MedNexus
2020年 · 第133卷第24期
出版日期 2020-12-20电子版 ￥0.00元
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Editorial
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银屑病关节炎中的自身抗体：它们与致病相关吗？Jing Zhu, Xiao-Fei Shi, Cong-Qiu Chu
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001228
摘要
临床实践中的医生通常不命令自身抗体测试来帮助随后的诊断或监测银屑病或银屑病关节炎(PsA)患者的疾病活动，尽管在这些患者中存在多种自身抗体。我们对银屑病和PsA中自身抗体的了解有限。
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肠道微生物群、胆汁酸和Th17/IL17轴在乙型肝炎病毒相关性肝纤维化中的作用Yan-Fei Chen, Jiu Chen, Lan-Juan Li
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001199
摘要
影响中国9000万人的乙型肝炎病毒（HBV）感染仍然是肝癌和肝硬化的主要原因。[
Original Article
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1%本维莫德乳膏治疗轻中度斑块型银屑病的双盲、随机、安慰剂和阳性对照III期试验Lin Cai, Gen-Hui Chen, Qian-Jin Lu, Min Zheng, Yu-Zhen Li, Jin Chen, Jie Zheng, Fu-Ren Zhang, Jian-Bin Yu, Sen Yang 等
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001221
摘要
Background:
Benvitimod cream, a novel synthetic small molecule, was effective in treating mild-to-moderate plaque psoriasis. We conducted a phase III clinical trial to assess the efficacy and safety of benvitimod cream in patients with mild-to-moderate plaque psoriasis.
Methods:
We randomly assigned 686 patients (2:1:1) to receive 1% benvitimod cream, 0.005% calcipotriol ointment or placebo twice a day for 12 weeks. The primary efficacy end points were the percentage of patients with a 75% or greater reduction from baseline in the psoriasis area and severity index (PASI 75) score and with a score of 0 or 1 in static physician’s global assessment (sPGA) at week 12.
Results:
The results showed that 50.4% of patients in the benvitimod group achieved PASI 75, which was significantly higher than that in the calcipotriol (38.5%, P < 0.05) and placebo (13.9%, P < 0.05) groups. The proportion of patients achieving an sPGA score 0 or 1 was 66.3% in the benvitimod group and 63.9% in the calcipotriol group, which were both significantly higher than that in the placebo group (34%, P < 0.05). In the long-term follow-up study, 50.8% of patients experienced recurrence. After retreatment with 1% benvitimod, 73.3% of patients achieved an sPGA score of 0 or 1 again at week 52. Adverse events included application site irritation, follicular papules, and contact dermatitis. No systemic adverse reactions were reported.
Conclusion:
During this 12-week study, benvitimod cream was demonstrated with high effectiveness and safety in patients with mild-to-moderate plaque psoriasis.
Trial Registration:
Chinese Clinical Trial Registry (ChiCTR), ChiCTR-TRC-13003259; http://www.chictr.org.cn/showprojen. aspx?proj=6300.
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靶向角蛋白17的小干扰RNA减轻咪喹莫特诱导的银屑病样皮炎的炎症Chun-Ying Xiao, Zhen-Lai Zhu, Chen Zhang, Meng Fu, Hong-Jiang Qiao, Gang Wang, Er-Le Dang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001197
摘要
Background:
Psoriasis is a common chronic inflammatory skin disease with 2% to 3% prevalence worldwide and a heavy social-psychological burden for patients and their families. As the exact pathogenesis of psoriasis is still unknown, the current treatment is far from satisfactory. Thus, there is an urgent need to find a more effective therapy for this disease. Keratin 17 (K17), a type I intermediate filament, is overexpressed in the psoriatic epidermis and plays a critical pathogenic role by stimulating T cells in psoriasis. Therefore, we hypothesized that inhibiting K17 may be a potential therapeutic approach for psoriasis. This study aimed to investigate the therapeutic effect of K17-specific small interfering RNA (siRNA) on mice with imiquimod (IMQ)-induced psoriasis-like dermatitis.
