(CIP) / - :, 2004 7 ( ) ISBN 7801943155 R593 21 CIP ( 2004) 042664 : : : : : : : : : : 22 3 :100842 : (010) 66882586() 51927290( ) : (010) 68222916() 66882583( ) : www.pmmp.com.cn : : :787mm1092mm 1/ 36 :4 875 :96 :2004 7 1 :2004 7 1 : 00014000 :12 00,, : ( 010)6688258551927252
, ( ), 29,,
,,,,,,,,,,,,,, 2004 3
1 ( rheumatic diseases, ) (diffuse connective tissue disease,,ctd), : ( ), ; ;, ; ;, ;,,,,,,, PTH, 1
,( ),,,,,,,,, 2,,,,,,,, 2
2 ( rheumatoid arthritis, RA),,,,, 1 (1): ( 1h), (2):, (3): ( ) (4): 3
,,,, (5):,,,, 2 (1): RA,,,, (2): RA,,,, (3):, (4):, (5):, (6): (7):,, (8):,, 4
2 (9) 1 (1):,, (2):RA (3)C:C (4)(RF):,RA RF, RF,5% RF (5): RA, (6):RA,,, (7): RA 2 (1) X : RA, X : :, : 5
: : (2)B: 1987 : 1 1h()(6 ); 2 3 3 ( 6 ); 3 ( 6 ); 4 (6 ); 5 ; 6 X ( ) ; 7 ( >120) 7 4 1 2 3 4 5 1 2 (1)( NSAID) :1 22 4g/ d, 3 4 6
2 :0 51 0g/ d, 2 :75100mg/ d, 3 ( ):02g/ d, 2 ( ): 0 4g, 1 2 ( ): 15mg, 1 2 : 2, NSAID, 2 NSAID,, (2) (MTX) :,, 7 520mg, (1),46,, :2g/ d, 2, : 60mg/ d, 3 :,,, :,6mg/ d, 2 3,,, 50mg, 1 7
: 100mg/ d, 2 50mg, : : 0 751 0g,1/ d, 200mg, 1, 100mg,1/ d,, : 3 5mg/ kg,1/ d ( ):,1 8g/ d, 3 ( ):, 20mg/ d,1 (3):, RA,3040mg/ d, 1,, 10mg/ d, 3,, RA, 8
3 ( seronegative spondyloar thropathies) ( spondyloarthropathies, SPA) : ; ; ; ; ; ; HLAB27 ;, (Reiter),,,, (ankylosing spondylitis, AS),,, B27 (HLAB27 ) X, 9
1 (1): AS, 1040, 20 30, (2):,,, 50%,,,,, (3):AS,,, Ig A,, (4)(JSPA):16,JSPA AS X, (JRA),, 2, 10
3, AS : 4; Schber ;, 5cm 1 AS 90 % HLAB 27 C, 2 X,,,,, CTMRI AS 1984 1 (1) 3,, ; (2); (3) 2, X : 0 : : : (,,) : (, 11
,, ) :, 3 AS, 1 ( ) AS, 3,,,,, 1,,,,,, 2 (1)(NSAID),, ( ) ( ) () (2),,,,,, ( ) (3),,, 3, 12
3 (Reiter), 75 % HLAB 27,,,,, 1 46 %, 2 20 %, 3 2,,,, 13, 4 5 1%2%, 13
, 6 1 (1),C, (2)HLAB27 (75%) 2 (1), (2),,, X,, 1 1 1 2 3 ( ), 1,, 1 2, 3,, 14
3 4,,, 15 %, (psoriatic arthritis),,, HLAB27, 1 (1): 2 3, ( ),, ( ) ; (2): ; (3): 5%, ; (4): 5%,, 2 15
,,,,, 3, 80 %,, 4,, 1 (1) (2) 2 X (1), ( ) ; (2); (3),,; (4); (5) 1 ; 2 ; 3, 1 16
