抗缪勒管激素在女性系统性红斑狼疮中的临床意义及与抗卵巢细胞抗体的关系

目的 研究抗缪勒管激素(AMH)在初治的女性系统性红斑狼疮(SLE)患者中的水平变化情况,并分析AMH与抗卵巢细胞抗体(AOAB)的关系.方法 选取84例女性初治SLE患者血清及同年龄范围的健康女性血清90份,采用酶联免疫吸附试验(ELISA)法检测患者及健康人血清中AMH及AOAB水平.采用t检验统计分析.结果初治女性SLE患者血清中AMH平均水平[(3.2±1.5)ng/ml],明显高于健康对照组[(2.6±1.4),ng/ml],差异有统计学意义(P<0.05),且与患者皮疹、肾炎及疾病活动度有相关性.SLE患者和健康人血清中AMH水平随年龄增加均呈现先升高后降低的趋势,但SLE患者血清AMH水平达到高峰的年龄较健康对照组延后.另一方面,女性SLE患者AOAB阳性率显著高于健康人,且AOAB阳性的SLE患者血清AMH水平[(4.1±1.8)ng/ml]显著高于AOAB阴性者[(2.7±1.1)ng/ml,差异有统计学意义(P<0.01).结论 初治的女性SLE患者血清AMH水平高于同龄健康女性,而且AMH的升高与SLE患者皮疹和肾炎的发生、疾病活动度及AOAB的存在具有相关性.     

Lupus anticoagulant after measles

A 22/12 years old boy developed a lupus anticoagulant after measles. Fibrinogen concentration and activity of factors II, V, VII, VIII, IX, X, XI and XII were normal, but partial thromboplastin time and thromboplastin time were prolonged. Thrombin time was within the normal range. Mixing normal plasma with the patient's plasma immediately prolonged the partial thromboplastin time, and incubation of the sample did not increase the inhibition. The immunglobulin fraction prepared from the patient's plasma on DEAE-sephacel also prolonged the partial thromboplastin time in cross mixing experiments. The thrombocyte count and thrombocyte functions were normal.In spite of the pathological partial thromboplastin and thromboplastin times, surgery was performed without excessive bleeding during the operation and without delayed wound healing.     

Tamoxifen flare hypercalcemia: an additional support for gallium nitrate usage

In 12 of 93 hypercalcemic patients with metastatic advanced breast cancer treated with tamoxifen the most common life-threatening metabolic complication of flare hypercalcemia developed. All the hypercalcemic patients had osteolytic or mixed lytic and blastic bone metastases. In patients with advanced breast cancer, hypercalcemia develops within the first few weeks of initiation of tamoxifen therapy. In our study group, calcium levels were measured frequently in both serum and urine samples by a semi-autoanalyzer and an autoanalyzer, using standard methods. Elevation of calcium levels was noticed in the tamoxifen-receiving hypercalcemic breast cancer patients, and levels returned to normal when tamoxifen was withdrawn. The median duration of flare hypercalcemia was 9 days (range, 4–16 days). The median calcium value was 13.6 mg/dl (range, 11.7–15.8). The diagnosis of tamoxifen flare hypercalcemia was based on the normal pretreatment serum or urine calcium values and the occurrence of hypercalcemia within the first few weeks of tamoxifen initiation. There are no specific treatment recommendations for hormone flare hypercalcemia, except for tamoxifen withdrawal, which is usually temporary, and the introduction of a low dose of an antihypercalcemic drug. We evaluated the effect of such a drug, gallium nitrate, on flare hypercalcemia. All the patients were treated with hydration, and 6 patients, whose calcium level was above 13.6 mg/dl, were treated with a moderate dose of gallium nitrate (200 mg/m² per kg) for 5 consecutive days, they achieved normocalcemia and continued with tamoxifen. The median time from hormonal drug initiation to flare hypercalcemia was 17.5 days, and median duration was 9 days. The above result indicates that the serious metabolic complication of hypercalcemia develops due to the iatrogenic effect of tamoxifen, but it can be controlled with an antihypercalcemic drug, gallium nitrate, while continuing tamoxifen therapy. It seems that the use of gallium nitrate in the treatment of flare hypercalcemia could allow safe readministration of tamoxifen and prevent premature tamoxifen discontinuance or withdrawal.     

