初发系统性红斑狼疮并发人巨细胞病毒感染的临床特点

目的 总结初发系统性红斑狼疮(systemic lupus erythematosus,SLE)患者并发人巨细胞病毒(human cytomegalovirus,HCMV)感染的临床特点.方法 回顾性收集2012年7月至2020年9月在北京协和医院住院的所有SLE患者的病史资料,筛选出初发SLE并发单纯HCMV感染组(...     

人巨细胞病毒感染与系统性红斑狼疮的相关性研究

目的 研究人巨细胞病毒(HCMV)在系统性红斑狼疮(SLE)中的感染状况,探讨HCMV活动性感染与SLE病情及发病的相关性. 方法 选择63例SLE患者,将外周血白细胞接种于人胚成纤维细胞(HF)进行病毒分离,再分别用问接免疫荧光(HF)、聚合酶链反应(PCR)检测HF中HCMV pp65抗原及HCMV UL54 DNA,分析SLE患者的HCMV活动性感染率,以及与SLE病情、临床表现、实验室指标等之间的关系. 结果 ①SLE患者HCMV活动性感染率明显高于健康对照(27%与0%,P＜0.05).②病情活动组SLE患者的HCMV活动性感染率明显高于非活动组(39%与13%,P＜0.05).③HCMV活动性感染组的SLE患者尿蛋白定量(24 h)、红细胞沉降率(ESR)、SLE疾病活动指数(SLEDAI)明显高于非活动性感染组[(1.7±1.3) g/d与(0.8±0.8) g/d,(64±38) mm/1 h与(38±29) mm/1 h,15±6与9±6,P＜0.05].④HCMV活动性感染组SLE患者关节炎的发生率以及抗舣链DNA(dsDNA)抗体、抗核小体抗体(AnuA)、β2糖蛋白1(β2-GPI)阳性率均高于非活动性感染组(35%与13%,47%与17%,53%与22%,47%与13%,P＜0.05).⑤初发SLE患者的HCMV活动性感染率高于非初发患者(35%与22%),但两者差异无统计学意义. 结论 SLE患者的HCMV活动性感染率明显高于健康对照,HCMV活动性感染可能导致SLE病情活动并且与SLE患者蛋白尿、关节炎以及抗dsDNA抗体、AnuA、β2-GP1等自身抗体的产生有关,HCMV活动性感染可能参与SLE发病.     

Possible triggering effect of cytomegalovirus infection on systemic lupus erythematosus

We report on a patient with systemic lupus erythematosus (SLE) who showed elevated titers of IgM antibodies to cytomegalovirus (CMV), suggesting CMV infection at the onset of SLE. Serum CMV antigens were also detected in the patient. These findings raise the possibility that CMV infection may be related to the onset of SLE in certain patients.     

系统性红斑狼疮患者医院感染的调查研究

目的：了解系统性红斑狼疮（SLE）的患者的医院感染情况。方法：对1995年3月至2002年3月新入院的456例SLE患者的医院感染进行调查。结果：SLE患者医院感染率为36．4％，呼吸道45．2％，泌尿道16．0％，皮肤12．6％，其他26．2％，以G－杆菌感染为主，致病菌对抗生素耐药率较高，结论：医院感染的易发因素是大量使用抗生素，激素及免疫抑制剂等。     

系统性红斑狼疮伴结核分枝杆菌感染42例临床分析

目的 探讨系统性红斑狼疮(SEE)患者伴结核分枝杆菌感染的临床特点.方法 回顾性分析452例SLE患者在应用糖皮质激素和免疫抑制剂治疗过程中出现结核分枝杆菌感染的临床资料.结果 452例SLE患者中42例(9.29%)在住院期间被确诊为活动性结核,单纯浸润犁肺结核11例(26.19%);肺外结核31例(73.81%),其中有10例(23.81%)未找到结核感染病灶,8例(19.05%)血行播散型肺结核,6例(14.29%)结核性脑膜炎,2例(4.76%)胸腔结核,2例(4.76%)腹腔结核,1例(2.38%)淋巴结核,1例(2.38%)骨结核,1例(2.38%)肾结核.42例结核感染患者有狼疮肾炎38例,血清白蛋白低40例,有结核病史10例,白细胞低14例,血糖升高14例.抗结核治疗起效时间一般在1周以上,最长可达4周.死亡2例,均为血行播散型结核.结论 应用糖皮质激素及免疫抑制剂治疗SLE的过程中,结核分枝杆菌感染的发病率明显升高,以重症结核和肺外结核为多.既往有结核病史、狼疮肾炎等SLE患者,町能易感染结核分枝杆菌.     

