34例系统性红斑狼疮患者行中期引产术临床分析

目的：分析系统性红斑狼疮（SLE）患者于妊娠中期终止妊娠的原因及引产方式的选择,探讨SLE患者的生育管理和中期引产相关问题。方法：回顾性分析1994年1月—2012年4月收治的34例SLE患者于妊娠中期行中期引产的相关数据。引产原因分为可避免和不可避免2类,可避免中期引产指社会因素和SLE治疗中意外妊娠;不可避免中期引产包括胎儿因素、妊娠期SLE初发和疾病稳定期计划内妊娠后妊娠期SLE复发。结果：可避免中期引产者共15例（占44.1%）,不可避免中期引产者共19例（占55.9%）。引产方式中：12～16周行大钳刮术者3例,行米非司酮加米索前列醇药物引产者2例,17～28周行依沙吖啶羊膜腔内引产者25例,行剖宫取胎术者4例。除1 例钳刮时大出血外,无手术并发症。2组相比妊娠周及引产方式差异无统计学意义,但妊娠期疾病活动者在不可避免组（16/19）显著高于可避免组（6/15）,差异有统计学意义（P＜0.05）。结论：SLE妇女缺乏生育管理,应加强该人群的妊娠前和避孕咨询,以减少可避免的引产手术。此类患者的中期引产系高危手术,术前应全面评估,选择适合的手术方法以确保母亲的安全。     

Contraceptive Prevalence and Consulting Service in Women with Systemic Lupus Erythematosus: A Cross-Sectional Study

BackgroundSystemic lupus erythematosus (SLE), often affects women of childbearing age. Family planning consultation is a major aspect of medical care in these patients because of the risk of disease activation and poor pregnancy and fetal outcomes. The aim of the present study was to evaluate contraceptive prevalence and consulting service in women with SLE.MethodsIn a cross-sectional study, a total of 144 female patients with SLE, ages 15–50, who were presented to rheumatology clinics in Sari, north of Iran, were evaluated. The study was conducted between March 2019 and May 2020. Patients'' clinico-demographic profile and fertility information were obtained. Disease activity and damage were assessed by the systemic lupus erythematosus disease activity (SLEDAI) and Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI).ResultsOne hundred and forty-four SLE patients of childbearing age participated in this study. From 102 patients with the possibility of pregnancy, 36(35.2%) received contraceptive consultations in last year. Withdrawal was the most prevalent contraceptive method (41.7%), followed by permanent (11.8%), and barrier methods (9%). There were no significant differences in age, disease duration, marriage duration, SDI or SLEDAI scores between the women who received or not received contraceptive counseling (P>0.05).ConclusionMany SLE patients did not receive adequate information about contraception, and it may be associated with many adverse effects on disease activity and pregnancy outcomes. Therefore, contraceptive consultation as an important aspect of patient''s management is strongly suggested.     

Dietary Inflammatory Index Score and Cardiovascular Disease Risk Markers in Women with Systemic Lupus Erythematosus

BackgroundPatients with systemic lupus erythematosus (SLE), a chronic inflammatory autoimmune disease, have an increased risk of developing cardiovascular diseases. Environmental factors like diet and nutrition are known to play a key role in modulating inflammation and the prognosis of cardiovascular diseases.ObjectiveTo investigate the relationship between Dietary Inflammatory Index score and cardiovascular disease risk markers in a population of women with SLE.DesignA cross-sectional study was conducted in women with SLE recruited from 2016 through 2017.Participants/settingsClinically stable women with SLE were enrolled from three public hospitals in the Andalusian region of Spain. Participants with chronic renal failure, active infections, recent trauma, pregnancy, and/or other autoimmune diseases were excluded.Main outcome measuresA 24-hour diet recall was used to estimate Dietary Inflammatory Index score and physical activity was assessed through the International Physical Activity Questionnaires. Cardiovascular disease risk markers included blood lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels), high-sensitivity C-reactive protein levels, and homocysteine levels, along with diagnosis of obesity, diabetes mellitus, hypertension, dyslipidemia, and ankle-brachial index measurement.Statistical analysisComparisons of cardiovascular disease risk markers across Dietary Inflammatory Index score tertiles were analyzed through a one-way analysis of variance and linear regressions adjusting for age, physical activity level, and medical treatment.ResultsA total of 105 women (aged 45.4±12.8 years) were included. Linear regression analysis revealed that Dietary Inflammatory Index score was significantly associated with total cholesterol levels (β=.26, 95% CI 1.66 to 14.28; P=0.014) after adjusting for age, physical activity, and the use of medical treatment. No significant associations were observed between Dietary Inflammatory Index score and the other cardiovascular markers considered.ConclusionsHigher inflammatory potential of the diet was positively associated with higher total cholesterol levels in women with SLE. These findings suggest that the inflammatory potential of a person’s diet may play a role in lipid profiles in this population. Future intervention studies are needed to build on these results and explore the effect of anti-inflammatory diets on health outcomes in individuals with SLE.     