3 2 3 4 ( undifferentiated spondyloar thropathy,uspa), : AS, AS; AS, AS;, ;, (ESSG), USPA ESSG :, 1 :;; ; ; ; 17
4 ( systemic lupus erythematosus, SLE),, (79)1, 75/ 10,,, ;,, 1 SLE,,, 2 SL E,, 18
4 SLE 3,,,,,,, 4 SLE,, SLE, SL E, SLE 5,, SLE, 6 SLE SLE,,, SLE,,,,, IgG IgM,, 7 SLE,,, 8, 19
,,, 9,,,,, 10 11 SLE, SSA ( ) SSB 1,,, 2 (1): SLE, 95 %, 65 %,, 180, (2) DNA( dsdna ) : 95 %, 70%, (3) S m : 99 %, 25 %, SLE, (4): nrnp rrnp SSA 20
4 SSB, 50%,, SLE 3 CH 50 ( ) C 3 C 4 SLE, C3a C5a 4 IgG, IgG 5 6 X SLE,,CT 1982 SLE, 1 2, 3 4 5, 2 6 7 >0 5g/ d 8 21
9 10 dsdna S m 11 11, 4 4 SLE1997 10, 1 SLE, RF,,, 2 SLE, 3, 4,,, 5,, SL E, 1 SLE,, 22
4,, 0 25g, 1 2, 0 204g, 1 2, 1%,, 25mg,3/ d,( )0 2 0 4g, 1/ d,, ( <30mg/ d)( <15mg/ d) 2 SLE,, SL E (1): SL E,, 1000mg 500ml,, 1/ d, 3d, SLE MTX 510mg 510mg (2): SL E, 1mg/ (kgd),, 46,,, 1 2 10 %, 0 5mg/ kg,, ( <15mg/ d), (3): SL E, (CTX), 1016mg/ kg, 0 9% 200ml,, 4 1, 6, 23
3 1, 1 2, 2 1 CTX 2mg/ (kgd), 2,, <310 9 /L, (4): SL E CTX, (CsA)35mg/ ( kg d) ()0 7520g/ d, 2 3,, ( )2040mg/ d,1, (5): SL E,,, 0 4g/ (kgd),57d 1 (6): 200mg, 3/ d,,1 1,,, (7):, SLE (8)( ):,600mg,3/ d,, SLE, (9): SLE (10):, SL E 24
4 3 SLE,, 15mg/ d,,,,,, 50mg/ d 4,, 7 5mg, SL E,5 10 95 % 85 %,, :,, ( ),,,,, 1 2,,,, 3 4, 25
5, 1,, 2 ANA, S m dsdna,,,,,,, S m dsd NA,,,, (510mg/ d ), (2060mg/ d) 26
5 ( vasculitides),,,,, ( Takayasu arteritis),, 1525,,, 4 1 ( ) (1):, 27
(2):, :,, 2, :, ;, ; ;, 2 675 33kPa(2040mmHg), 2 67kPa(20mmHg), 3 2,, 4,, 1,,,C C 2 X,, 28
5 3,, 1990 : 1 40, <40 2,, 3, 4 >133kPa(10mmHg), >1 332 67kPa(1020mmH g) 5, 6,, 6 3 1 ( ) 3060mg/ d,1, 100300mg/ d, 2 (MTX) (CTX)(CsA),,, 29
3,,,, 4, 5 93 % 15 95 % ( polyarteritis nodosa, PAN),, PAN, 1,, 2 (1):, (2):, 30
5 (3):, (4):,, (5):, (6):, 1,, CR P,RF,,, C3 2, 3, 1990 1 4kg 2 3 4 31
5 6 12 0kPa(90mmHg) 7 8 HBV 9 10 10 3, PAN 1 PAN, 1 2mg/ (kgd), 2mg/ ( kgd), 2,,,5 90%, ( microscopic polyangiitis, MPA),,,,, 32
5,, 1 65% 72% 2 44 % 58 %, 3 32 % 58 %,29% 4 14 % 36 % 5 6 100%,,, 7 12 % 29 %,,, 1 2 3 ( ANCA) ANCA 75 %, 60 % (P 33