Methods:
Eight-week-old female BALB/c mice were administered a 5% IMQ cream on both ears to produce psoriatic dermatitis. On day 3, K17 siRNA was mixed with an emulsion matrix and applied topically to the left ears of the mice after IMQ application every day for 7 days. The right ears of the mice were treated in parallel with negative control (NC) siRNA. Inflammation was evaluated by gross ear thickness, histopathology, the infiltration of inflammatory cells (CD3+ T cells and neutrophils) using immunofluorescence, and the expression of cytokine production using real-time quantitative polymerase chain reaction. The obtained data were statistically evaluated by unpaired t-tests and a one-way analysis of variance.
Results:
The severity of IMQ-induced dermatitis on K17 siRNA-treated mice ears was significantly lower than that on NC siRNA-treated mice ears, as evidenced by the alleviated ear inflammation phenotype, including decreased ear thickness, infiltration of inflammatory cells (CD3+ T cells and neutrophils), and inflammatory cytokine/chemokine expression levels (interleukin 17 [IL-17], IL-22, IL-23, C-X-C motif chemokine ligand 1, and C-C motif chemokine ligand 20) (P < 0.05 vs. the Blank or NC siRNA groups). Compared to the NC siRNA treatment, the K17 siRNA treatment resulted in increased K1 and K10 expression, which are characteristic of keratinocyte differentiation (vs. NC siRNA, K17 siRNA1 group: K1, t= 4.782, P= 0.0050; K10, t= 3.365, P= 0.0120; K17 siRNA2 group: K1, t= 4.104, P= 0.0093; K10, t= 4.168, P= 0.0042; siRNA Mix group: K1, t= 3.065, P = 0.0221; K10, t = 10.83, P < 0.0001), and decreased K16 expression, which is characteristic of keratinocyte proliferation (vs. NC siRNA, K17 siRNA1 group: t= 4.156, P= 0.0043; K17 siRNA2 group: t= 2.834, P= 0.0253; siRNA Mix group: t= 2.734, P = 0.0250).
Conclusions:
Inhibition of K17 expression by its specific siRNA significantly alleviated inflammation in mice with IMQ-induced psoriasis-like dermatitis. Thus, gene therapy targeting K17 may be a potential treatment approach for psoriasis.
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长效融合抑制剂albuvirtide在接受过抗逆转录病毒治疗的成人人类免疫缺陷病毒-1患者中的疗效和安全性：随机、对照、3期、非劣效性TALENT研究的中期分析Bin Su, Cheng Yao, Qing-Xia Zhao, Wei-Ping Cai, Min Wang, Hong-Zhou Lu, Yuan-Yuan Chen, Li Liu, Hui Wang, Yun He 等
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001273
摘要
Background:
Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.
Methods:
We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.
Results:
At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.
Conclusions:
The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.
Trial registration:
ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.
Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx
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CD56早期激活增加昏暗的CD16昏暗/-免疫无应答者中的自然杀伤细胞与CD4相关+T细胞恢复Qiu-Yue Zhang, Xin Zhang, Bin Su, Li-Feng Liu, Xiao-Dong Yang, Bin Tang, Huan Xia, Ping Ma, Tong Zhang, Hao Wu
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001262
摘要
Background:
Natural killer (NK) cells play a critical role in suppressing human immunodeficiency virus-1 (HIV-1) infection, but knowledge on whether and how NK cells affect immune reconstitution in HIV-1-infected individuals who receive antiretroviral therapy (ART) is limited.
Methods:
We performed a case-control study with 35 healthy individuals and 66 HIV-1-infected patients including 32 immunological non-responders (INRs) with poor CD4+ T-cell recovery (<500 cells/μL after 4 years of ART) and 34 immunological responders (IRs) with improved CD4+ T-cell recovery (>500 cells/μL after 4 years of ART). NK cell phenotype, receptor repertoire, and early activation in INRs and IRs were investigated by flow cytometry.
