道支原體感染后的血清學(xué)變化及臨床意義。將第一部分試驗(yàn)篩選的女性RA患者,分為支原體感染組(感染組)及支原體未感染組(未感染組),對(duì)其血清學(xué)、DAS28等數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理、分析,研究感染組較未感染組的血清學(xué)變化情況及趨勢(shì),以及初步了解二組的RA疾病活動(dòng)性情況,并判斷其臨床意義。結(jié)果:1.實(shí)驗(yàn)納入女性RA患者(RA組)246例、女性非RA其它疾病患者(非RA組)113例、女性健康體檢者(健康組)126例,合計(jì)485例,支原體感染者合計(jì)290例,總的陽性率為59.79%,將三組支原體陽性率進(jìn)行比較后未見差異,不具有統(tǒng)計(jì)學(xué)意義(P0.05)。其后,將支原體陽性者進(jìn)行支原體分型,RA組144例,解脲脲原體(Uu)構(gòu)成比為35.42%(51/144)、人型支原體(Mh)構(gòu)成比為3.47%(5/144)、Uu+Mh構(gòu)成比為61.11%(88/144);健康組80例,Uu構(gòu)成比為57.50%(46/80)、Mh構(gòu)成比為2.50%(2/80)、Uu+Mh構(gòu)成比為40.00%(32/80),RA組、健康組二組組間比較明顯不同,差異具有統(tǒng)計(jì)學(xué)意義(P0.001)。2.上述支原體感染及分型試驗(yàn)中支原體感染者共290例,其中,女性RA患者支原體感染者144例,其耐藥率分別為交沙霉素10.42%、強(qiáng)力霉素18.06%、米諾環(huán)素22.22%、四環(huán)素28.47%、克拉霉素48.61%、阿齊霉素50.69%、羅紅霉素61.11%、左氧沙星61.81%、氧氟沙星64.58%、司巴沙星71.53%、紅霉素74.31%、環(huán)丙沙星88.19%。3.女性RA患者陰道支原體感染者(感染組)血清中人體白細(xì)胞(WBC)、中性粒細(xì)胞(Neu)、淋巴細(xì)胞(Lymph)、單核細(xì)胞(Mon)、血小板(PLT)計(jì)數(shù)分別為為(6.60±2.95)、(4.38±2.61)、(1.61±0.64)、(0.46±0.23)、(282.34±140.81)10^9/L,均高于女性RA患者陰道支原體未感染者(未感染組)[分別為(6.01±2.08)、(4.04±1.82)、(1.43±0.63)、(0.40±0.20)、(237.26±98.39)10^9/L],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。感染組血清中嗜酸性粒細(xì)胞(Eos)計(jì)數(shù)、血鈣(Ca2+)濃度分別為(0.14±0.13)10^9/L、(2.17±0.12)mmol/L,低于未感染組[分別為(0.17±0.22)10^9/L、(2.19±0.11)mmol/L],差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.女性RA患者陰道支原體感染率與健康體檢者比較未見明顯不同;2.女性RA患者陰道支原體感染類型的構(gòu)成情況較女性健康體檢者發(fā)生了明顯改變。3.女性RA患者陰道支原體感染后對(duì)四環(huán)素類抗生素的藥物耐藥程度低,對(duì)大環(huán)內(nèi)酯類抗生素的藥物敏感程度中介或耐藥程度高。4.女性RA患者陰道支原體感染應(yīng)用米諾環(huán)素抗感染治療后,RA病情活動(dòng)性、ESR較用藥前有所降低。5.女性RA患者陰道支原體感染后,血WBC、Neu、Lymph、Mon、PLT計(jì)數(shù)較未感染者呈上升趨勢(shì),有加重炎癥反應(yīng)及促進(jìn)凝血的趨勢(shì),有使Eos計(jì)數(shù)、血Ca2+下降的傾向。6.女性RA患者陰道支原體感染后RA疾病活動(dòng)性未出現(xiàn)明顯改變,也未出現(xiàn)血沉(ESR)、C-反應(yīng)蛋白(CRP)血清學(xué)明顯變化。
[Abstract]:Rheumatoid arthritis (Rheumatoid arthritis, RA) is a chronic, systemic autoimmune disease whose pathological changes are based on systemic synovitis, with repeated chronic, symmetrical features of the small joints of the limbs (such as hand, wrist, etc.). The inflammatory changes of multiple joints are the main clinical manifestations, which can stimulate pannus formation and lead to the formation of pannus. The destruction of the cartilage and bone in the joint, the dysfunction of the joints, and the disability. At the same time, there can be extraarticular lesions, such as the possible occurrence of heart, lung, kidney disease, and gastrointestinal, nervous system,.RA is a disease caused by a variety of factors, which can be associated with genetic, environmental, psychological, social, and suction. The vaginal mycoplasma is one of the environmental factors, which affects the pathogenesis of rheumatoid arthritis. The Mycoplasma in the vagina is a conditional pathogen. Mycoplasma is parasitic in the female vagina. If the immunity is low or the mucosal damage is damaged, the vaginal microecological balance can lead to the occurrence of the disease. There are few cases of vaginal mycoplasma infection in female RA patients, drug sensitivity research and serological change analysis. Our work has made up the gap in this study, which is helpful to reveal the relationship between female rheumatoid arthritis and Mycoplasma vagina, to guide the formulation of clinical treatment scheme, and to pay attention to mycoplasma infection in female RA patients. After the results of serological changes and clinical significance, the potential risk prevention was foreseen. Methods: 1. the relationship between female RA and Mycoplasma vaginae was studied. This study divided women into three groups: female RA patients (group RA), female non RA disease patients (non RA group) and female healthy persons (Health Group), through mycoplasma culture. And the classification technique will be taken from the female RA patients, women non RA other diseases and women's cervix oral epithelial cells and secretions to carry out mycoplasma detection and classification, and then analyze the three groups of vaginal mycoplasma infection and classification of the composition, so as to reveal the relationship between female RA and Mycoplasma vaginae in.2. research Study the drug sensitivity of female RA patients with