ANCA), 15% (CAN CA)PANCA, MPA 1 2 3, 4 5 6 PANCA, 60mg/ d, 5 60 %, 2/ 3 (ChurgStrauss ) 34
5, 1 2 (1): (2): (3): (4): (5), (6):, 1,, 10 % 2,C 3 IgE 4, 67 % PAN CA 5 2,, 35
6,, 7, 1990 : 1 2, 10 % 3 4 5 6 6 4 4,, 85%, 99 2%,5 50 %,,,, ( hypersensitivity angiitis) ( leucocytoclastic vasculitis) 36
5 ( allergic vasculitis),,, 1,, ; 2, ; 3, ; 4 1 (1), ; (2) C 4 2, 1990 : 1 >16 ; 2 ; 3, ; 4 ( ); 5 37
5 3 1, ; 2 ; 3, 3060mg/ d ; 4 0 5mg, 2 3 ; 5,75150mg/ d; 6,,, ( Wegner granulomatosis) ( ),,, 1, 2 70 % 38
5 (1): 85%, 64 %80 %, (2):25%44 %, (3):,, ( ),, (4):,,, 3 45 % 87%,, 4 70 % 80 %, 5 28 % 58 %,8%,, :, 39
6 7, 8 22 % 55%,, ( ) 9 30 %, 6% 12 % 1 ( ANCA) 90 % CANCA( ANCA, PR 3), (90%97 % ), AN CA 2 90%,,, 3% 3 X, 1990 40
5 1 2 X 3 ( >5/) 4 2 2,, 88 2%, 92% 1,,,1g/ d, 3d,, 1mg/ ( kgd),68 2 2, (1):2mg/ (kg d),, 3 5mg/ ( kgd), 34d,,, 1, 23 25mg/ d,, (2):, 41
3, : 7 525mg, 1 4,,, 5,,91%,75%,, 5,82% 1, ( temporal arteritis) (gi antcellarteritis,gca),,, 50 %,,,,, 31 1, 42
5, 2,, 3,, 4,,, 5, 6,,, 1,,C; 2 ; 3 IgGIL6 1990 : 1 50 ; 2 ; 3,(); 4 5mm/ h; 5,,, 5 3, GCA,, 2030mg/ d,1 4 43
7 510mg/ d, 1 2,, (Behcet syndrome),,,,, 1 (1):,, 1 (2): (3): (4): 20,2448h, (5): (6):,, 2 (1):, 44
5 (2):,, (3):,,, (4):, (5): 1 (1); (2),C; (3) 2 2, ;,, 3 1989 ( ): 1,1 3 ; 2 ; 3, 45
; 4, ( ); 5 5, 1, 4 2 1, 10mg/ d,, 10mg, 1 2,,, 1mg/ (kg d),,,, 46
6 (scleroderma),, 3050, 34, 1 (1):,,,,,,,,,,,,, (2):,,, 47
,, (3):,,,,,, 2 (systemic scleroderma,ssc) (1): 70 % 90%, 12,,,,, (2): 3 :, :,,,,,,:,,,,,,,,, (3):,, (4):,,,, 48
6 (5):,,,,,,,,,, (6):,,,,,, SSc (7):,,, SSc (8): SSc,,,, SSc,,, 23, (9): 25 %, 14 % (10): 20 % 30%, 49
(11):,, (12)CREST : SSc, ( ), ( ACA),,, (13):,( ) 1 (ANA) 50% 90 %, 2 Scl70 20 %40%, SSc 3 ( ACA) CREST 50 %90% SSc 10% 4 nrnp 20 % 5 (RF) 30% 6 C3 C4 50 %, C 3 C 4 7,,,,,,,, X, 50
6 1980 ARA, 1 2 SSc 1,, 2 : : X,,, SSc 1, SSc,, 2 (MCTD) MCTD 2 2, RNP, SSc 3,, ANA, SSc, 51
1 SSc, 30 40mg/ d,, 1015mg/ d, SSc SSc, (), 2,, 40, ( ), ( ),, 3,,, D, 0 125g/ d, 2 4 0 125 0 75g/ d, 13, 0 51 5g/ d,, 4 SSc,, ;, ; SSc SSc, 52