Results:
A significantly higher proportion of CD56dimCD16dim/- NK cells was observed in INRs than IRs before ART and after 4 years of ART. The number of CD56dimCD16dim/- NK cells was inversely correlated with CD4+ T-cell counts in INRs before ART (r = -0.344, P = 0.050). The more CD69-expressing NK cells there were, the lower the CD4+ T-cell counts and ΔCD4, and these correlations were observed in INRs after ART (r = -0.416, P = 0.019; r = -0.509, P = 0.003, respectively). Additionally, CD69-expressing CD56dimCD16dim/- NK cells were more abundant in INRs than those in IRs (P = 0.018) after ART, both of which had an inverse association trend towards significance with CD4+ T-cell counts. The expression of the activating receptors NKG2C, NKG2D, and NKp46 on CD56dimCD16dim/- NK cell subsets were higher in IRs than that in INRs after 4 years of ART (all P < 0.01). Strong inverse correlations were observed between CD69 expression and NKG2C, NKG2A-NKG2C+, NKG2D, and NKp46 expression on CD56dimCD16dim/- NK cells in INRs after ART (NKG2C: r = -0.491, P = 0.004; NKG2A-NKG2C+: r = -0.434, P = 0.013; NKG2D: r = -0.405, P = 0.021; NKp46: r = -0.457, P = 0.008, respectively).
Conclusions:
INRs had a larger number of CD56dimCD16dim/ - NK cells characterized by higher activation levels than did IRs after ART. The increase in the CD56dimCD16dim/- NK cell subset may play an adverse role in immune reconstitution. Further functional studies of CD56dimCD16dim/- NK cells in INRs are urgently needed to inform targeted interventions to optimize immune recovery.
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未接受抗逆转录病毒治疗的人类免疫缺陷病毒感染成人骨密度变化的患病率和危险因素：一项中国队列研究Yong-Qin Zeng, Jiang Xiao, Cui-Lin Li, Yu Wang, Ling Zhang, Xiao-Li Pang, Di Wang, Juan Du, Hong-Xin Zhao
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001317
摘要
Background
Studies have reported that low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected patients; however, the factors that contribute to HIV-related BMD changes are yet to be fully understood. Due to the application of dual X-ray absorptiometry (DXA) among a select group of hospitals only, the prevalence and risk factors of low BMD in HIV-infected populations have not been intensively investigated in China. Thus, the aim of our study was to investigate the prevalence of and risk factors associated with BMD changes among antiretroviral therapy (ART)-naive HIV-positive patients in China.
Methods
The assessment of the prevalence of and risk factors associated with BMD changes was conducted among 156 ART-naive HIV-infected patients. Demographic and clinical data, as well as results of fasting blood tests were obtained from patients. Further, all patients underwent DXA scans to determine BMD, which was then used to classify patients with osteopenia/osteoporosis. The risk factors of reduced BMD were then evaluated using binary logistic regression.
Results
Among the 156 ART-naive HIV-infected participants, osteopenia and osteoporosis were diagnosed in 48.7% (76/156) and 4.5% (7/156) of patients, respectively. The lumbar spine was most likely to have reduced BMD (49.4% [77/156]), and the proportion of osteopenia in the left hip (32.7% [51/156]) was higher than in the right hip (24.4% [38/156]). In the lumbar spine, bone loss rate in the L1 section (60.9% [95/156]) was the most significant (L2, 53.2% [83/156]; L3, 45.5% [71/156]; L4, 52.6% [82/156]). Further analysis showed that, compared with the neck (26.9% [42/156] in the left, 18.6% [29/156] in the right) and the interior (15.4% [24/156] in the left, 13.5% [21/156] in the right), the trochanter had the greatest probability of reduced BMD (46.2% [72/156] in the left, 28.8% [45/156] in the right). In the risk factor analysis, low body mass index (BMI: <18.5 kg/m2) was positively associated with reduced BMD (Exp (B) = 39.743, 95 % confidence interval: 3.234-488.399, P = 0.004), and was specifically positively correlated with BMD values at three sites (r = 0.335 at right hip, r = 0.327 at left hip, r = 0.311 at lumbar spine).