女性系统性红斑狼疮发病危险因素的病例对照研究

目的探讨系统性红斑狼疮(SLE)发病的相关危险因素,为SLE的病因学研究及一级预防提供理论依据。方法采用病例-对照研究方法 ,选取天津医科大学总医院感染免疫科121例SLE患者及妇科122例对照者进行问卷调查,采用非条件Logistic回归进行危险因素分析。结果单因素Logistic回归分析结果显示,居住环境潮湿(OR=3.60,95%CI:1.39~9.36)、其他结缔组织病(OR=14.88,95%CI:3.43~64.52)、药物过敏(OR=9.52,95%CI:3.58~25.31)、日光过敏(OR=9.78,95%CI:4.61~84.92)、扁桃腺炎(OR=4.06,95%CI:2.14~7.72)、不明原因发热(OR=33.06,95%CI:9.95~109.79)、流产手术(OR=7.53,95%CI:3.09~18.36)、绝育手术(OR=30.04,95%CI:3.88~232.92)、经量(OR=2.00,95%CI:1.08~3.69)、出生时母亲的年龄(OR=1.08,95%CI:1.02~1.15)、减肥(OR=3.57,95%CI:1.26~10.07)、工作应激事件(OR=25.41,95%CI:0.36~192.22)、接受家庭批评(OR=0.41,95%CI:0.27~0.62)与SLE的发病有统计学意义。多因素Logistic回归分析显示,其他结缔组织病(OR=12.12,95%CI:1.79~82.04)、药物过敏(OR=5.95,95%CI:1.73~20.52)、日光过敏(OR=21.91,95%CI:4.08~117.54)、不明原因发热(OR=27.53,95%CI:7.11~106.59)、流产手术(OR=4.87,95%CI:1.69~14.04)、工作应激事件(OR=18.72,95%CI:1.76~198.74)、居住环境潮湿(OR=6.42,95%CI:1.79~23.05)是SLE的影响因素。结论 SLE是一种反复发作的自身免疫性疾病,其病因复杂,因此,尽早明确其致病相关影响因素,对今后制定该病的相关防治措施意义重大。     

系统性红斑狼疮合并麻痹性肠梗阻的营养支持

目的探讨系统性红斑狼疮(SLE)合并麻痹性肠梗阻营养支持和综合治疗改善营养状况的方法。方法对5例临床确诊SLE合并麻痹性肠梗阻发生营养不良的患者,给予营养支持等综合治疗。结果经过肠外及肠内营养支持后,肠梗阻的症状改善,血清白蛋白由治疗前(25.3±6.9)g/L增至(32.2±8.5)g/L(P=0.09),总蛋白由(53.2±8.7)g/L增至(63.8±10.3)g/L(P=0.11),血红蛋白由(90.6±22.8)g/L增至(109.8±15.3)g/L(P=0.15),体重增长(1.3±2.4)kg,营养状况有改善的趋势并最终出院。结论SLE合并麻痹性肠梗阻可严重影响患者的营养状态,合理的肠外及肠内营养支持等综合治疗可能逐步改善患者的营养状态。     

