类风湿性节炎肾损害 刘莎.doc

类风湿性关节炎肾损害 RA肾损害既可由血清白蛋白降低，球蛋白增高。免疫蛋白电泳显示IgG、IgA及IgM增多。抗核抗体在RA的阳性率约10%～20%。血清补体水平多数正常或轻度升高，重症者及伴关节外病变者可下降。早期RA患者的关节X线检查。关节部位骨质疏松可以在起病几周内即很明显。关节间隙减少和骨质的侵蚀，提示关节软骨的消失，只出现在病程持续数月以上者。半脱位，脱位和骨性强直更后期的现象。当软骨已损毁，可见两骨间的关节面融合，丧失原来关节的迹象。弥漫性骨质疏松在慢性病变中常见，并因激素治疗而加重。无菌性坏死的发生率特别在股骨头，亦可因用皮质类固醇治疗而增多。可确定晨僵至少1小时，持续至少6周。3个或3个以上的关节炎肿胀持续至少6周。腕关节、掌指关节或近侧指间关节肿胀6周或以上。对称性关节肿胀。类风湿结节。RF阳性。手的X线多发生在侵蚀性关节炎及有显著结节形成的病人中本病应排除其它结缔组织病所致的肾损害，如系统性红斑狼疮、混合性结缔组织病和风湿性关节炎等还应除外原发性小血管炎、痛风等所致的肾损害。?1. 治疗原发病。RA治疗的一线用药为NSAIDs类，在疾病发作期使用能达到非特异性抗炎、消肿和止痛的作用。二线用药如甲氨蝶呤、雷公藤多苷和爱若华等，亦为改变病情药，起作用时间缓慢，可延缓和改善疾病的发展和预后。三线用药为激素，在疾病的发作期，尤其是关节肿胀疼痛明显时，短期小量使用，可取得较好疗效。此外，还应补充钙剂、骨代谢调节剂等抗骨质疏松治疗。关节肿胀明显时，可进行关节腔穿刺等。 2. 确定引起肾损害的病因。如属所致，立即停用这类药物。RA所致的肾小球肾炎可用皮质激素或环磷酰胺、硫唑嘌呤、甲氨蝶呤、环孢素或雷公藤总苷治疗这些药物对RA的关节肿痛亦有效。近年可溶性基因重组肿瘤坏死因子α-受体拮抗剂只能清除血循环中的致病活性物质，清除后数日又可恢复原水平，故同时加用免疫抑制剂。苯丁酸氮芥或二甲亚砜治疗。后者可使淀粉样纤维溶解，减轻蛋白尿，改善肾功能。 the same direction of rotation 90 ° or 180 ° for; after each disc rotor when measuring position alignment of the two half coupling constant, should also be in terms of accuracy and consistency. Surface deviation measurement, must in every 180 degrees corresponding to the two radii are equal to each other in order to eliminate errors caused by movement of the rotor. Only a support bearing of the rotor, WA couplings, such as the use of temporary leave the Center, should pay attention to keep the rotor in the measuring process in the center of the bearing oil retaining the nest does not change. Steam oil block, there should be sufficient clearance between the rotor and, in rotors make sure rotor is not on the block or seal oil. At the time of measurement, connections are not allowed between two rotors, each in a free State. Not allowed in case of assembled sleeve, Center work on the toothed coupling. Coupling tool should have adequate stiffness, installation must be secure and reliable. Coupling Center using a dial indicator, the table should be put in prison and avoid touching, to ensure correct measurement. Coupling disc after a week to retu