Conclusion
Reduced BMD was found in the majority of ART-naive HIV-infected patients and BMI was identified as an additional risk factor for reduced BMD. Our results show that BMD reduction was simultaneously present in the left hip, right hip, and lumbar spine among nearly one fifth of patients. Our work highlights the importance of closely monitoring BMD in ART-naive patients and provides a foundation for the clinical intervention of bone demineralization in them.
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预测医院获得性肺炎患者30天死亡率的评估模型的性能和比较Jia-Ning Wen, Nan Li, Chen-Xia Guo, Ning Shen, Bei He
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001252
摘要
Background:
Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection in China with substantial morbidity and mortality. But no specific risk assessment model has been well validated in patients with HAP. The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.
Methods:
This study was a single-center, retrospective study. In total, 223 patients diagnosed with HAP from 2012 to 2017 were included in this study. Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index (PSI); consciousness, urea nitrogen, respiratory rate, blood pressure, and age ≥65 years (CURB-65); Acute Physiology and Chronic Health Evaluation II (APACHE II); Sequential Organ Failure Assessment (SOFA); and Quick Sequential Organ Failure Assessment (qSOFA) scores. The discriminatory power was tested by constructing receiver operating characteristic (ROC) curves, and the areas under the curve (AUCs) were calculated.
Results:
The all-cause 30-day mortality rate was 18.4% (41/223). The PSI, CURB-65, SOFA, APACHE II, and qSOFA scores were significantly higher in non-survivors than in survivors (all P < 0.001). The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores (ROC AUC: APACHE II vs. CURB-65, 0.863 vs. 0.744, Z = 3.055, P= 0.002; APACHE II vs. qSOFA, 0.863 vs. 0.767, Z= 3.017, P= 0.003; SOFA vs. CURB-65, 0.856 vs. 0.744, Z= 2.589, P = 0.010; SOFA vs. qSOFA, 0.856 vs. 0.767, Z = 2.170, P = 0.030). The cut-off values we defined for the SOFA, APACHE II, and qSOFA scores were 4, 14, and 1.
Conclusions:
These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments. The qSOFA score may be a simple tool that can be used to quickly identify severe infections.
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靶向miR-135a-5p/叉头盒O1轴与缺氧诱导的H9c2细胞心肌细胞损伤相关的长非编码RNA浆细胞瘤变异易位1Jin-Juan Xu, Wei-Hong Zheng, Jun Wang, Yuan-Yuan Chen
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001147
摘要
Background:
Myocardial infarction occurs due to insufficient (ischemia) blood supply to heart for long time; plasmacytoma variant translocation 1 (PVT1) is a long non-coding RNAs (lncRNAs) involved in the pathogenesis of various diseases, including heart disease; However, few studies have explored its role. The present study evaluated the effects of lncRNA PVT1 on hypoxic rat H9c2 cells.
Methods:
Hypoxic injury was examined by measuring cell viability and apoptosis by using cell counting kit-8 activity and flow cytometry assays. Gene expressions after hypoxia were estimated by quantitative real time polymerase chain reaction and the signaling pathway were explored by Western blot analysis. RNA immunoprecipitation and luciferase reporter assays were applied to examine the interactions among genes. Data were analyzed using t-test with one-way or two-way analysis of variance.
Results:
The lncRNA PVT1 is up-regulated in hypoxia-stressed H9c2 cells and knockdown of PVT1 mitigates hypoxia-induced injury in H9c2 cells. PVT1 acts as a sponge for miR-135a-5p and knockdown of PVT1 attenuated the increased hypoxia-induced injury by up-regulating miR-135a-5p. Forkhead box O1 (FOXO1) was identified as a target of miR-135a-5p, and the expression was negatively regulated by miR-135a-5p. The exploration of the underlying mechanism demonstrated that knockdown of FOXO1 reversed PVT1/miR-135a-5p mediated hypoxia-induced injury in H9c2 cells.