系统性红斑狼疮HLA-DM基因与环境危险因素研究

目的探索HLA-DM基因及其与环境危险因素的交互作用对系统性红斑狼疮(SLE)发病的影响.方法采取病例对照研究,用PCR-RFLP的方法确定HLA-DM的基因型,用非条件logistic模型分析SLE的危险因素,用广义线性模型分析环境与基因的交互作用.结果共检测到3种DMA与4种DMB等位基因,其分布在SLE组与正常对照组分布一致.logistic模型分析显示SLE的环境危险因素有5个(潮湿、精神刺激、日晒、刀豆、扁桃体感染),女性个人婚育史因素有3个(出生时母亲的年龄、月经初潮年龄、流产次数).广义线性模型分析提示HLA-DMB*0102与扁桃体感染的交互项效应达到显著水平.结论有多个环境危险因素与SLE的发病有关,HLA-DM基因的遗传多态性对SLE发病及活动性没有独立作用,但HLA-DM基因与某些环境因素存在交互作用.     

A Population‐based Study of Perinatal Infection Risk in Women with and without Systemic Lupus Erythematosus and their Infants

Background

Increased risk of adverse birth outcomes is well described in women with systemic lupus erythematosus (SLE), but risk of maternal or infant infection in the peripartum period has not been well studied. We conducted a population‐based cohort study of infection risk in women with and without SLE and their infants.

Methods

Linked birth‐hospital discharge data identified 1297 deliveries to women with SLE and a 4:1 comparison cohort of deliveries to women without SLE in Washington State, 1987–2013. Maternal and infant infections during the first 30 days after delivery were identified. Relative risks (RR) and 95% confidence intervals (CI) were estimated.

Results

Women with SLE were 1.7 times more likely (95% CI 1.4, 2.0) to have an infection during the birth hospitalisation and more likely to receive antibiotics during labour (RR 1.3, 95% CI 1.1, 1.5), though there was no increased risk of chorioamnionitis in women with SLE. Infants of women with SLE had an increased risk for an infection during the birth hospitalisation (RR 2.2, 95% CI 1.3, 3.5), although the size of the difference was smaller when adjusted for gestational age (RR 1.4, 95% CI 0.9, 2.1). Risks of neonatal infection, sepsis, receipt of antibiotics, and admission to neonatal intensive care were also increased, and were also attenuated after adjustment for gestational age.

Conclusions

Women with SLE have an increased risk of peripartum infections and antibiotic exposure. Their neonates have a greater likelihood of infection, much of which is attributable to preterm birth.     

The Role of Spirituality in Sustaining the Psychological Well-Being of HIV-Positive Black Women

ABSTRACT

Historically, spirituality has been an instrumental component to the survival of Black women. In an era when the HIV epidemic disproportionately compromises their health, it is imperative to explore spirituality's role in sustaining the psychological health of Black women living with HIV. This study examined the relationship between spirituality and self-reported depression among Black women living with HIV. A sample of 308 HIV-positive Black women were recruited from HIV/ AIDS clinics in the Southeastern United States. Participants completed an interview assessing demographics, quality of life, depression, coping, and spirituality. A hierarchical multiple regression was used to determine the association between spirituality and depression. The results suggest that in our sample, spirituality accounted for a small, yet significant proportion of variance in reducing depressive symptoms, above and beyond variance accounted for by demographic variables and other theoretically important psychosocial factors. In light of these findings, future studies with HIV-positive Black women should assess spirituality as a salient factor affecting psychological health. Developing interventions that address spirituality may serve to enhance women's psychological adjustment to living with HIV.     

Role Involvement and Well-Being in Middle-Aged Women

ABSTRACT

Objectives: The aim of this research was to shed light on the relation of social role experiences and health to well-being outcomes of 198 middle-aged (40–55 years old) Swiss women living in various familial contexts (double-track women, i.e., partnered working mothers, homemakers, single mothers, single women).

Results: Our results revealed that the way roles were experienced was primarily a function of a specific living context and satisfying social resources. Double-track women and homemakers showed the highest social role satisfaction rates and had better health and well-being outcomes than other women. Common to all groups was a considerable difference between actual and desired role investment.

