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中药熏蒸法对强直性脊柱炎患者关节功能改善的影响
强直性脊柱炎(ankylosing spondylitis,AS)为一种慢性进行性疾病,主要侵犯骶髂关节脊柱、脊柱旁软组织及外周关节,并可伴发关节外表现,严重者可发生脊柱畸形和关节强直[1].骶髂关节影像学的改变可作为确诊的依据之一[2],骶髂关节正、斜位X 线为临床常用的检查方法[3].目前控制AS 的药物主要有柳氮磺吡啶(sulfasalazine,SSZ)、甲氨蝶呤(methotrexale,MTX) 及非甾体抗炎药等,但副作用较大.笔者自2000 年以来应用中药熏蒸治疗AS,取得满意疗效,现报告如下.
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The current established drugs used to treat inflammatory bowel disease include glucocorticoids includingnewer agent budesonide, sulfasalazine and 5-ASA compounds such as Asacol, Pentasa, Dipentum andBalsalazide and immunomodulatory agents such as azathioprine, and 6-mercaptopurine. Additional drugswhich have been found to be useful, particularly in refractory cases of Crohn's disease including fistulizingtype of Crohn's disease, include cyclosporine A, methotrexate, humanized antibody against TNFa(cA2),FK506, IL-10, IL-11 and Probiotics. Various agents, whether used alone or in combination, have to betailored for each patient and none is ideal. Exciting new developments directed against proinflammatorypathways, cytokines, free oxygen radicals and cell surface related immune targets are areas of intense recentinvestigations and many novel therapeutic agents are expected to be available in the near future for medicaltreatment of inflammatory bowel disease.
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The 1990's have brought a significant promise and the hope for a better and brighter future in the new millennium for patients with inflammatory bowel disease (I3D). A better understanding of the pathophysiology of IBD symptoms has led to newer treatnent modalities and streamlining of therapy for specific subsets of patients. ULCERATIVE COUTISThe treatnent for ulcerative colitis (UC) is aimed at modulating the inflammatory response. The drugs which are found to be effective are sulfasalazine (Azulfidine, Salazopyrin) and its 5ASA derivatives, glucocorticosteroids, immunomodulators/immunosuppressants, and other new potential drugs (Table 1).
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柳氮磺吡啶药物遗传学的研究进展
柳氮磺胺吡啶(Sulfasalazine,SSZ,或Salicvlazosulfapyri-dine,SASP)是磺胺毗啶(SP)与5-氨基水杨酸(5-ASA)的偶氮络合物,早于40年代被试用于类风湿性关节炎的治疗.可以消除自由基,抑制前列腺素、白三烯等炎性介质的合成,抑制激活的白细胞产生炎症递质[1].为治疗轻到中度溃疡性结肠炎的首选药,也是维持缓解为有效的一类药物.药物在体内要经过吸收、分布、代谢和排泄,才能完成药物发挥药效的过程.在此过程中,许多环节都与酶和受体的作用密切相关.倘若决定这些酶或受体蛋白的基因出现变异或缺陷,必将导致药物代谢发生异常反应.因此,为提高药物的有效性及安全性有必要深入了解遗传变异对药物反应的影响及其分子基础,并据此预测对药物异常反应的个体,从而进行有效的防治.