Conclusions:
PVT1 plays a crucial role in hypoxia-injured H9c2 cells through sponging miR-135a-5p and then positively regulating FOXO1.
Consensus Statement
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2019冠状病毒病重症和危重症患者诊疗中国专家共识Tong-Wen Sun, Xi-Jing Zhang, Zhui Yu, You Shang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001264
摘要
冠状病毒疾病2019（新冠肺炎）威胁着全球人类的健康，在撰写本文时，还没有专门针对新冠肺炎的有效药物。新冠肺炎患者的主要初始症状是发热、干咳和疲劳，尽管一些患者主要出现呕吐、腹泻和其他胃肠道症状。其他严重症状，即胸闷、呼吸困难和呼吸窘迫，通常在一周后出现，部分患者迅速发展为急性呼吸窘迫综合征（ARDS）、感染性休克，甚至可能死亡。最近一项对新冠肺炎危重患者的回顾性研究报告称，67.3%的患者出现ARDS，28.9%出现急性肾损伤，23.1%出现心脏损伤，28.9%出现肝功能异常。此外，28天死亡率高达61.5%。[
Review Article
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抗菌肽：银屑病发病机制中先天免疫和适应性免疫的桥梁Jing-Yi Ma, Shuai Shao, Gang Wang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001240
摘要
Antimicrobial peptides (AMPs) are small molecules produced by a myriad of cells and play important roles not only in protecting against infections and sustaining skin barrier homeostasis but also in contributing to immune dysregulation under pathological conditions. Recently, increasing evidence has indicated that AMPs, including cathelicidin (LL-37), human β-defensins, S100 proteins, lipocalin 2, and RNase 7, are highly expressed in psoriatic skin lesions. These peptides broadly regulate immunity by interacting with various immune cells and linking innate and adaptive immune responses during the progression of psoriasis. In this review, we summarize the recent findings regarding AMPs in the pathogenesis of psoriasis with a main focus on their immunomodulatory abilities.
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银屑病代谢及代谢组学研究进展与展望Ni Lian, Li-Qing Shi, Zhi-Min Hao, Min Chen
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001242
摘要
Psoriasis is considered a systemic disease associated with metabolic abnormalities, and it is important to understand the mechanisms by which metabolism affects pathophysiological processes both holistically and systematically. Metabolites are closely related to disease phenotypes, especially in systemic diseases under multifactorial modulation. The emergence of metabolomics has provided information regarding metabolite changes in lesions and circulation and deepened our understanding of the association between metabolic reprogramming and psoriasis. Metabolomics has great potential for the development of effective biomarkers for clinical diagnosis, therapeutic monitoring, prediction of the efficacy of psoriasis management, and further discovery of new metabolism-based therapeutic targets.
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中医药治疗肺癌的临床应用及机制探讨Xiao-Lin Su, Jiang-Wei Wang, Hui Che, Chang-Fu Wang, Hai Jiang, Xia Lei, Wan Zhao, Hai-Xue Kuang, Qiu-Hong Wang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001141
摘要
Lung cancer is a malignant tumor characterized by a rapid proliferation rate, less survivability, high mortality, and metastatic potential. This review focuses on updated research about the clinical application of traditional Chinese medicine (TCM) as an adjuvant therapy to lung cancer treatment and the mechanisms of TCM effect on lung cancer in vitro and in vivo. We summarized the recent 5 years of different research progress on clinical applications and antitumor mechanisms of TCM in the treatment of lung cancer. As a potent adjuvant therapy, TCM could enhance conventional treatments (chemotherapy, radiation therapy, and epidermal growth factor receptors [EGFRs] tyrosine kinase inhibitors [TKIs]) effects as well as provide synergistic effects, enhance chemotherapy drugs chemosensitivity, reverse drug resistance, reduce adverse reactions and toxicity, relieve patients’ pain and improve quality of life (QOL). After treating with TCM, lung cancer cells will induce apoptosis and/or autophagy, suppress metastasis, impact immune reaction, and therapeutic effect of EGFR-TKIs. Therefore, TCM is a promisingly potent adjuvant therapy in the treatment of lung cancer and its multiple mechanisms are worthy of an in-depth study.
