Frequency of HLA antigens in patients with psoriasis or psoriatic arthritis

A study of 138 patients with psoriasis--74 with psoriasis alone and 64 with psoriatic arthritis--revealed a significantly increased frequency of the HLA antigens A1, A28, B13, DR7 and MT3 in those with psoriasis alone and of Bw39 in those with psoriatic arthritis. The frequency of B17 was higher in both patient groups than in a control group of healthy individuals. The frequency of DRw6 was slightly higher in the patients with psoriasis alone (17.8%) than in the controls (4.7%), and that of DR7 was higher in the patients with psoriatic arthritis (52.9%) than in the controls (32.6%). Elevated levels of serum IgG and IgA along with positive results of tests for antinuclear antibody or rheumatoid factor or both were present in less than a tenth of the patients with psoriatic rash alone and in up to a third of those with psoriatic arthritis. Psoriatic arthritis was found to be less likely to develop in patients with purely guttate psoriasis than in those with other types of psoriasis. Clinical subtypes of psoriatic rash or psoriatic arthritis were not associated with the presence of particular HLA antigens.     

甘肃地区汉族人HLA—DR4基因检测与进展性类风湿性关节炎的关系

目的：探讨HLA—DR4基因与进展性类风湿性关节炎（RA）临床特征的关系。方法：记录73例类风湿关节病例的临床资料和相关实验室检查结果及HLA—DR4基因携带情况,并比较HLA—DR4阳性组与阴性组的临床表现、实验室指标、X线表现及功能分级。结果：HLA—DR4阳性27例,基因频率为37％,阴性46例。HLA—DR4阳性组关节肿胀指数、疼痛指数较高,晨僵持续时间较长,关节功能分级为Ⅲ～Ⅳ级的比例较高,出现骨质破坏比例也较高;HLA—DR4阳性组的ESR、CRP和RF,抗CCP抗体值高于阴性组。结论：甘肃地区汉族人RA患者的HLA—DR4阳性率与国内其他地区汉族人RA患者的阳性率较为接近。HLA—DR4阳性组的RA患者的病情相对较HLA—DR4阴性组的RA病例炎症活动严重,且进展较快,应积极联合治疗。     

HLA antigens and acetylcholine receptor antibodies in penicillamine induced myasthenia gravis

Antibodies to the acetylcholine receptor and HLA antigens have been studied in patients with myasthenia gravis occurring in association with penicillamine treatment. The properties of the antiacetylcholine receptor in these patients differed from those in patients with idiopathic myasthenia gravis in terms of specificity and affinity. These patients had an increased prevalence of HLA Bw35 and DR1 compared to controls and a decreased frequency of B8 and DR3 compared to patients with idiopathic myasthenia gravis. Likewise, they had a decreased frequency of DR4 compared to patients with rheumatoid arthritis. These data provide supportive evidence for a role for penicillamine in the induction of myasthenia gravis in genetically predisposed individuals.     

武汉籍汉族类风湿关节炎患者HLA-DRB1*04、*01基因分型和临床相关性研究

为探讨人类白细胞抗原(HLA)-DRB1*04、*01基因与武汉籍汉族类风湿关节炎(RA)的相关性.采用聚合酶链反应-序列特异性引物法(PCR-SSP),对78例RA患者和126例健康者的HLA-DRB1*01、*04基因型进行检测.结果显示RA患者DR4基因频率为52.5%,对照组为21.6%,2组有显著性差异(P＜0.01),DR1基因频率两组无差异(P＞0.05).RA患者HLA-DR4的主要亚型为DRB1*0405(32.1%)与对照组(6.3%)有显著性差异(P＜0.01).DR4阳性的RA患者的关节压痛数、关节肿胀数、类风湿因子(RF)阳性率、关节侵蚀性病变明显高于DR4阴性的患者(P＜0.01).提示HLA-DR4基因与RA患者易感性及疾病严重性相关,其主要亚型为DRB1*0405、DRB1*0401.DR4基因检测可作为一项病情严重程度及预后判断的辅助指标.     

HLA-DRB1 ALLELES GENOTYPING IN PATIENTS WITH RHEUMATOID ARTHRITIS IN CHINESE

ＨＬＡ－ＤＲＢ１ＡＬＬＥＬＥＳＧＥＮＯＴＹＰＩＮＧＩＮＰＡＴＩＥＮＴＳＷＩＴＨＲＨＥＵＭＡＴＯＩＤＡＲＴＨＲＩＴＩＳＩＮＣＨＩＮＥＳＥＺｈａｏＹａｎ（赵岩）；ＤｏｎｇＹｉ（董怡）；ＺｈｕＸｉｌｉｎ（朱席林）ａｎｄＱｉｕＣｈａｎｇｃｈｕｎ（邱长春）（Ｎ...     