7 ( idiopathic inflammatory myosi tis,iim), 2,, 1 ( polymyositis, PM),,,,,,,,, 2 ( dermatomyositis, DM) 53
,,,, V,,,,,, 3 16, : (1),, ; (2), ; (3) 4 PM DM PM DM 10 %,, 5,,,, 6 PM DM SLESScPSSRA, 1, 54
7 2 (CPK), CPK 3 4,,,,,,, 1/ 3 5, PM DM Jo1 Mi2 PM DM, 30% 21 % 1 ; 2 ; 3 ; 4 4 (PM), (DM) 1,,,,, 2, 3, 55
4, 5, 6, 1 1 5mg/ ( kg d),,,,, 4 3, 7 5 10mg/ d 12,,, 56
8 (Sjgren syndrome,ss),,,, 2,, 1,,, 50 %,,, 2, 3, 57
4,, 5,50%,,, 6 30%50 %,,,,,,, 7, 8,, 9 ( ), 1 (ANA) 50 % 80 %, SSA SSB 70% 40%, SSA SSB 2 90 %,, 58
8 3 ( CIC) 80 % CIC,, 4 (RF) 70%90 % RF (1992 ) 1 3, ; 2 3 ; 3, 3 (Schivmer), 5mm/ 5min 4 5 SSA ( ) SSB 6 1 4mm 2,50 6 4 4 5 ( ) 6,HIV,, 1, 2,, 2 59
,, 3,, 1060mg/ d,,, 4 5,,, 60
9 ( panniculitis) 2, ( nodular panniculitis ) WeberChristian,,, () ( ),, 6 64, 20 40 61
1,,,, 1 2cm, 10cm,,,,,,,, 2, 1 2,,, 40, 2 2, 3, ( ),,, 4, 5,,,,, 6,, 62
9 7 8 1,,,,,, 2,, IgGIgM, 3, 3 : :,,,, :,, :,,,,,,,,, 63
: 1 ; 2,,,, ; 3,; 4 ; 5 ; 6 ; 7 : 1,,, 2,,, 3,,, 1, 2 1 53g/ d, 3 ( )( ) 64
9 3 40 60mg/ d,,, 4,,,, 35,,,, 0 55cm,,,,, 2040 40 1,, 2 3, 65
1 2, 3, 1,, 2,,, 3 CT,,, 66
9,,,,,,, 0 52cm,,,,,,, 20cm,,,,, 1, O, 2, 67
,,,,,,,,, 1,, 2 24g, 24,, :0 5g,4/ d( )0 1g, 1 2, 13, 8, 68
10 ( fibromyalgia syndrome, FS),, 2545, 1, ( ), 2 90 %,50 %90%, 76 % 91%, 3, 69
,, 1/ 3,,C 3 1990 : 1 3, () 2 ( 4kg)18 11, 18 (9 ) : ; ; 5 7 ;; 2cm ; 2, ;,; ; 2 1,,,,,,, 2 (PMR) PMR, 60, 70
10,,,C 3,,,,,,,,,, 1,,,,, 2 1025mg 1040mg,,,,, 3 4, 71
11 ( overlap syndrome), 2 2, (MCTD) MCTD 2, ANA U 1 RNP, dsdna,,, 1 (SLE)( SSc) SL E,, ENA, ANA,, dsdna 2 ( SSc) (PM/ DM),,, 3 (SLE)(RA) SLE, 72
11 (RF) 4 (SLE) (PAN) SL E,,,,, 73
12 ( polymalgia rheumatica, PMR ),,, 1,,,, 2, 3,,,,,, 1, PMR, 74
12 C,, 2 30 %, 3, 4,, PMR 1986 Nancy PMR : 1 50 ; 2 4 ; 3 ESR > 50mm/ h ; 4 (1015mg/ d) 4d ; 5 ( RAPM ) 1 (PM), 2 (RA) RA,,,X 3, 1, PMR 1 4, 75
1 10 20mg/ d, 24,, 57 5mg/ d 2 ( )0 2g, 1 2, 76
13 (cryoglobu linemia) 4, 37 ( ) ( ) (,)( ) : 1,,,,,,, 2 15% 3,, 77
,, 4, 5,,,, 6,, 7, 2080mg/ L 1,,, 2, 3, 4 5 6 78
