2013年 · 第51卷第03期

In recent years, the research on the pathogenesis of systemic lupus erythematosus (SLE) has been deepened, from the level of histopathology to the level of cellular and molecular biology, thus promoting the progress of pharmacotherapy of SLE. In March 2011, the U.S. Food and Drug Administration (FDA) approved the launch of a humanized monoclonal antibody, Belimumab, for the treatment of SLE, ending the embarrassing situation of no new drug for SLE for more than half a century. On the other hand, the continuous accumulation of evidence-based medical data has enabled rheumatologists to have a more comprehensive and in-depth understanding of the application of traditional treatment drugs for SLE, further improved the treatment strategy of SLE, and also put forward higher requirements for treatment goals^[1]。 At the same time, the progress of therapeutics has also greatly improved the survival rate and prolonged the survival time of patients, while the importance of long-term complications such as premature atherosclerosis and cardiovascular events has become increasingly prominent and a new challenge. In view of several hot issues in the clinical treatment of SLE, this paper introduces the research progress in recent years.

The adoption of evidence-based methods to formulate clinical practice guidelines has become the mainstream trend and consensus in the world. The widespread application of evidence-based clinical practice guidelines has also become the most substantial change in the clinical field in the past ten years^[1]。 The methodology used to develop evidence-based Clinical practice Guidelines has also matured, with the National Institute for Health and Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) And other authoritative institutions have formulated corresponding methodologies^[2,3]。 Since 2008, the number of evidence-based guidelines in clinical practice guidelines developed in China has increased year by year, and there is a trend of gradually replacing expert consensus guidelines^[4]。 However, in the field of pediatrics, the formulation of evidence-based guidelines is facing great challenges, including the lack of high-quality evidence, the lack of evidence-based concept and evidence-based methodology caused by the particularity of pediatric clinical research^[5]。 As of July 2010, only five evidence-based clinical practice guidelines have been formulated in the field of pediatrics in China^[6]。

A 2-year-old and 5-month-old male was found to be a mass in the right upper abdomen for more than 1 month and went to the doctor 2 weeks after operation. The parents of the child inadvertently touched a mass in the right upper abdomen of the child while bathing the child in March 2011. On April 7, 2011, they went to the local hospital for MRI examination, and found a huge space-occupying lesion in the right kidney of the child, about 12.1 cm ×7.6 cm ×7.7cm in size, considered to be nephroblastoma (Figure 1), and performed "radical resection of right nephroblastoma + right renal hilar lymph node dissection + right adrenalectomy" in this hospital on April 23, 2011. The postoperative pathology was confirmed as right renal nephroblastoma by consultation in our hospital.

The child, 5 months old, was admitted to hospital for more than 1 month due to dyspnea. The child developed inspiratory dyspnea without obvious trigger more than 1 month ago, obvious after crying, intermittent facial cyanosis, cough, a small amount of white sticky sputum, and no fever. In the local hospital, considered "pneumonia" and "bronchial asthma", ipratropium bromide, budesonide aerosol antispasmodic and asthmatic treatment, dexamethasone anti-inflammatory (dose unknown), cefamandol anti-infective treatment, symptoms did not improve, dyspnea progressively aggravated, and then inspiratory wheezing sound appeared. He visited a hospital in Beijing 4 days ago, and the blood gas analysis showed pH 7.345, PO₂7.70 kPa, PCO₂6.58 kPa, SaO₂0.919. Chest CT showed that the middle trachea was not continuous, the soft tissue behind the vena cava was thickened, the pulmonary bronchial vascular bundle was increased and blurred, and the patchy high-density foci were seen in both upper lungs. Laryngoscopy was performed 3 days ago, and a spherical red mass was seen about 2 cm below the glottis, which originated from the posterior wall of the trachea. Transferred to our hospital for further diagnosis and treatment.