系统性红斑狼疮患者活动性发热特点及相关性分析

目的 探讨系统性红斑狼疮(SLE)患者活动性发热的临床特点并进行相关性分析.方法 由各参研单位根据统一方式收集病历资料,总结江苏省1999-2009年住院SLE患者的临床资料及治疗情况,分析发热与SLE的临床表现、免疫学指标、疾病活动及治疗情况间的关系.组间的计数资料比较采用x2检验,非正态分布的计量资料比较采用秩和检验,相关性分析采用Logistic回归分析.结果 1762例SLE患者纳入研究范围,其中活动性发热患者729例,非发热患者1033例,通过对照研究,发热组入院年龄、是否初治、光敏感、浆膜炎、神经精神系统累及、肝脾淋巴结肿大、血白细胞、血红蛋白、红细胞沉降率(ESR)、C反应蛋白(CRP)、丙氨酸转氨酶(ALT)、白蛋白、血清肌酐、补体C3、抗双链DNA (dsDNA)抗体、抗Sm抗体、SLE疾病活动指数(SLEDAI)评分、既往治疗与非发热组比较差异有统计学意义(尸＜0.05);Logistic回归分析显示血白细胞异常[比值比(OR)=1.396,95％可信区间(CI)1.114～1.711,P=0.004]、CRP (OR=1.005,95％CI 1.002～1.009,P=0.002)、ALT( OR=1.003,95％CI 1.001 ～1.005,P=0.005)、血清肌酐(OR=0.997,95％CI 0.995～0.999,P=0.007)、血红蛋白(OR=0.986,95％CI0.981～0.992,P=0.000)、入院年龄(OR=0.984,95％CI 0.974～0.993,P=0.001)及环磷酰胺应用比例(OR=0.557,95％CI 0.382～0.813,P=0.002)与SLE 患者发热相关.结论 发热是SLE常见的临床表现之一.血白细胞下降、CRP升高、肝功能异常、贫血、入院年龄轻为SLE患者出现发热症状的危险因素,而肾累及、环磷酰胺应用为保护因素.     

辨证论治系统性红斑狼疮及对患者疲劳程度及生活质量的影响

目的:观察辨证论治系统性红斑狼疮及对患者疲劳程度及生活质量的影响。方法:采用辨证论治系统性红斑狼疮患者20例,并设对照组观察两组的临床疗效、系统性红斑狼疮活动指数积分、损伤指数积分、生活质量量表评分、抑郁自评量表积分。结果:治疗前后治疗组疲劳指数有显著统计学差异(P<0.01),对照组疲劳指数亦有统计学差异(P<0.05)。治疗前后治疗组和对照组生活质量评分躯体功能项目均有统计学差异(P<0.05),治疗组QOL自评分改善(P<0.01)优于对照组(P<0.05)。中医证候评分治疗组治疗前后有显著性差异(P<0.01);对照组治疗前后组内比较无统计学差异(P>0.05)。结论:本方法对本病有扶正固本,标本兼顾的功效;可缓解临床症状及疲劳,可提高系统性红斑狼疮生活质量。     

肿瘤坏死因子⁃α拮抗剂对类风湿关节炎伴发骨质疏松患者骨密度及血清骨代谢标志物的影响

目的：研究肿瘤坏死因子（tumor necrosis factor,TNF）?α拮抗剂对已出现骨质疏松的稳定期老年类风湿关节炎（rheumatoid arthritis,RA）患者骨密度（bone mineral density,BMD）及血清骨代谢标志物的影响。方法：50例稳定期RA患者按照随机数字表法随机分为研究组和对照组,其中研究组使用TNF?α拮抗剂,对照组使用阿仑膦酸钠,在治疗第0、32周进行BMD检测,在治疗第0、16、32周检测骨代谢标志物。结果：两组患者治疗后腰椎BMD均升高（P＜0.01）,组间差异无统计学意义,研究组治疗后股骨颈的BMD无明显变化。两组治疗后血清Ⅰ型胶原羧基末端肽（serum C telopeptide of type?I collagen,CTX）水平与治疗前比较有不同程度的改善（P＜0.05）,两组相比差异无统计学意义。研究组治疗后血清Ⅰ型胶原羧基端前肽（C?terminal propeptide of type?1 precollagen,PICP）水平无明显变化。结论：TNF?α拮抗剂治疗老年类风湿关节炎并骨质疏松可以有效减少骨吸收。     

白塞氏病合并淋巴瘤一例报告并文献复习

显,皮温增高,轻度活动受限.     