14 ( antiphospholipid syndrome, APS) (APLA),,,, 1 :;: ; :, 2 3, 4 Coomb 79
1 (ACLA)(LA) 2 1 ; 2, ; 3 MRI, (APS): 1 (1):,, (2):,,,,, 2 (1) (2) ( IgGIgM Ig A), 1 ( ) 1 ( ) 1992 AlarconSegovia : 1 (1) 2 2 :,,,,,, (2) APL 2 1 APL ; 2 2 80
14 APL (IgG IgM ) 1,, APLA 2,, 3 (Buerger ),, ; 4 (ITP),,, 1 2 3, ; ( ) 4 81
15 ( Raynaud syndrome), 110 20 40 ( ),,,,,,,,, 310min,,,,,,, 1/ 3, 1h,, 82
15,,,,,,, 10% 20 %( ) 1 : ( ) 4 1min, : 1 5min,, 2 20s, 510min, 20min 3 533kPa(40mmHg), 4, ;, ;,, 5 ( ),, 6,, : 83
( ) ;,2%5% : 1,,, 2, 3, 1,, 2,, :, 25mg/,46/ d,, 50 100mg/ :, 0 51mg,3/ d,, :,1020mg,34/ d:25mg,3/ d,,12, 50mg/ :PGE1 PGI 2,610g/ ( k g min) 3d :25g,3/ d,, 3 : 3 84
15,, 85
16,,,,,,,, 1, 86
16 2,, 40,, 3, 4,,, 5,,,,, 6,, 1, 2,,,, 3 X,,,, 1, 87
2 3 4, 3 1,,, 2,, 3,,,, 4,, 5,,,,,,,,, 88
16 1,, 2,, 3 (1) (2) 3,, 23 (3), 4 (1):,, (2):,,1/ d,, (3):,, (4): 712d,,, 89
(5):,,,, 95 %,, 50 %, 1, ;,, 2,, 3,,,,, 4,,; 90
16,, 5,,,,,, 6, 7 8 : ;, (); 1,, 2 ;, 3 91
70 %, 4 DNA,, PCR DNA, 5,,,, 6,,, 70 % 80%, 70 % 90 % 7 X,, 2 X,,, 8, 9 CT X,, 10 MRI, MRI 11 92
16 12 :,,OT,,,,,, OT, X, 6 OT, 1 10 20 4050,,,,70% 2 16 30,,, X, 1 2,,X,,, 3, 93
, 4,,,,,, X, 5,,,,,,,,,, X, 6, Charcot,,,, X,,,,, 7 Poncet,,, : ; X ; ;; ; 94
16 1 (1):,, (2): ( ), +, + 3 : 300mg/ d, 3, 1 2 : 450mg, 1,, 3 :, 750mg, 1/ d, :, 1g/ d, 2,, 24 2g, 2 6090g 95
: 8g/ d, 4 12g/ d,; 1g/ d, 2, 2? :,, ;,,;X,,,;3 ; 1, 4, 2 (1): 2, 1, 3,,, (2):, 100200mg, 0 250 5g, 1 2,3 1 (3):,, 96
16,, ( viral arthritis), 310d EB, (HIV) 1 ; 2 97
17 1 1 4,,, 2, ( ), 3,, 4,, 5 98
17 1 ; 2 ; 3 X, 1 ; 2 ; 3 ; 4, 1, 2, 3 99
18 ( ) ( hyperuricemia) ( recurrent acute monoarthritis) (tophi) ( gouty nephropathy) 2, 0 13% 0 37%,,,, 1%2%, ( HGPRT )(APRT) 100
18 1, (1),,,,,90% (2),, (3),, (4), 2,,, (1):,, (2),,, (3),,, 3, 90 % 100% 101
(1),,,,, (2):,,,,,, 17 %25% (3):,,, 4 25 %, X, 5 2, 1 (, ) >420mol/ L(7 0mg/ dl), 150380mol/ L(2 46 4mg/dl) >350mol/ L(6 0mg/ dl), 100300mol/ L(1 63 2mg/dl) 2 5d, >3 57mmol/ L( 600mg/ dl), 102