Discussion: The findings are discussed in terms of a resource-oriented model of well-being.     

Integration of Medical and Psychological Treatment within the Primary Health Care Setting

ABSTRACT

Integrated care entails the provision of behavioral health services within the primary care setting and emphasizes a collaborative approach between mental health professionals and primary care providers (Kenkel, Deleon, Orabona Mantell, Steep, 2005 Kenkel, M., Deleon, P., Orabona Mantell, E. and Steep, A. 2005. Divided no more: Psychology's role in integrated health care. Canadian Psychology, 4(3): 189–202.  [Google Scholar]). Research was collected to highlight the history, development, and implementation of integrated care within primary care facilities. The authors performed a comprehensive literature review of collaborative care and summarized the program design of the site where they work. It is hypothesized that integration will improve patient access to health care, increase the rate of evidence based practice, improve patient health and satisfaction, and reduce long-term costs.     

系统性红斑狼疮患者革兰阳性球菌感染病原菌分布及耐药性分析

目的 了解系统性红斑狼疮(SLE)患者革兰阳性球菌感染病原菌的种类、分布及耐药状况,指导临床医师合理使用抗菌药物.方法 应用ATB Expression自动细菌鉴定系统对菌种进行鉴定,用K-B纸片扩散法对病原菌进行药物敏感性试验.结果 481例SLE患者并发革兰阳性球菌感染122例,感染率为25.4%,例次感染率54.5%;共分离出病原菌262株,主要为金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、粪肠球菌、屎肠球菌;179株葡萄球菌属中检出耐甲氧西林葡萄球菌(MRS)124株,占69.3%;57株对红霉素耐药而克林霉素敏感的葡萄球菌属中,D试验阳性26株,占45.6%;替考拉宁和万古霉素对MRSA和MRCNS的抗菌活性高;粪肠球菌对青霉素、氨苄西林、呋喃妥因、替考拉宁和万古霉素的耐药率低;屎肠球菌仅对替考拉宁和万古霉素敏感;粪肠球菌及屎肠球菌对高浓度庆大霉素的耐药率为62.5%和74.2%;未检出耐替考拉宁及万古霉素肠球菌.结论 调查结果表明,SLE患者并发细菌感染的临床表现无特异性,对SLE患者并发革兰阳性球菌感染的治疗和抗菌药物的选用具有重要参考价值.     

Association of Polyphenols from Oranges and Apples with Specific Intestinal Microorganisms in Systemic Lupus Erythematosus Patients

Our group has recently shown the existence of a gut microbial dysbiosis in systemic lupus erythematosus (SLE), supporting previous evidence involving intestinal bacteria in the initiation and amplification of autoimmune diseases. While several studies have addressed the use of dietary fibres to modify intestinal microbiota, information about other correlated components, such as polyphenols, is scarce. The aim of this work was to identify dietary components able to influence this altered microbiota in 20 SLE women and 20 age-matched controls. Food intake was recorded by means of a food frequency questionnaire. The intake of fibres was calculated from Marlett tables, and Phenol-Explorer was used for polyphenol consumption. Results showed positive associations between flavone intake and Blautia, flavanones and Lactobacillus, and dihydrochalcones and Bifidobacterium in the SLE group. Regarding the controls, dihydroflavonols were directly associated with Faecalibacterium, whereas flavonol intake was inversely associated with Bifidobacterium. From the food sources of these polyphenols related to microbiota, orange intake was directly associated with Lactobacillus and apple with Bifidobacterium in SLE, whilst red wine was the best contributor to Faecalibacterium variation. The association between common foods and particular microbial genera, reported to be decreased in SLE, could be of great importance for these patients.     