Mycoplasma vagina infection. Cervical epithelial cells and secretions swabs from female RA patients infected with Mycoplasma vagina in the first part of the trial were taken out from -70 centigrade refrigerator, and after rewarming the drug sensitivity test.3. was used to study the serological changes in female RA patients after vaginal Mycoplasma infection. The first part of the screening of female RA patients was divided into mycoplasma infection group (infection group) and Mycoplasma uninfected group (uninfected group). The serology, DAS28 and other data were processed and analyzed. The serological changes and trends of the infected group compared with the uninfected group were analyzed, and the RA disease activity of the two groups was preliminarily understood. Results: the 1. experiment included 246 cases of female RA patients (group RA), 113 cases of non RA other patients (non RA group), 126 cases of female health examination (healthy group), 485 cases, 290 cases of mycoplasma infection, the total positive rate was 59.79%. No difference was found between the positive rates of Mycoplasma in the three groups, no difference was found. There were statistical significance (P0.05). Subsequently, Mycoplasma positive patients were divided into Mycoplasma genotyping, RA group 144, Ureaplasma urealyticum (Uu) composition ratio was 35.42% (51/144), Mycoplasma hominis (Mh) constituent ratio was 3.47% (5/144), Uu+Mh composition ratio was 61.11% (88/144); healthy group 80 cases, Uu composition ratio of 57.50% (46/80), Mh constituent ratio 2.50% (2/80), constitute ratio of 2.50% 40% (32/80), group RA and two groups in the health group were significantly different, and the difference was statistically significant (P0.001) 290 cases of mycoplasma infection and mycoplasma infection in.2.. Among them, 144 cases of mycoplasma infection in the female RA patients, the rate of resistance to Mycoplasma 10.42%, doxycycline 18.06%, minocycline 22.22%, and tetracycline 2, respectively. 8.47%, clarithromycin 48.61%, azithromycin 50.69%, roxithromycin 61.11%, levofloxacin 61.81%, ofloxacin 64.58%, sparfloxacin 71.53%, erythromycin 74.31%, and ciprofloxacin 88.19%.3. female RA patients with Mycoplasma vagina infection (WBC), neutrophils (Neu), lymphocyte (Lymph), mononuclear cells (Mon), blood The PLT counts were (6.60 + 2.95), (4.38 + 2.61), (1.61 + 0.64), (0.46 + 0.23) and (282.34 + 140.81) 10^9/L, all higher than those of uninfected vaginal Mycoplasma in female RA patients [6.01 + 2.08), (4.04 + 0.46), (0.64), (P0.05). The difference was statistically significant (P0.05). The count of eosinophils (Eos) and blood calcium (Ca2+) were (0.14 + 0.13) 10^9/L and (2.17 + 0.12) mmol/L respectively, lower than that of uninfected Group [0.17 + 0.22) 10^9/L and (2.19 + 0.11) mmol/L] (P0.05). Conclusion: the infection rate of Mycoplasma vaginae in 1. women RA patients was not significantly different from those in healthy persons; 2. women R. The composition of the type of Mycoplasma vaginae infection in A patients was significantly lower than that in women's healthy subjects. The drug resistance to tetracycline antibiotics in.3. RA patients was low, the drug sensitivity to the macrolide antibiotics, or the high degree of drug resistance in.4. female RA patients with Mycoplasma vaginae infection, should be observed. After the treatment of infection with minocycline, RA was active, and ESR decreased.5. female RA patients after vaginal mycoplasma infection. The blood WBC, Neu, Lymph, Mon, PLT counts were on the rise compared with those in the non infected patients. There was a tendency to increase the inflammatory response and promote the coagulation. There were Eos counts, and the tendency of Ca2+ decline in blood was the vaginal mycoplasma. There was no significant change in RA activity after infection, nor did erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) serology change significantly.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R593.22

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 劉曉飛;王志中;王勇;李景怡;張娟;曾本華;萬萍;吳力克;魏泓;方勇飛;;早期類風(fēng)濕關(guān)節(jié)炎患者腸道微生物群落的分析[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2012年23期

2 方德剛;肖清華;;支原體感染免疫研究進(jìn)展[J];醫(yī)學(xué)臨床研究;2006年08期

，

本文編號(hào)：1935328