Prevalence of active hepatitis C virus infection in patients with systemic lupus erythematosus

OBJECTIVE: Hepatitis C virus (HCV) infection is associated with various autoimmune disorders and can mimic systemic lupus erythematosus (SLE) clinically and serologically. There are few reports of prevalence of HCV infection in patients with SLE. The aim of this study was to determine the prevalence of HCV viremia by polymerase chain reaction (PCR) in patients with SLE. METHODS: We tested sera from 40 consecutive patients with SLE collected from 1993 to 2000. All of the patients had HCV viral load measured by PCR. The results were compared with the prevalence of HCV viremia in a control group of blood donors in our geographic area as well as in United States general population. RESULTS: HCV was detected in 4 of 40 patients (10%). The prevalence of HCV in our area blood donors is 130 cases per 100,000 persons (0.13%; P<0.0001). The prevalence of HCV infection in the United States general population, screened by PCR, is 1330 cases per 100,000 people (1.33%; P=0.002). The prevalence of HCV infection was significantly higher in our SLE patients than in our area blood donors. The frequency of HCV infection was also higher than that of the United States general population. CONCLUSION: Our observations support those of other investigators who have reported an increased prevalence of HCV infection in SLE patients. Further detailed investigation of this association may help in understanding the pathogenesis of SLE. HCV infection should be tested when the diagnosis of SLE is considered.     

Mycobacterium tuberculosis infection in systemic lupus erythematosus patients

Aim of the work

To estimate prevalence of tuberculosis (TB) infection in systemic lupus erythematosus (SLE) patients; to study its relation to disease duration, activity, damage and treatment as well as to compare the performance of interferon gamma (IFN-γ) release assay and tuberculin skin test (TST) in detection of TB infection.

Cytomegalovirus infection in patients with systemic lupus erythematosus

Cytomegalovirus (CMV) infection is known to induce several autoimmune abnormalities in mice that resemble those found in systemic lupus erythematosus (SLE). In addition, a potential role for CMV in the development and/or progression of SLE has been suggested. In order to further clarify this issue, we reviewed the relationship between SLE and CMV infection on the basis of the clinical and immunological features of cases reported in the literature and our own patients.     

Congenital cytomegalovirus infection and maternal systemic lupus erythematosus: a case report

We describe an infant with symptomatic congenital cytomegalovirus infection, who was born to a mother with active systemic lupus erythematosus. Infection in the child resulted from reactivation of maternal cytomegalovirus infection. The mother's use of prednisone may have contributed to the reactivation. The role of maternal immunosuppression in the acquisition of congenital viral infection by the neonate is discussed.     

绝经后发病的系统性红斑狼疮20例临床分析

目的　研究绝经后发病的系统性红斑狼疮 (SLE)的临床特点。　方法　从 1992～ 2 0 0 3年住院的女性SLE患者中选出自然绝经至少 1年后发病的患者 (绝经组 ) 2 0例 ,并以同期住院的月经正常的 70例育龄期发病的患者 (育龄组 )和 4 3例男性患者 (男性组 )作为对照组 ,对比 3组间的临床资料。　结果　绝经组患者占女性患者的 2 9% ,其平均发病年龄为 5 5岁 (4 2～ 6 6岁 ) ,5 0～ 5 9岁为14例 (70 % )。常见的临床表现依次是关节炎、疲乏、发热、脱发、颊部皮疹、心脏损害和体重下降 ,而实验异常依次为血沉快、补体C3下降、抗核抗体 (ANA)≥ 1∶80、γ 球蛋白增高和抗RNP抗体阳性。与育龄组相比 ,绝经组体重下降、肌痛和肌无力的发生率均明显增高 (均为P <0 0 1) ,而颊部皮疹和肾损害的发生率明显降低 (分别P <0 0 5和 0 0 1) ,白细胞下降的发生率和ANA阳性率明显降低 (分别P <0 0 5和 0 0 1)。与男性组相比 ,绝经组狼疮活动性指数 (SLEDAI)平均得分明显降低 (P <0 0 5 ) ,肾损害发生率明显降低 (P <0 0 1) ,而疲乏和体重下降的发生率明显增高 (分别P <0 0 1和<0 0 5 ) ,尿蛋白≥ 1 0 g/d的发生率和抗双链DNA(ds DNA)抗体的阳性率明显降低 (分别P <0 0 1和 0 0 5 )。　结论　绝经后发病的狼疮患     

A longitudinal study of high and low avidity antibodies to double-stranded DNA in systemic lupus erythematosus

The role of avidity in the pathogenicity of double-stranded DNA/anti-double-stranded DNA immune complexes in systemic lupus erythematosus (SLE) has been controversial. We used polyethylene glycol to identify low avidity antibodies and the standard Farr assay to detect high avidity antibodies against double-stranded DNA in a longitudinal study of sera from 19 patients with SLE. We found that high and low avidity antibodies to double-stranded DNA did not move independently, but instead, rose and fell in a parallel and relatively fixed manner in these patients. The mechanisms responsible for the changes in titer of anti-double-stranded DNA antibody appeared nondiscriminatory in regard to avidity. In addition, the humoral immune response in SLE depicted by these antibody measurements appeared atypical, lacking maturational features.     