Double-blind, crossover comparison of olopatadine and cetirizine versus placebo: suppressive effects on skin response to histamine iontophoresis

Olopathadine, a newly developed histamine H1-receptor antagonist, was compared with cetirizine in its suppressive effects on histamine-induced wheal and flare reaction using an iontophoresis technique in a double-blind, crossover, placebo-controlled fashion. As a result, olopathadine was found to have effects comparable to cetirizine. This finding may predict the efficacy of this new H1-antagonist in treating pruritic skin diseases.     

Comparison of on-site and photographic evaluations of the suppressive effects of cetirizine, loratadine, and fexofenadine on skin response to histamine lontophoresis: A double-blind, crossover study in healthy volunteers

Background:

The standard method used to determine the potency of antihistaminesis to assess the degree of suppression of skin response to histamine challenge.

Objectives:

The aims of this study were to compare the efficacy of 3 antihistaminesusing a histamine challenge test and the usefulness of on-site evaluation with that of photographic evaluation of skin-test reactions.

Methods:

In this prospective, double-blind, crossover study, healthy volunteerswere given cetirizine 5 mg (CTZ-5) and 10 mg (CTZ-10), loratadine 10 mg (LOR), fexofenadine 60 mg BID (FEX), and placebo (PLC), in a randomly assigned order, with an interval of at least 1 week between treatments. Before and 0.5 to 24 hours after administration, the areas of flare and wheal induced by histamine iontophoresis were measured directly (on site) by 1 evaluator and by another evaluator using photographic images on a computer monitor.

Results:

Ten healthy volunteers (6 men, 4 women; mean age, 28.2 years[range, 20-39 years]; mean weight, 60.7 kg [range, 41-81 kg]) were enrolled. The data from 9 subjects were analyzed; the data from 1 subject were omitted because the subject used an over-the-counter cold medication containing diphenhydramine several times during the study. By both methods, all antihistamines were shown to suppress flare significantly from 4 to 24 hours after administration. CTZ was most potent in suppressing both flare and wheal. For flare, the areas as measured using on-site evaluation were larger overall than those measured using photographic evaluation, but the shapes of the time-course graphs were similar for both. Overall, the flare area measurements started to decrease significantly from baseline values 4 hours after drug administration, reached a nadir at 10.5 hours, and remained significantly lower compared with baseline values at 24 hours. Comparisons between antihistamines showed significant differences in mean flare areas between the 2 doses of CTZ and LOR from 8 to 12 hours after administration in both evaluation methods. The wheal areas were significantly reduced from baseline values by most of the antihistamines 4 to 12 hours after drug administration, reached their lowest values at 10.5 hours, and returned to near-baseline values at 24 hours. Comparisons with PLC values at each time point, however, showed significant differences only for CTZ-5 and CTZ-10 from 4 to 12 hours after administration. Comparison between antihistamines showed significant differences in mean flare areas between the 2 doses of CTZ and LOR from 8 to 12 hours after administration in both evaluation methods. Although the flare areas measured by both methods correlated linearly (r = 0.90; P < 0.001), the correlation for wheal areas was weaker (r = 0.76; P < 0.001).

Conclusions:

In this study in healthy volunteers, single doses of CTZ 5 mg and CTZ 10 mg were more potent compared with single-dose LOR 10 mg and FEX 60 mg BID in suppressing skin response. Although linear correlations were found between skin-response areas, as measured by on-site and photographic evaluation, it was difficult to differentiate between wheal and flare by photographic evaluation, especially when a typical wheal was suppressed to slightly edematous erythema by antihistamines.     