Acute polyarthritis associated with active Epstein-Barr virus infection

Nine patients with an initial onset of symptoms of acute arthritis within the preceding four weeks were enrolled in a prospective serological study with clinical follow-up for six months to two years. Four adults with chronic rheumatoid arthritis and ten healthy adults were similarly studied. Serial titers measured included antibodies to Epstein-Barr virus (EBV) antigens, group B coxsackieviruses, rubella virus, cytomegalovirus, and herpes simplex virus. Serological evidence of active EBV infection was found in four of the patients with acute arthritis, none of the patients with chronic arthritis, and one of the ten healthy adults. There was no similar correlation between acute disease and presence of antibodies to the other viruses tested. We suggest that EBV may cause acute rheumatic illnesses more commonly than is currently appreciated but is probably not involved in the etiology of typical chronic rheumatoid arthritis.     

HLA抗原与胆石症关联研究

本文对37例胆石症病人作了HLA抗原测定并与100名健康人对照比较,发现胆石组HLA-CW_6、-DR_1、-DR_3及-DRW_8的分布频率分别为43.2％、21.6％、27％和40.5％.明显较对照组9％、2％、7％和9％的分布频率为高。其中-CW_6和-DR_1在胆囊结石组具有显著性;而-DRW_8抗原在胆管结石组中显著高于对照组。本组结果提示胆囊结石与胆管结石的易感基因可能存在于HLA不同的位点上。     

汉族类风湿关节炎患者人白细胞抗原DR抗原β链多态性分析

目的探讨人白细胞抗原（ＨＬＡ）ＤＲ抗原中同源表位与我国汉族类风湿关节炎（ＲＡ）的相关性。方法采用聚合酶链限制片段长度多态性分析方法对汉族人群中１００名健康者和３５例ＲＡ患者的ＤＲ抗原β链进行了分析。结果ＤＲ４频率在正常对照组为２４．０％,在ＲＡ患者为５１．４％（Ｐ＜０．０１,ＲＲ＝３．３）。含有ＱＫＲＡＡ或ＱＲＲＡＡ同源表位的ＤＲ抗原阳性率在正常对照组为３０．０％,在ＲＡ组为６５．７％（Ｐ＜０．０１）,在ＤＲ４＋正常对照组为７５．０％,及在ＤＲ４＋ＲＡ组为１００．０％（Ｐ＜０．０５）。在ＤＲ抗原的ＱＫＲＡＡ和Ｖ８５、Ｇ８６中有０～１个氨基酸被取代的个体中,ＲＡ占４８．８％,有２～３个氨基酸被取代者为１６．７％。结论ＤＲ４与我国汉族ＲＡ相关;ＤＲ抗原中ＱＫＲＡＡ或ＱＲＲＡＡ同源表位及Ｖ８５、Ｇ８６序列可能与ＲＡ的发病有关。     

广西壮族人群类风湿关节炎患者HLA-DR53、DR4基因及其与抗-CCP抗体的相关性研究

目的探讨广西壮族类风湿关节炎(RA)患者人类白细胞抗原(HLA)-DR53、DR4基因发生的频率数及其与抗-CCP抗体相关性。方法研究对象为49例RA患者及54例健康体检者,采用PCR-SSP法检测HLA-DR53、DR4基因;ELISA法检测抗-CCP抗体。结果 1DR4基因出现频率在RA患者与健康者相当(P>0.05)。2DR53基因出现频率在RA患者明显高于健康者(P<0.05)。3HLA-DR4基因阳性患者更易出现抗-CCP抗体阳性(P<0.05)。结论 1我区壮族人群DR4与RA的发病无相关。2DR4基因阳性RA患者更易出现抗-CCP抗体阳性。3DR53基因阳性RA者与抗-CCP抗体阳性无相关。     

Coxsackievirus and adenovirus infection. Association with acute febrile and juvenile rheumatoid arthritis.

