目的 评价来氟米特(LEF)联合小剂量糖皮质激素(GCs)治疗老年类风湿关节炎(RA)的有效性和安全性.方法 活动期RA老年患者68例,随机分为LEF治疗(LEF组,34例)和LEF联合小剂量GCs治疗(联合组,34例),治疗0、4、8、12周用美国风湿病协会(ACR) 20标准评价疗效,记录不良反应.结果 与LEF组比较,联合组治疗4周,晨僵时间、关节压痛数、关节压痛指数、关节肿胀数、关节肿胀指数、疼痛VAS、医生总体评价VAS、病人总体评价VAS、DAS28、C反应蛋白(CRP)均有更大改善(P＜0.05),治疗后12周医生总体评价VAS、病人总体评价VAS、血沉( ESR)均显著好转(P＜0.05)；皮疹、肝损害较少(P＜0.05).结论 LEF联合小剂量GCs能迅速改善老年RA患者症状、体征和实验室炎性活动指标,不良反应少.%Objective To compare the efficacy of continence rates and urodynamic parameters of the sigmoid and orthotopic ileal neobladdder in the patients underwent radical cystectomy. Methods A total of 39 cases with neobladdders after radical cystectomy was followed up, of whom 22 cases underwent orthotopic ileal neobladder reconstruction (group A) and 17 cases underwent sigmoid neobladder reconstruction (group B). The continence and urodynamic parameters were compared between two groups at a median time after surgery of 12 months. Results Compared to group B, the complete daytime continence was slightly higher in group A(89.1% vs. 92. 2%),but the functional nocturnal continence in group A was significantly higher(45.2% vs. 68.3%) (P<0.05). The urodynamic data showed that the patients in group A had larger initial volume and better compliance than those in group B(P<0.05). Conclusion Compared to sigmoid neobladder reconstruction, orthotopic ileal neobladders have larger intial volume, greater compliance and better nocturnal continence.
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