18 3,,, 4 (1)(murexide): 1,,, 1, (2):, 5 X (1): (2):,,, (3):, 6 7 X 8 X, 1, ; 2 ; 3 ; 4, X ; 5 103
1 ; ; ; ; 2 X, 3 ;; :, ; ; 1 (1); (2),( ); (3); (4),, ; (5) ; (6),( ) 2 (1)(colchicine) : :0 5mg/ h 1mg/ 2h, 4 8mg/ d, 2448h 104
18 :12mg 20ml,5 10min,45h, <4mg: (2)(NSAIDs) :( indometa cin )50mg, 3/ d( ) (3)ACTH : ACT H, 25U 40 80 U ;, 30mg/ d,()520mg (4): 3 (1):, ( probenecid) : 0 25g,2/ d;2 0 5g, 3/ d; 2g/ d ( sulfinpyrazone) : 50mg, 2/ d, 100mg, 3/ d ( benzbromarone) :25100mg,1/ d (2):,,0 1g,3/ d, 0 2g,3/ d, 0 3g, 1/ d, (3):, (ac etazomide) 0 5g, 0 25g, 3/ d, 1 25%, 60 100mg, (4): HGPRT 105
19 (osteoarthritis, OA),,, 50, 65 68 %,, 40,, 1 (1):,, (2): 30min, (3):,, 106
19 2 (1):, (2): (3):, 3 (1):,, 1, Heberden, Bouchard (2):,,,,, (3):,, (4): 1,, (5):,,, (6): C 107
,,,, 2 10 9 /L, 50 % OA, X,,,MRI, CT X,,,,,X,,, : 1 1986 OA (1), 3 1, >50, <30min, (2)X, 2 1990 OA 4 3 : (1)10 2 (2) 3 (3)2 (4)10 1 :10 23 1 108
19 3 1991 OA 3 2 : (1)( )<20mm/ h (2)X (3)X,, 1,,,, 2 (1):,,,, (2):,,, COX2,,,,,,,, 109
, 1 5g/ d, OA 3 110
20 ( H enochschonlein purpura),,, 411, 80%, 10 % 20 %, 1, 3 6 2 2/ 3 1 13 2,,,,,, 111
3 80 %,,,,, 4,,, 12d, 5,,, 6, ; 7,,, 1,, 112
20,, IgA 2,, Ig A C 3 2 : 20,,,,, 1,, ( ) 2 ( )( ) ( ), C 3 113
, 12mg/ kg,,, 4, 25mg/ (kgd), 2 5mg/ (kg d), 46, 6, 114
21 1, 2, 3,, 4,,,,,,,, 5, 1,,, 2 X,,, 115
,,,,,X 1,, 2,,, 3,,, ( ), : 1 2,,, 3 4,, 5 116
Cogan 22 Cogan,: ;; ;, Cogan,,,,, 1 2,,,,,,, 117
10 % 3 8,,, 4 1/ 10,,,, 5,,, 6 1/ 4, 1/ 10,, 1, 1/ 3,, 2,X, 118
22 Cogan Cogan :,,, Cogan :,,,, 1, 12mg/ ( kgd),, 2 3 4,,, 10, 57 119
23 ( rheumatic fever) A, 1 2 5,,, 2 (1):50%70% (2):,, (3):, 120
23 (4):,,,,, (5):,,,,, (6): 47,, (7): 1 (1):,, (2)(ESR) (3)C(CRP) (4), 1 2 2 (1): (2) O( ASO) : 500 U (3)( DNA B) : 250 U (4)( ASK): 80U (5)(AH): 128U 121
(6)(ANAD): 275U 3 (1), IgGIgM (2) C 3 C 4 (3)( CIC), CIC (4): >120, (5):, 60 % 70% (6)T : CD 4 + /CD 8 +, (7)(PCA):, 4 (1):, STT, (2):, (3)X :, X, CT,, 1992 122
23 : 1 ; ; ; ; 2 ; ; ESR CR P ;PR 3,, 2 1 2, 1,,, 2 (Poncet ),, 3, HLAB27,, 4,,, 5 ( ), 123