The prearthritic manifestations of juvenile rheumatoid arthritis in a 16-year-old boy were associated with a rise in coxsackievirus B3 and A9 neutralizing antibody titers from 1:16 to larger than or equal to 1:512, and 1:64 to 1:512, respectively. Recurrent polyarthritis followed and has persisted for three years. Adenovirus 7 was isolated from the pericardial fluid of a 9-year-old girl in whom juvenile rheumatoid arthritis then developed. Of 11 patients with acute, nonspecific, febrile arthritis subsequently studied, fourfold or greater antibody elevations occurred against coxsackieviruses in five, and against rubella and varicella-zoster virus in two. Antibody titers against other viral (and Mycoplasma) antigens remained stable. These findings suggest that coxsackieviruses, as well as other common viruses, may cause acute, nonspecific, febrile arthritis. In certain instances, such infection may be related to the development of juvenile rheumatoid arthritis.     

类风湿关节炎患者外周血CD4+CD25+CD127-调节T细胞的检测及临床意义

目的探讨CD4＋CD25＋CD127-调节T细胞（Treg）在类风湿关节炎中的诊断价值及临床意义。方法选取42例类风湿关节炎（RA）患者和20正常健康者分为两组,采用流式细胞仪检测两组调节T细胞的表达频率,检测两组实验室指标,观察两组实验室指标与调节T细胞的关系。结果与正常对照组相比,RA组白细胞（WBC）、免疫球蛋白A（IgA）、抗链球菌溶血素O（ASO）、类风湿因子（RF）、糖酸蛋白（α1-AGP）、C反应蛋白（CRP）、血沉（ESR）显著升高（P〈0.05或P〈0.01）;血红蛋白（Hb）、CD25＋T细胞、CD4＋CD25＋T细胞、CD4＋CD25＋CD127-T细胞的表达频率降低（P〈0.05）。Spearman相关分析显示,CD25＋T细胞与Hb、IgM、ESR呈正相关,CD4＋CD25＋CD127-T细胞与IgM呈正相关（P〈0.01或P〈0.05）;CD25＋T细胞与RBC、IgA呈负相关,CD4＋CD25＋T细胞与补体C4呈负相关,CD4＋CD25＋CD127-T细胞与ASO呈负相关（P〈0.05）。结论CD4＋CD25＋CD127-Treg在RA患者的外周血中显著降低,并且与疾病的活动性高度相关,说明调节T细胞可能参与了RA的发病,早期检测可能为RA的诊断及治疗提供依据。     

Association of specific immune response to pork and beef insulin with certain HLA-DR antigens in type 1 diabetes

To test the association of HLA-DR antigens with high-responder and low-responder status to either beef or pork insulin, insulin antibodies in diabetic sera were separated into those with average low and those with average high affinity and their insulin-binding capacities for each insulin determined. Significantly less binding of pork insulin by the high affinity antibodies occurred in the group of patients with DR3 antigens compared with those with DR4 antigens (p less than 0.01) and DR3/4 antigens (p less than 0.01). The difference in the binding capacity of beef insulin by the high affinity antibodies between the groups with DR3 and DR4 antigens was less pronounced but still significant. The high-responder status of DR3/4 antigens to pork insulin suggests that the gene or genes associated with HLA-DR4, and responsible for a high response to pork insulin, are dominant to genes associated with HLA-DR3 and a low response. If extended to human insulin and different HLA-DR and HLA-B antigen patterns, these finding should help in the therapeutic selection of the appropriate insulin and thus reduce the induction of an anti-insulin response in patients with diabetes.     

类风湿关节炎临床检验诊断性能评价

目的:类风湿关节炎患者IL-1RI、RFs、IL-lβ、CDK2等重点指标进行检测诊断性能评价。方法:以我院2011年8月～2012年8月收治的85例类风湿性关节炎确诊患者作为研究对象,其中活动期37例,缓解期48例。对活动期与缓解期患者进行指标比较,同时采用ELISA方法检测并比较活动期组患者与同期收治的同例数上呼吸道感染和健康体检患者IL-1RI、RFs、IL-lβ、CDK2等指标。结果:类风湿活动期与缓解期比较IL-1RI差异无统计学意义(P>0.05),两组CDK2差异对诊断有统计学意义,与上呼吸道感染和健康组比较IL-1RI、CDK2经秩和检验具有统计学意义(P<0.05)。结论:IL-1RI在类风湿临床诊断中具有重要作用,RFs是一项类风湿关节炎临床活动重要指标,可能与炎症严重程度有关,CDK2或可为治疗类风湿关节炎提供支持,由于例数较少,指标包含种类也不够完全,检测结果对于诊断类风湿性关节炎尚不够确切,还需进一步深入研究。     