Medical Progress
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用于治疗斑块型银屑病的不同生物制剂停药后的复发时间Xiao-Yu Wang, Chun-Lei Zhang, Wen-Hui Wang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001232
摘要
银屑病是一种常见的慢性复发性炎症性疾病。斑块型银屑病占银屑病患者的90%以上。目前，没有治愈的疗法。与常规治疗相比，生物制剂大大提高了临床疗效，并且在对主要器官的毒性方面可能提供更好的长期安全性；然而，停止治疗后的复发仍然是一个重要问题。尽管大多数指南推荐维持治疗，但在现实世界的临床实践中，停药的情况相当频繁。因此，在选择不同疗法时，复发时间是一个重要的考虑因素。
Viewpoint
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银屑病关节炎相关心血管损害的研究进展Ming Liu, Man Han, Xiao-Mei Leng
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001215
摘要
致编辑：银屑病关节炎（Psoriatic arthritis，PsA）是一种与银屑病相关的慢性炎症性肌肉骨骼疾病，主要表现为外周关节炎、附着点炎、手指或脚趾炎症、脊柱关节炎。[
Clinical Observation
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点滴型银屑病与斑块型银屑病血清炎性细胞因子和抗菌肽的比较Xiao-Yang Liu, Yan Zhao, Heng Zhang, Lin Cai, Jian-Zhong Zhang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001227
摘要
银屑病是一种慢性炎症性皮肤病，免疫紊乱在银屑病的发病机制中起着至关重要的作用。抗菌肽（AMPs），包括凯萨林菌素（LL-37）和人β-防御素（HBD）-3，不仅是先天免疫的基础，也是激活适应性免疫的桥梁。在免疫应答中，包括肿瘤坏死因子-α、白细胞介素(IL)-6、IL-10、IL-17、IL-22和IL-23在内的几种炎性细胞因子参与银屑病的发生和发展。[
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MicroRNA-98可作为先天性心脏病相关肺动脉高压的诊断标志物Yao-Zhong Zhang, Gang Li, Dao-Le Yan, Ying-Long Liu
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001193
摘要
先天性心脏病（CHD）已经成为先天性异常婴儿死亡的主要原因。肺动脉高压（PAH）是冠心病的并发症之一。[
Correspondence
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皮肤镜和反射共聚焦显微镜诊断银屑病的准确性Zi-Yi Wang, Chang-Bing Shen, Wen-Min Fei, Xue Shen, Cheng-Xu Li, Yan Jing, Yong Cui
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001198
摘要
致编辑：银屑病是一种慢性炎症性疾病，通常根据典型的临床特征进行诊断。然而，有时会存在模棱两可的病例，有时会被误认为是其他红斑鳞状疾病。尽管组织病理学诊断仍然是此类病例的金标准，但它经常被绕过以避免损伤病变区域并减少患者的不适。因为活检不能提供实时监测，所以在过去几年中，具有成本效益的非侵入性技术，例如皮肤镜检查和反射共聚焦显微镜(RCM)，已经越来越多地用于临床实践。
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司库奇尤单抗成功治疗阿达木单抗耐药掌跖脓疱病1例Qing-Yang Li, Gang Wang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001246
摘要
致编辑：掌跖脓疱病（PPP）是一种慢性顽固性疾病。各种生物制剂已用于成功治疗斑块型银屑病，但其用于治疗PPP的用途有限。尽管具有有希望的作用，但生物制剂如肿瘤坏死因子-α(TNF-α)抑制剂可能加重或诱导PPP。在此，我们报告了一例对TNF-α抑制剂阿达木单抗难治但成功接受白细胞介素-17A（IL-17A）抑制剂司库奇尤单抗治疗的PPP患者。