6,,,,,, 3 4 4 7, STT, 1,, 2 80 160 U, 2, 1014d 120 U, 1, 612,, 3,( ), 3 4g/ d, 80100mg/ (kgd), 3 4,, 30 40mg/ d, 1 01 5mg/ (kgd), 3 4 1015mg/ d,, 5 10mg/ d, 200mg/ d, 68, 124
23 12 4,, ( ) 5,,,, 3 120 U,, 0 25g,2/ d;(sd)0 5g,2/ d 6,,, 125
24 (Marfan syndrome),( ),,, 1,, ( ) ( ) 5cm, ( ),(, ),(, ),,,,,,, 2,,,5, 126
24 3,, 4,, 5, 1, 2 X,,,,,,, 3 4 3, 1, ( ) 2, 3, 4,,,, 1 (1), 127
(2), (3) C,( 5mg,2/ d) ; ( ),,, (4), (5), 2, 6cm,,, 128
25,,,, 1 (1) (2) (3) (4),,,, (5), (6)Ortolani Barlow Allis 2 : (1), 129
(2),,, (3),, (4),, (5)Allis Trendelenburg X 2 20, > 30, 3335, <323942,47,4247 X Barlow,, Still,,, 1 3,,, 2 3 130
26 (amyloidosis) ( ),,,, 1,, 2, 3,,,,, 131
4,,,, 1 2 X,,,, 3 (1), (2) 7 9nm(70 90A), (3) X 4,,,,,, 132
26 1,,,,, 2,,,,,, 3,, 1, 2,,,, 3 133
27 (Lyme disease),,,,,, 1 1 332d,,,,,,,,,, 2 14, 15%,, 8%, 134
27 11 % 3,,,,,, 1,, 2 3 4, IgM, 5 (ELISA) (IFA)( BB ) 53% 67 %, 2 100 % : 1, ( 5cm,) 135
1256 1 1 2, 1256, 1 1 1 1,, 2 (SLE),,,, C3 C4, 1,250mg,4/ d 2, (),2g/ d,, 14d,,( ) ( ), PR, 3, ( ) 100mg,,2/ d 30d, ( ) 500mg,4/ d, 2 000 U, 2, 14 21d50 %,, 136
27 4, ( ) 500mg,,3/ d, 21d, 2 000 U, 2, 1421d 5 137
Still 28 Still (adultonset stills disease, AOSD) (JCA),, 1825 1,, 2,,,,,, koebrer, 3,,,,, 138
28 Still 4, 5,,, 6,,, 7,, 1,1510 9 /L, 2 3 4,C 5 Cush : 1 39 ; 2 ; 3 <180; 4 <1100 2 : 1 1510 9 /L; 139
2 ; 3 ; 4 1 20mg/ (kg d) 4,()0 53mg/ kg 2 0 5mg/ ( kgd) 3 (MTX),7 5 15mg, 1, 4, 250mg/ d, 2g/ d, 2,,25mg,3/ d,,,,, 140
29,, 4,,,,, 20 50, 1 (1):, (2):,,, 141
, 2,,,,,,,, 3,,,,,, 1, 3 275mmol/ L, 1 0mmol/ L,, > 5mmol/ 24h 2 (AKP),,AKP 3 (PTH) 4 50 100mg/ d 30mg/ d, 3, 10d, D, 142
29 5 (1)X :,,, ( ), (2)B: (3)CT MRI:, 80 %90% (4): Tc/ TI, 92 %, 1cm, X,, 1,,,, PTH 2,, PTH 3, 143
, X 1, ( ),, 2 : (1),,,,,,, (2) 3 7mmol/ L,, (3) ( )3040mg/ d, (4), ( serum sickness),, 144
29 1 3, 13d,, 1, 3840, 12d 2,,, 3,, 4, 2d,, 5,,,, 145
,,,, ( ),,, ; 1, ( ) 25mg, 3/ d, ; ( )0 1g,2/ d,; 0 51 5g,3/ d, 2 ( ) ( ) ( ) 3, 30mg/ d, 4, 0 1% 0 1 03ml, 1,, 146
29,, 147