1958例系统性红斑狼疮住院患者首发表现和起病特点的回顾分析

目的 分析江苏省15所医院近10年来系统性红斑狼疮(SLE)住院患者的首发表现和起病特点.方法 由各参研单位根据统一方式收集病历资料,汇总建立资料数据库,进行回顾分析,组间的计数资料比较采用X2检验.结果 ①入选病例共1958例,男女比例1∶15.0.②首发症状明确者1798例,最多见的是皮肤黏膜损害(769例,占42.8%)和关节炎(697例,占38.8%).其中皮肤黏膜损害主要表现为颊部红斑(706例).在首发症状中与男性相比,女性关节炎比例显著增高.③所有病例在首次住院时均有多器官多系统受累:皮肤黏膜受累(82.3%)最为常见;血液系统损害:74.0%出现血细胞3系中至少1系减低;肌肉骨骼受累以关节炎(1156例,占56.5%)明显多于肌炎(51例);发现蛋白尿1046例,血尿385例,肾活检病理显示以Ⅳ型肾炎为主.结论 ①SLE住院患者以女性为主,男女比例1∶15.0.②皮肤黏膜损害和关节炎是SLE的最常见首发表现;与男性相比,女性更容易出现关节炎.③初次住院病例受累最多的器官或系统为皮肤黏膜、血液、关节和肾脏,肾活检病理显示以Ⅳ型病变为主.

Abstract：

Objective To investigate the initial manifestation and disease onset feature of systemic lupus erythematosus(SLE) in the past ten years in fifteen hospitals in Jiangsu Province.Methods Data was collected by the same Methods in all the participated hospitals and then it was summarized for retrospective analysis.Two groups were compared by chi-square test.Results ① One thousand nine hundred and fifty eight patients were investigated and the male-to-female ratio was 1∶15.0.② One thousand seven hundred and ninty eight patients had clear initial manifestations.The most common initial manifestations were skin and mucosal lesions(769 cases,42.8％ ) and arthritis (697 cases,38.8％ ).The main skin lesion was malar rash (706 cases).Arthritis was found to be more common in female than male.③ All hospitalized patients at their first admission showed multiple organ/system involvement:the most common involvement was skin and mucous membrane (82.3％),hematologic damage (74.0％),in which at least one series of blood cells were involved,arthritis (1156 cases,56.5％ ) much more than myositis (51 cases),proteinuria 1046 cases and hematuria in 385 cases.Renal biopsy pathology showed type Ⅳ glomerulonephritis.Conclusion ① SLE patients are mainly female and the male to female ratio is 1∶15.0.② The most common initial manifestations are skin and mucosal lesions.③ The most commonly involved organ/system are skin and mucous membrane,blood,joint and kidney.The most common pathological changes shown in renal biopsy is type Ⅳ glomerulonephritis.     

4种抗体联合检测在类风湿关节炎中的临床意义

类风湿关节炎（rheumatoid arthritis,RA）是一种以慢性破坏性多发关节炎为主要表现的全身自身免疫性疾病,在发病的前2年内即可出现不可逆的骨关节破坏,导致患者出现残疾和功能障碍。早期诊断和系统性治疗是防止关节畸性和致残的关键。以往RA的辅助检查多依赖x线和类风湿因子（RF）检测,x线改变发生时关节已经受损,不能做到早期诊断;而RF并非RA的特异性抗体,     

23例白塞氏综合征病人的症状观察与护理

白塞氏综合征（behcets disease，BD）是一种以反复发作的口腔及外阴部溃疡、眼病及皮肤损害为临床特征，累及全身多系统的慢性疾病。病理改变的特征是血管炎。由于疾病反复发作，病人常悲观失望，同时护理不当易造成感染等并发症，因此良好的护理措施在本病尤为重要。我科通过对23例白塞氏病人进行精心的护理，取得良好效果。现报道如下。     

