2014年 · 第94卷第13期

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease prototype. Clinically, it can involve important organs such as heart, brain, lung and kidney, resulting in a significant reduction in the quality of life and death of patients. A large number of studies have revealed that early diagnosis and treatment can significantly improve the long-term prognosis of SLE. In 2012, the SLE Clinical International Collaborative Research Group (SLICC) proposed a new classification standard for SLE^[1]The new criteria are divided into clinical criteria (11 items) and immunological criteria (6 items), emphasizing that SLE diagnosis needs to meet 4 criteria, and must contain at least 1 clinical criteria and 1 immunological criteria, or renal biopsy confirms lupus nephritis and is positive for antinuclear antibodies or anti-dsDNA antibodies. The application of new classification criteria can improve the sensitivity of diagnosis. Before the 1980s, the main cause of death in SLE was organ failure and infection caused by the disease itself. However, by the 1990s, with the improvement of clinical treatment level, the prognosis of patients improved significantly, and their 10-year survival rate reached more than 80%. However, the long-term cause of death has become increasingly prominent. Many studies have shown that 10% to 40% of SLE patients die of coronary artery disease, and the age of atherosclerosis is also significantly earlier. Female SLE patients before menopause have a 52-fold risk of atherosclerosis than normal women^[2,3]。 Clinically, the mortality of SLE presents a bimodal pattern^[4]。 Therefore, the treatment of SLE should aim at inducing remission of SLE in the early stage of the disease, and should aim at reducing organ damage and improving the long-term prognosis and quality of life of patients in the long term.

Since Hench et al. discovered that glucocorticoids have anti-inflammatory and immunosuppressive effects in 1949, they have greatly improved the survival rate and prognosis of patients with systemic lupus erythematosus (SLE). The 3-year survival rate of SLE patients has increased from 50% in 1953 to 92% in 2003^[1,2]。 Intravenous methylprednisolone (MP) shock treatment of severe SLE in the 1970s saved many lives. Undoubtedly, for more than half a century, hormones have brought gratifying therapeutic effects on rheumatism patients and improved the quality of life of patients. However, at the same time, countless patients have also paid a heavy price for its adverse reactions, such as death due to severe infection, disability due to aseptic osteonecrosis, severe osteoporotic fractures, childhood growth and development disorders, cardiovascular and cerebrovascular diseases, etc. Before the 1990s, infection caused by hormone and/or immunosuppressant therapy was one of the main causes of death in SLE, suggesting that the amount of hormone used was even worse. Therefore, it is necessary to reorient the dosage, course of treatment and status of hormones in the treatment of SLE.

The patient was a 42-year-old female. Due to decreased menstruation for 4 months, increased leucorrhea with peculiar smell and contact bleeding for 1 month, he was admitted to Suining Central Hospital of Sichuan Province on December 24, 2012. Four months ago, the patient had obvious decrease in menstruation, prolonged cycle, no obvious change in menstrual period, mild symptoms, and did not see a doctor. One month ago, the patient had increased leucorrhea, yellow color, occasionally accompanied by pale red blood and peculiar smell. More than 20 days ago, the patient had bleeding in the same room, which was dripping endlessly. He went to the local hospital for treatment. Colposcopy showed cervical neoplasms. For further treatment, he came to Suining Central Hospital of Sichuan Province. Physical examination: Hysteroscopy showed that the mucosa of the cervical mouth was not smooth and congested, and a large bulge was visible. After applying acetic acid, the edema turned white, so a biopsy was taken. Under the microscope, the tumor cells were sheet-like and nest-like, small but consistent, round or oval, with less cytoplasm, translucent cytoplasm in some areas, round or oval nucleus, deep stain, fine chromatin, and not obvious nucleolus (Figure 1)； Immunophenotype CD99 (+) (Figure 2), Vimentin (+), Bcl-2 (+), CgA focal (+), Syn focal (+), NSE (-), P63 (-), LCA (-), desmin (-), CD10 (-), CK (-), TTF-1 (-) and Ki-67 were positive about 98%, and the pathological diagnosis was primitive neuroectodermal tumor of the cervix. Extensive hysterectomy plus pelvic lymph node dissection was performed under general anesthesia on 16 Jan 2013. The pathological diagnosis was primary primitive neuroectodermal tumor (PNET) of the cervix with no involvement of the pelvic lymph nodes. Adjuvant therapy such as radiotherapy and chemotherapy was given postoperatively, and PET-CT whole body scan was performed. No positive findings were found, and he was discharged from hospital. The patient is still alive after follow-up.

In-depth research on pelvic biomechanics is helpful to improve the surgical treatment effect of pelvic trauma. In solid biomechanics research, it is difficult to obtain cadaveric pelvic specimens and it is difficult to collect or make enough specimens, which easily leads to large errors in solid biomechanics experiment results due to insufficient sample size; At the same time, solid biomechanical experiments cannot measure the internal biomechanical characteristics of bones, which makes the pelvic biomechanical research urgently need new means to further improve. The finite element analysis method adopts the basic idea of dividing the whole into parts and gathering the zero into the whole, and uses the multi-morphological grid to divide each region and arrange the required nodes according to the needs, which has good applicability to various complex object structures; At the same time, the finite element method can understand the internal stress and strain changes of each part of the model when it is stressed^[1,2]。 These make finite element has unparalleled advantages in biomechanical research, making it an effective research method for pelvic biomechanics.