系统性红斑狼疮肺胸膜病变(附50例报告)

50例SLE患者有肺胸膜病变,其中女性47例(94％),男性3例(6％),小于40岁者41例(82％)。50例中表现为胸膜炎和(或)胸腔积液26例,狼疮肺炎15例,弥漫性肺间质纤维化5例,肺不张3例,肺纹理增多17例。经激素治疗随SLE症状改善,肺胸膜病变好转。     

神经精神性狼疮MRI检查的临床应用价值

目的：探讨神经精神性狼疮(NPSLE)MRI表现特点及其与临床的关系。方法：52例NPSLE患者在出现症状后1天～2个月内进行头部MR检查。另选取26例无神经系统症状的SLE患者和27例健康志愿者行MR检查并与NPSLE组比较。结果：NPSLE的MRI主要表现为斑点状和大片状脑炎样病变、出血、脑梗死和脑萎缩，额、顶叶和基底节区好发。表现为点状病灶的临床以精神障碍和头痛为主要表现，片状病灶以癫痫和偏瘫为主要表现。临床病情严重患者的片状病灶的发生率、病灶总面积较轻微组显著增高。片状的，边缘模糊的，T1WI等、略低信号，T2WI高信号的病灶变化迅速。结论：NPSLE的MRI检查有助于明确脑病性质及更准确的评估病情和预后，从而指导治疗和评价疗效。     

Phenotypic and genetic analyses of T-cell-mediated immunoregulation in patients with Type 1 diabetes.

AIMS: To investigate the contribution of regulatory T cells and co-stimulatory molecules in CD4(+) T cells to the development of Type 1 diabetes (T1D). METHODS: Twelve patients with T1D, nine patients with systemic lupus erythematosus (SLE), and 12 age-matched healthy control subjects participated. We analysed the proportions of CD25(+)CD4(+) T cells and natural killer T cells (NKT cells), and the expression levels of Foxp3, CTLA-4, CD28, ICOS, PD-1 and BTLA in peripheral blood mononuclear cells and purified CD4(+) T cells. RESULTS: There were no significant differences in the proportions of CD25(+) CD4(+) T cells or NKT cells among the three groups. PD-1 expression levels of peripheral CD4(+) T cells from T1D patients were significantly lower than those from healthy control subjects (P = 0.00066). In contrast, PD-1 expression levels were similar in SLE patients and healthy control subjects. The expression levels of Foxp3, CTLA-4, CD28, ICOS and BTLA were similar in the three groups. CONCLUSIONS: Decreased expression of the PD-1 gene in CD4(+) T cells may contribute to the development and/or maintenance of autoimmune T1D. As the population studied was small and heterogeneous, further studies are required to confirm the findings.     

伽玛刀治疗全身肿瘤1168例初步报告

目的 探讨国内首创的OUR-QGD全身伽玛刀治疗头、颈、胸、腹、盆腔内肿瘤的疗效。方法 应用OUR-QCD全身伽玛刀治疗头、颈、胸、腹、盆腔内肿瘤1168例，男822例，女346例，其中肺癌664例。应用西门子SOMATOM-E spring型螺旋CT行薄层扫描，获得定位图像，在γ-TPS治疗规划系统上进行三维图像重建、显示；根据肿瘤性质、类型、部位及脑干、脊髓、血管、神经、气管、食管、胃、肠、膀胱的毗邻关系制订适合的治疗计划，再行治疗方案的模拟显示，评估、修正、确定最佳治疗方案。结果 在702例随访复查资料完整的病例中，伽玛刀治疗后3～6个月复查评价其近期疗效．肿瘤局部控制率(CR PR)91．7％(644／702)；症状、体征的改善率为90．9％。放射性食管炎、放射性肺炎、放射性肠炎等并发症仅8．3％，未见穿孔致死等严重并发症病例。1年、2年生存率正在统计中。结论 伽玛刀治疗全身肿瘤等病变是一种安全、有效，并发症较少的方法。采用放化疗配合伽玛刀进行综合治疗疗效更好，更为合理。     

Monospecific but not polyreactive human hybridoma rheumatoid factors exhibit preferential binding specificities for IgG3 and IgG4

Summary Among 38 human hybridoma-derived monoclonal rheumatoid factors (RFs) generated from patients with either rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), two groups of RFs can be identified. Monospecific RFs were derived primarily from patients with RA and are characterized by a binding specificity for IgG3 and/or IgG4. Polyreactive RFs were derived largely from patients with SLE and show a broader pattern of reactivity to all four isotypes of IgG. Neither population of RFs was exclusive to either disease. The binding specificities identified appear to be different from the RFs isolated from patients with mixed cryoglobulinemia and may reflect a different antigen selection mechanism.     

COX-2在系统性红斑狼疮病人PBMC中的表达及意义

目的：检测环氧全酶-2(Cyclooxygenase-2，COX-2)蛋白在系统性红斑狼疮(Systemic lupus erythematosus．SLE)患外周血单核细胞(Peripheral blood monoeytes，PBMC)中的表达情况。探讨COX-2蛋白表达水平与SLE病情活动程度之间的关系。方法：从外周血中分离PBMC后涂片，用免疫组化染色的方法测定COX-2蛋白的表达情况。结果：COX-2蛋白在SLE实验组呈高表达状态，与SLE疾病的活动性之间呈正相关。结论：COX-2的表达与SLE的发病有关，可作为今后辅助治疗措施的目标和病情变化和疗效评价的参考指标之-。     

Resolution of skin fibrosis and joint contractures in aggressive diffuse systemic sclerosis using autologous stem cell transplantation

The use of haematopoietic stem cell transplantation (HSCT) has now expanded beyond the domain of haematological diseases. Increasingly, the benefits of intense immunosuppression in the management of severe autoimmune diseases are being recognized. In diffuse systemic sclerosis (SSc), there has been increasing evidence of the efficacy of HSCT in improving morbidity and mortality. We present the first Australian patient to undergo autologous HSCT for SSc and review the current literature in the use of HSCT in SSc. Remarkably, the patient had complete resolution of skin disease (modified Rodnan skin score 27/51–0/51), tenosynovitis, synovitis and myositis.