Red cell ferritin content: a re-evaluation of indices for iron deficiency in the anaemia of rheumatoid arthritis

In iron deficiency anaemia basic red cell content of ferritin is appreciably reduced. This variable was determined in 62 patients with rheumatoid arthritis to evaluate conventional laboratory indices for iron deficiency in the anaemia of rheumatoid arthritis. For 23 patients with rheumatoid arthritis and normocytic anaemia irrespective of plasma ferritin concentration, red cell ferritin content did not differ significantly from that for non-anaemic patients with rheumatoid arthritis. For 27 patients with rheumatoid arthritis and microcytic anaemia, the mean red cell ferritin content for patients with a plasma ferritin concentration in the 13-110 micrograms/l range was appreciably reduced. It was indistinguishable from that for patients with rheumatoid arthritis and classical iron deficiency anaemia, indicated by plasma ferritin concentrations of less than 12 micrograms/l. In contrast, the mean red cell ferritin content for patients with rheumatoid arthritis, microcytic anaemia, and plasma ferritin concentrations above 110 micrograms/l did not differ from that for patients with rheumatoid arthritis and normocytic anaemia. Oral treatment with iron in patients with rheumatoid arthritis, microcytic anaemia, and appreciably reduced red cell ferritin concentrations was accompanied by significant increases in haemoglobin concentration (p less than 0.01), mean corpuscular volume (p less than 0.01), and red cell ferritin contents (p less than 0.05). This treatment, however, did not produce any appreciable change in haemoglobin concentration in patients with rheumatoid arthritis, normocytic anaemia, and normal red cell ferritin contents. These findings suggest that the indices for iron deficiency in patients with rheumatoid arthritis and anaemia should include peripheral blood microcytosis together with a plasma ferritin concentration of less than 110 micrograms/l.     

Safety of low dose methotrexate in elderly patients with rheumatoid arthritis

Weekly low dose methotrexate is an established treatment for rheumatoid arthritis, but its use in elderly people has not been adequately examined. The aim of this study was to evaluate its safety in elderly patients with rheumatoid arthritis. A retrospective review of the clinical records of rheumatoid arthritis patients over the age of 65 attending a rheumatology unit was conducted. Eligible patients were followed for at least two years and treated with methotrexate in a dose of 7.5 mg/week while being maintained on concurrent treatment. Thirty three patients were studied. Their mean age was 78.8 years; 32 were female and one was male. Treatment was discontinued in four patients, two because of raised serum liver enzymes and two because of gastrointestinal irritation. No serious adverse events were reported. After two years, haemoglobin levels increased from a mean (SD) of 12.4 (1.3) g/dl to 13.0 (1.1) g/dl (r = 0.226, p < 0.005). The white blood count was significantly reduced from 7.9 (1.8) x 10(9)/l to 6.8 (1.7) x 10(9)/l (r = 0.184, p < 0.05). No episodes of neutropenia or agranulocytosis were observed. There was a non-significant decrease in platelet count. The erythrocyte sedimentation rate decreased from 56.8 (30.8) to 35.2 (24.6) mm/h (r = 0.246, p < 0.01). In conclusion, low methotrexate treatment in elderly patients appears to be safe. Routine determination of serum liver enzymes and renal function may reduce individual risk.     

Cardiac rheumatoid nodules

Rheumatoid nodules in the heart are unusual specific manifestations of rheumatoid arthritis. This paper describes three cases in which these nodules were found at necropsy. The patients were women with long histories of rheumatoid arthritis, two of whom had significant but unexplained congestive cardiac failure. The rheumatoid nodules were present in the patients' myocardium and in one patient's pericardium. We suggest that in patients with rheumatoid arthritis with severe but unexplained cardiac failure, the possibility of rheumatoid nodules in the heart should be considered.     