Non-tuberculous mycobacterial infection in patients with systemic lupus erythematosus

OBJECTIVES: Patients with systemic lupus erythematosus (SLE) are susceptible to opportunistic infections. To examine the clinical manifestations of non-tuberculous mycobacterial (NTM) infections with those of Mycobacterium tuberculosis (MTB) infections in SLE patients. METHODS: Medical records of a cohort of 725 SLE patients were reviewed for previous NTM infections. Demographic characteristics, predisposing factors and clinical outcomes were compared with patients who had previous MTB infections (n = 39). RESULTS: Eleven (nine female and two male) cases were identified (prevalence 1.5%). The mean +/- S.D. age at the time of infection was 42.8 +/- 13.9 yrs, 9.3 +/- 5.8 yrs after the onset of SLE. The mean +/- S.D. time taken from onset of symptoms to the diagnosis of NTM infection was 5.7 +/- 7.2 months. Sites of involvement included skin and soft tissue (n = 8), chest (n = 2) and disseminated infection (n = 1). NTM infections were more likely to involve extrapulmonary sites (P = 0.006), presented in patients with longer lupus disease duration (P < 0.001), occurred in older patients (P < 0.001) and in those who had a higher cumulative dose of prednisolone (P = 0.01) than MTB infections. Using a stepwise logistic regression, disease duration was found to be the only independent predictive factor (P = 0.005) for NTM infections. Ten (25.6%) patients with MTB infections but none of the patients with NTM infections presented concomitantly at the onset of SLE (P = 0.09). There were no differences in the recurrence rate (P = 0.64) and frequency of disseminated infections (P = 0.40) between NTM and MTB infections. CONCLUSIONS: NTM infections tended to develop in SLE patients later in their disease course than MTB infections. A high index of suspicion is required for its diagnosis.     

系统性红斑狼疮伴结核菌感染临床特点分析

目的 分析系统性红斑狼疮(SLE)并发结核菌感染的临床特点。方法 分析我院自1991年1月至2004年1月共收治的426例SLE住院患者。结果 426例SLE患者中18例伴有结核，患病率为4．2％，死亡7例，病死率为39％。明显高于普通人群。其中肺结核12例，结核性脑膜炎3例，淋巴结核3例。18例做结核菌素试验纯蛋白衍生物(PPD)强阳性2例(12．5％)，阴性16例(87，5％)，结核菌素试验PPD阴性率明显高于正常人群。15／18(83％)患者在应用免疫抑制剂6个月-3年内患结核。结论 SLE患者由于长期服用免疫抑制剂，易发生结核菌感染且临床表现不典型。其患病率及病死率均明显高于普通人群．因此对结核菌感染的早期诊治对降低病死率十分重要。     

Listeria monocytogenes infection in patients with systemic lupus erythematosus

Back problems and back pain are amongst the most prevalent conditions afflicting Australians and carry high direct and indirect costs for the health care systems of all developed countries. A major gap in the research literature on this topic is the longitudinal analysis of health seeking behaviour for people with back pain. All studies to date have been cross-sectional and it is important that the use of different providers (both conventional and complementary and alternative medicine, CAM) is examined over time. This study analysed data from a longitudinal study conducted over a 3-year period on 8,910 young Australian women. Information on health service use, self-prescribed treatments, and health status was obtained from two questionnaires mailed to study participants in 2003 and 2006. We found that there is little difference in the consultation practises or use of self-prescribed CAM between women who recently sought help for back pain and women who had longer-term back pain; the only difference being that women with longer-term back pain consulted more with chiropractors. We conclude that women who seek help for their back pain are frequent visitors to a range of conventional and CAM practitioners and are also high users of self-prescribed CAM treatments. The frequent use of a range of conventional providers and practitioner-based and self-prescribed CAM amongst women with back pain warrants further investigation.     

A case of acute pericarditis with hemophagocytic syndrome,cytomegalovirus infection and systemic lupus erythematosus

Hemophagocytic syndrome, cytomegalovirus infection and systemic lupus erythematosus (SLE) would each be critical diseases separately. Viral infections, autoimmune diseases or malignancies can complicate the Hemophagocytic syndrome. Cytomegalovirus infection is known to be prevalent in immune compromised hosts, and can exacerbate the symptoms of systemic lupus erythematosus. A 25-year-old man presented with fever and acute pericarditis with the hemophagocytic syndrome, cytomegalovirus infection and systemic lupus erythematosus; all developed concurrently at the onset of illness. With treatment, using ganciclovir and glucocorticoid medication the patient improved. Here we report this rare case and review the medical literature.