抗核小体抗体与系统性红斑狼疮活动性的相关研究

目的探讨抗核小体抗体与系统性红斑狼疮活动度的相关性。方法采用酶联免疫吸附试验(ELISA)检测88例系统性红斑狼疮患者血清中的抗核小体抗体，将抗核小体抗体与疾病活动度(以SLEDAI评价)、抗双链DNA抗体、补体等指标进行比较。结果抗核小体抗体在70例系统性红斑狼疮患者(79．5％)中为阳性，抗核小体抗体与疾病活动度SLEDAI评分、抗双链DNA抗体、补体C3水平和血沉有相关性。结论抗核小体抗体在系统性红斑狼疮中敏感性较高，是了解狼疮活动度的良好指标。     

胸腺肽治疗对狼疮性肾炎患者医院感染率的影响

目的 观察胸腺肽治疗对狼疮性肾炎（LN）患者医院感染率的影响情况。方法 对73例LN住院患者采用随机对照方法观察比较胸腺肽治疗组和对照组的医院感染率。结果 胸腺肽治疗组的医院感染率为14．28％，对照组为39．47％，两组间比较有统计学差异。结论 胸腺肽治疗可降低LN病人医院感染率。     

CD137与系统性红斑狼疮

系统性红斑狼疮是自身免疫性疾病的原型,主要表现为T、B淋巴细胞功能异常,产生大量自身抗体,近年来发现,T细胞及其亚群和共刺激分子可能是SLE的发病机制的关键.本文就共刺激分子CD137的结构、配体、生物学功能及其在系统性红斑狼疮发生、发展中的作用作一综述.     

血管细胞黏附分子-1在红斑狼疮小鼠NZB/NZW F1肾脏中的表达

目的了解血管细胞黏附分子-1(VCAM-1)在红斑狼疮小鼠肾脏组织中的表达情况.方法新西兰黑色品系(NZB)与新西兰白色品系(NZW)杂交的子一代NZB/NZW F1小鼠(可自发地发生类似人的系统性红斑狼疮)6周龄和10周龄各6只,用RT-PCR法和蛋白印迹法检测两组小鼠肾脏组织中VCAM-1在mRNA和蛋白水平的表达.结果用VCAM-1 cDNA/GAPHDcDNA的荧光强度比值作为VCAM-1 mRNA的表达量的指针,10周龄(已发生红斑狼疮)小鼠肾脏组织中VCAM-1 cDNA/GAPHD cDNA的荧光强度的比值为0.3～0.5,平均0.36;6周龄(未发生红斑狼疮)小鼠肾脏组织中VCAM-1 cDNA/GAPHD cDNA的荧光强度的比值为0.1～0.2,平均0.12,差异有显著意义(P<0.05).用Western Blotting法在红斑狼疮小鼠肾脏组织中可检测出VCAM-1蛋白条带;而未发生红斑狼疮的小鼠肾脏组织中不能测得.结论 VCAM-1的表达在红斑狼疮小鼠肾脏组织中明显增高,说明VCAM-1在小鼠狼疮性肾炎的发病过程中具有促进作用.     

系统性红斑狼疮患者外周血CD4+和CD8+细胞端粒长度及端粒酶活性的研究

目的:探讨系统性红斑狼疮(SLE)患者外周血CD4 、CD8 和CD19 细胞端粒长度和端粒酶活性变化及其在发病中的作用.方法:用免疫磁珠法,从外周血单个核细胞分离CD4 、CD8 和CD19 淋巴细胞,提取细胞蛋白后,用PCR为基础的端粒酶测定法(Telomeric repeats amplification protocol,TRAP)测定端粒酶活性;Southern Blot测定细胞端粒长度.结果:SLE患者CD4 、CD8 和CD19 细胞端粒酶活性均高于正常对照,但只有CD19 细胞端粒酶活性与正常对照相比差异有显著性(P<0.05).SLE患者CD4 和CD8 淋巴细胞的端粒长度均较正常对照明显缩短,CD19 淋巴细胞的端粒长度无明显缩短.结论:SLE患者CD19 细胞端粒酶活性显著增高,维持了细胞端粒长度;而CD4 和CD8 细胞端粒酶活性可能不足以维持由于细胞分裂所导致的细胞端粒缩短.