原发性干燥综合征50例临床分析

原发性干燥综合征(PSS)是一种较常见的自身免疫性疾病，在我国患病率为0．29％～0．77％，仅次于类风湿关节炎。由于对本病认识不足，常造成漏诊和误诊，现将本院确诊的PSS50例分析如下。     

系统性红斑狼疮血液系统损害与疾病预后分析

目的 分析系统性红斑狼疮(SLE)血液系统损害与疾病活动情况、免疫学指标的异常及疾病预后相关性.方法 总结江苏省1999-2009年间首次住院SLE患者的临床及实验室资料,观察血液系统损害情况,并分析了血液系统损害与SLE疾病活动情况、免疫学指标及SLE患者病死率间的关系.统计学处理采用X2检验.结果 1958例SLE患者纳入研究范围,其中女性患者1836例,男性患者122 例.所有SLE患者中,1549例(79.1%)患者合并血液系统损害,其中贫血占62.3%,白细胞减少占45.5%,血小板减少占29.4%;轻、中、重度活动组患者血液学损害率均高于基本无活动组(P=0.01和P＜0.01);血液系统损害发生率在红细胞沉降率、补体C3、抗双链DNA(dsDNA)抗体阳性组高于阴性组(P＜0.01);有166例患者在随访中死亡,其中因重症感染死亡占38.6%,因肾功能衰竭死亡占22.9%,因神经系统损害死亡占15.1%,心血管疾病占10.2%,其他死因占13.3%.死亡病例中存在血液系统损害占91.6%,无血液系统损害占8.4%,血液系统损害率在死亡患者中明显增高(p＜0.01).结论 血液系统是SLE最常受累的系统之一,其中以贫血最为常见,血液系统损害与狼疮病情活动密切相关;免疫性指标异常的患者容易继发血液系统的损害;重症感染是SLE患者死亡的主要原因,存在血液系统损害的SLE患者病死率高于非血液系统损害的SLE患者.

Abstract：

Objective To explore the relationship between the impairment of hematological system and disease activity,immunological parameters,and the prognosis of systemic lupus erythematosus (SLE).Methods The clinical and laboratory data of in-patients with SLE in Jiangsu Province were investigated and all patients were hospitalized between 1999-2009.The impairment of hematological system was assessed and the relationship between hematological system damage and disease activity,immunological parameters,mortality rate of patients with SLE were analyzed.Statistic method used was X2 test.Results One thousand nine hundred and fifty eight cases of SLE were included in the study,in which,1836 were female and 122 were male.One thousand five hundred and forty nine (79.1%) patients complicated with hematological system damage,62.3% were anemia,45.5% with leucopenia and 29.4% with thrombocytopenia.There were significant differences in hematological system damage rate among patients with mild activity group,moderate activity group,severe activity group and almost no activity group,compared respectively with almost no activity group.The P values were P=0.01 and P＜0.01 respectively.The incidence of hematological system damage in elevated ESR,low complement C3 level,anti-dsDNA antibody group was higher than that in patients who had normal ESR,complement C3 level and anti-dsDNA group.(P＜0.01).During follow-up,166 patients died,of which the mortality rate(91.6%) in patients had hematological system damage,was obviously higher than those without hematological damage(8.4%)(P＜0.01 ).Among the 166 deceased patients,38.6% died of severe infection,22.9% died ofrenal failure,15.1% died ofnervous system damage,10.2% died of cadiovascular damage and 13.3% died from other causes.Conclusion Hematological system is one of the most commonly involved system in patients with SLE,of which anemia is the most common,and the incidence of leukopenia follows.The impairment of hematological system is closely related to lupus activity.Patients with abnormal immune parameters tend to have secondary hematological system damage.Severe infection is the main cause of death in patients with lupus,followed by nervous system damage and kidney damage.The mortality rate in patients with lupus that complicated hematological system damage is higher than patients who have no hematological system damage.