系统性红斑狼疮患者革兰阴性菌感染病原菌分布及耐药性分析

目的 了解系统性红斑狼疮(SLE)患者革兰阴性菌感染病原菌的种类、分布及耐药性,为临床合理使用抗菌药物提供依据.方法 应用ATB Expression自动细菌鉴定系统对菌种进行鉴定,用K-B纸片扩散法对病原菌进行药物敏感性试验.结果 346例SLE患者并发病原菌感染112例,感染率为32.4%,例次感染率52.3%,共分离出病原菌181株,主要为大肠埃希菌(ECO)、铜绿假单胞菌(PAE)、肺炎克雷伯菌(KPN)、鲍氏不动杆菌(ABA)、奇异变形菌(PMI)、阴沟肠杆菌(ECL);大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)株检出率分别为27.5%和28.1%;药敏结果显示,哌拉西林/他唑巴坦和头孢吡肟对鲍氏不动杆菌抗菌作用差,对其他革兰阴性杆菌耐药率较低,分别为0～46.2%和13.0%～33.3%;美罗培南、亚胺培南及头孢哌酮/舒巴坦对革兰阴性杆菌的抗菌活性最强,耐药率分别为0～17.1%、0～22.9%和0～38.5%.结论 SLE患者并发病原菌感染的临床表现无特异性,本组资料对SLE病原菌感染的治疗和抗菌药物的选用具有重要参考价值.     

正念减压式护理对系统性红斑狼疮患者身心感受及睡眠情况的影响

目的探讨正念减压式护理运用在系统性红斑狼疮患者护理中的临床效果。方法将2016年3—6月收治的50例系统性红斑狼疮患者作为观察组,实施正念减压式护理;另选取2015年12月—2016年2月收治的50例系统性红斑狼疮患者作为对照组,实施常规护理,比较两组对象的护理效果。结果两组干预后SAS、SDS评分均有所改善,但组间比较观察组两项评分均低于对照组(P <0. 05);观察组干预后PSQI睡眠质量评分低于对照组,两项数据组间比较有统计学意义(P <0. 05);观察组干预后SF-36生活质量量表各指标评分均高于对照组,各项数据组间比较均有统计学意义(P <0. 05)。结论对系统性红斑狼疮患者实施正念减压式护理,可有效改善患者的心理状态和睡眠质量,方法值得在临床中借鉴。     

正常人与系统性红斑狼疮患者白细胞GPI-PLD基因多态性分析

目的检测湖南地区汉族系统性红斑狼疮(systemic lupus erydaematosus，SLE)患者外周血白细胞糖基化磷脂酰肌醇特异性磷脂酶D(glycosylpllosplhaftdylinositol-specific phospholipase D，GPI-PLD)基因外显子1及外显子25多态性、白细胞GPI-PLD活性及二者关系。方法聚合酶链式反应与单链构象多态性分析(PCR-SSCP)、测序技术进行多态性分析，利用自制具完整糖基化磷脂酰肌醇(GPI)结构的胎盘碱性磷酸酶(PLAP)做底物通过TX-114分相，定量检测白细胞中GPI-PLD活性。结果 湖南地区汉族62名SLE患者与109名正常人外周血白细胞GPI-PLD基因外显子1区均存在14处核苷酸改变：转录起始点上游-28A→C、-21C→T、-14G→A、-13G→C、-9T→C、-8G→C、-7G→C、 4T→G、密码子14TTG→AAG（Leu14Lys)、密码子17CTC→GTC（Leu17Val)、密码子20AGA→AAA(Arg20Lys)、密码子21GGT→GGG(Gly21Gly)、密码子30GTA→ATA(Val30lle)；另转录起始点上游-24C→T仅存在于SLE人群中，此变异在两组人群中具有显著性差异；该基因外显子25，即 60496G→A均存在于两组人群中。经SSCP检出阳性率分别为正常人33．03％，SLE患者25．81％。检测62例SLE患者外周血白细胞GPI-PLD活性(转化底物百分率)，发现SLE患者酶活性较正常人(109名)显著性增高，但与多态性位点未见明显相关性。结论湖南地区汉族系统性红斑狼疮患者与正常人外周血白细胞GPI-PLD基因具有多态性，且位于转录起始点上游-24位变异在两组人群中有显著性差异；SLE患者白细胞CPI-PLD酶活性较正常人明显增高。     

Associations between Ambient Fine Particulate Levels and Disease Activity in Patients with Systemic Lupus Erythematosus (SLE)

Background

Systemic lupus erythematosus (SLE) is a chronic disease of unclear etiology, characterized by an overactive immune system and the production of antibodies that may target normal tissues of many organ systems, including the kidneys. It can arise at any age and occurs mainly in women.