抗环瓜氨酸肽抗体在类风湿性关节炎诊断中的应用

目的探讨抗环瓜氨酸肽（CCP）抗体在类风湿性关节（RA）炎诊断中的应用价值。方法用酶联免疫吸附试验（ELISA）法分别检测109例RA、42例其他风湿免疫病患者及30例健康体检者血清中的抗-CCP抗体,用速率散射比浊法检测类风湿因子（RF）,并进行比较分析。结果抗CC-P抗体和RF的敏感性分另q为62．4％和70．6％,差异无统计学意义（X2=3．5,P〉0．05）;抗-CCP特异性为95．8％,明显高于RF的81．9％,两者之间有显著性差异（X2=38．2,P〈0．01）。两者联合检测敏感性下降（56．0％）,特异性却升高（98．6％）;两者总体符合率78．9％;抗CC—P与RF检测对RA的诊断差异无统计学意义（X2=2．8,P〉0．05）,两者之间存在明显的相关性（r=0．547,P〈0．01）。结论抗-CCP抗体是诊断RA的一个高度特异性指标,有很好的临床应用价值。     

辅助T细胞多巴胺受体(DR)表达对类风湿关节炎(RA)患者疾病活动度的影响

 目的 检测类风湿关节炎(rheumatoid arthritis,RA)患者外周血辅助T淋巴细胞(T helper cells,Th cells)不同亚群细胞膜表面多巴胺受体(dopamine receptor,DR)水平,分析其与疾病活动度、实验室指标及功能状态之间的关系。方法 选取25位初诊或3个月内未接受DMARDs治疗的RA患者(DAS28>3.2),12位健康对照及13位同期年龄匹配的骨关节炎(osteoarthritis,OA)患者。采用流式细胞术检测患者外周血Th细胞亚群表面DR1~DR5的表达情况,分析Th细胞DR表达水平与人口学资料、实验室检查、功能状态及疾病活动度之间的相关性。结果 RA组Th2细胞百分比为1.28%(0.74%~2.68%),较健康对照组(中位数0.18%,四分位数间距0.11~0.31%,P<0.001)及OA组(中位数0.48%,四分位数间距0.03%~1.47%,P=0.029)明显升高。RA组Th2细胞DR2表达水平为25.40%(四分位数间距3.79%~37.10%),明显高于健康对照组(中位数3.74%,四分位数间距0.00%~12.98%,P=0.006)及OA组(中位数3.45%,四分位数间距0.00%~20.55%,P=0.040)。RA组Th2细胞DR4表达量也高于健康对照组和OA组(健康对照组vs.RA组,P=0.022;OA组vs.组,P=0.010)。Th2细胞与关节肿胀数(swollen joint count,SJC)和简化疾病活动指数(SDAI)呈正相关(分别为r=0.421,P=0.036;r=0.396,P=0.050)。Th1细胞DR5百分比分别为2.22% (四分位数间距0.57%~12.24%)与SJC及临床疾病活动指数(CDAI)呈正相关(分别为r=0.492,P=0.012;r=0.445,P=0.026)。Th2细胞DR1和DR3百分比分别为11.15%(四分位数间距2.93%~36.20%)、9.80%(1.62%~23.05%),均与健康评估问卷(Health Assessment Questionnaire,HAQ)评分呈负相关(分别为r=-0.469,P=0.018;r=-0.464,P=0.019)。结论 RA患者Th2细胞多巴胺受体DR2和DR4明显升高,Th细胞DR水平与RA患者SJC、CDAI及HAQ存在相关性。     

类风湿关节炎诊治中的血脂变化研究

目的观察血脂变化在类风湿关节炎诊治中的临床价值。方法 86例类风湿关节炎（RA）患者,通过抗风湿药物和小剂量激素治疗1年后,对治疗前后的血沉、C反应蛋白、类风湿因子、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇进行检测,分析血脂变化在诊治中的价值。结果类风湿关节炎患者治疗后血沉、C反应蛋白、总胆固醇都明显低于治疗前（P〈0.05）,而高密度脂蛋白胆固醇较治疗前有明显的升高（P〈0.05）。但治疗前后低密度脂蛋白胆固醇和三酰甘油变化不明显（P〉0.05）。血沉与高密度脂蛋白胆固醇呈负相关（P〈0.05）,C反应蛋白、类风湿因子与高密度脂蛋白胆固醇未出现相关性（P〉0.05）。结论血脂变化在类风湿关节炎的诊治中具有重要价值,类风湿关节炎与脂代谢、炎症反应有着密切的关系。     

云克治疗类风湿关节炎的临床观察

目的：观察云克治疗类风湿性关节炎的疗效。方法：采用云克对65例类风湿性关节炎患者进行治疗,观察治疗前后临床表现及治疗的效果。结果：云克治疗类风湿性关节炎的总有效率为95．8％。结论：云克治疗类风湿关节炎能改善临床症状及实验室指标,远期疗效好,毒副作用小。