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司库奇尤单抗成功治疗泛发性脓疱型银屑病2例Zhi-Lin Sun, Zi-Lian Liu, Yuan-Yuan Xu, Xiu-Lian Zhang, Chun-Lei Zhang, Xin Guan
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001244
摘要
致编辑：全身性脓疱型银屑病（GPP）是一种罕见且严重的银屑病，传统治疗方法可能无效。传统的方法是用阿维A、甲氨蝶呤和环孢素进行全身治疗；但在给药过程中常出现明显的副作用，限制了其临床应用。司库奇尤单抗是一种全人抗白细胞介素（IL）-17A单克隆抗体，显示出治疗中度至重度斑块型银屑病的疗效。尽管如此，关于司库奇尤单抗治疗GPP的循证真实世界数据有限。北京大学第三医院近期成功应用司库奇尤单抗治疗2例GPP。本研究经我院伦理委员会批准（编号：328-01）。
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司库奇尤单抗在中国斑块型银屑病患者临床实践中的有效性和安全性：一项初步研究Si-Man Zhu, Wen-Hui Wang, Jin-Zhu Guo, Xin Guan, Yue-Hua Men, Hua Zhang, Yi-Ming Zhao, Chun-Lei Zhang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001258
摘要
致编辑：银屑病是一种慢性、复发性、全身性、免疫介导的炎症性疾病，主要影响皮肤、指甲和关节。斑块型银屑病是银屑病中最常见的类型，占所有病例的80%~90%以上。司库奇尤单抗是一种拮抗白细胞介素17A（IL-17A）的人IgG单克隆抗体，2015年获美国食品药品监督管理局批准用于治疗中重度斑块型银屑病。一项中国多中心、双盲、安慰剂对照的III期随机临床试验（RCT）证明了优异的疗效和安全性。[
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司库奇尤单抗在中国银屑病患者中的真实临床经验：一项24例患者的36周单中心研究Jing Zhang, Chao Ji, Bo Cheng, Shi-Fan Ruan, Tao Liu, Jin-Wen Huang
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000001259
摘要
致编辑：银屑病是一种慢性自身免疫性炎症性疾病，对生活质量有显著的负面影响。白细胞介素（IL）-17A是T辅助17途径中的关键分子，在银屑病的发病机制中很重要。司库奇尤单抗是一种靶向IL-17A的全人源免疫球蛋白G1 κ单克隆抗体，是2015年美国食品药品监督管理局批准的首个抗IL-17A抗体。在中国，它于2019年3月被批准用于治疗中度至重度寻常型银屑病（PsV），而在日本，它不仅用于PsV，还用于银屑病关节炎和泛发性脓疱型银屑病（GPP）。已在四项随机对照试验（RCT）（ERASURE、FEATURE、JUNCTURE和FIXTURE）中评估了司库奇尤单抗的安全性和有效性，这些试验显示司库奇尤单抗与安慰剂、依那西普和乌司奴单抗相比具有优越性，清除率具有长期持久性。然而，临床实践的真实世界设置不同于RCT的严格监管设置，RCT仅在符合严格纳入和排除标准的选定患者中进行，以最大限度地提高内部有效性。迄今为止，中国还没有发表过真实世界研究的官方英文报告。
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一个案例再一次动力蛋白2（DNM2）相关的中央核肌病伴电性但无临床肌强直Xiao Huang, Xiang-Yi Liu, Lu Chen, A-Ping Sun, Ying-Shuang Zhang, Dan-Feng Zheng, Yan-Feng Zhong, Dong-Sheng Fan
中华医学杂志英文版2020年 133卷 24期
DOI: 10.1097/CM9.0000000000000974
摘要
致编辑：一名39岁男性表现为进行性肢体萎缩和无力。患者出生时有全身性肌张力减退；他在小学跑得不好。神经系统检查显示面部肌肉萎缩和左眼内收受限。在上肢，患者表现为近端肌肉萎缩和无力[
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