Objective

Our aim was to evaluate the potential influence of particulate matter (PM) air pollution on clinical aspects of SLE.

Methods

We studied a clinic cohort of SLE patients living on the island of Montreal, followed annually with a structured clinical assessment. We assessed the association between ambient levels of fine PM [median aerodynamic diameter ≤ 2.5 μm (PM_2.5)] measured at fixed-site monitoring stations and SLE disease activity measured with the SLE Disease Activity Index, version 2000 (SLEDAI-2K), which includes anti–double-stranded DNA (anti-dsDNA) serum-specific autoantibodies and renal tubule cellular casts in urine, which reflects serious renal inflammation. We used mixed effects regression models that we adjusted for daily ambient temperatures and ozone levels.

Results

We assessed 237 patients (223 women) who together had 1,083 clinic visits from 2000 through 2007 (mean age at time of first visit, 41.2 years). PM_2.5 levels were associated with anti-dsDNA and cellular casts. The crude and adjusted odds ratios (reflecting a 10-μg/m³ increase in PM_2.5 averaged over the 48 hr prior to clinical assessment) were 1.26 [95% confidence interval (CI), 0.96–1.65] and 1.34 (95% CI, 1.02–1.77) for anti-dsDNA antibodies and 1.43 (95% CI, 1.05–1.95) and 1.28 (0.92–1.80) for cellular casts. The total SLEDAI-2K scores were not associated with PM_2.5 levels.

Conclusions

We provide novel data that suggest that short-term variations in air pollution may influence disease activity in established autoimmune rheumatic disease in humans. Our results add weight to concerns that pollution may be an important trigger of inflammation and autoimmunity.     

甲氨蝶呤联合地塞米松鞘内注射治疗神经精神狼疮最佳剂量探讨

目的探讨甲氨蝶岭联合地塞米松鞘内注射治疗神经精神狼疮的最佳用药剂量。方法将64例神经精神狼疮病例随机分为对照组和高、中、低剂量组各16例。对照组应用激素常规全身治疗,观察组在此基础之上应用甲氨蝶呤联合地塞米松鞘内注射,不同分组采用不同剂量;比较各组治疗前后临床表现、血沉、脑脊液压力及蛋白化验改善情况。结果各组接受治疗后,上述各指标均优于冶疗前,差异具有统计学意义（P均〈0．05）;与对照组相比,治疗后各观察组绝大多数观察指标均得到显著改善（P均〈0．05）,而高剂量组各方面改善情况优势明显。结论对于神经精神狼疮的治疗,在全身常规应用激素的基础上,我们推荐鞘内注射甲氨蝶呤联合地塞米松的最佳剂量均为20mg。     

系统性红斑狼疮患者医院感染的特点及其危险因素分析

目的 了解系统性红斑狼疮(SLE)患者发生医院感染的特点及其危险因素.方法 将597例SLE患者根据其细菌学检查结果分为医院感染组与对照组进行对比分析.结果 呼吸道与肺部感染占36.0%,尿路感染29.0%,血液感染19.9%,其他感染15.1%;75.8%的患者医院感染发生缓慢或隐匿,感染多系条件致病菌引起,其中G-杆菌占45.6%,G+球菌40.9%,其他病原菌13.9%;SLE发生医院感染的独立危险因素是:肺部病变>3个系统器官受损,血浆白蛋白<30 g/L,长时间大剂量应用糖皮质激素(GC),应用超大剂量GC冲击疗法,GC联合应用细胞毒免疫抑制剂治疗,入院前应用广谱抗菌药物,住院时间>3周.结论 SLE患者发生医院感染以呼吸道及肺部感染最常见,机会性G-杆菌和G+球菌是其主要病原菌;临床表现不同于一般病原菌感染,原发病情控制后应尽可能减少GC的用量,谨慎应用超大剂量GC和GC联合细胞毒免疫抑制剂;尽量缩短住院时间有可能减少SLE患者医院感染的发生.