系统性红斑狼疮患者热休克蛋白90和白细胞介素18的表达及意义

目的:研究系统性红斑狼疮(SLE)患者热休克蛋白90(HSP90)和血浆白细胞介素18(IL-18)的表达水平及与疾病活动的关系。方法:运用Westernblot技术检测SLE患者外周血单个核细胞HSP90的表达,ELISA方法检测血浆中的IL-18水平,并与SLE疾病活动指数(SLEDAI)进行相关性分析。结果:⑴SLE患者HSP90的表达水平在活动期组(0.82±0.10)和稳定期组(0.54±0.09)与正常对照组(0.37±0.11)比较均具有显著性差异(分别P<0.01),且活动期组较稳定期组增高更明显(P<0.01);⑵SLE患者血浆IL-18水平在稳定期组(327.82±101.45pg/ml)和活动期组(459.79±134.08pg/ml)均显著高于正常对照组(252.32±76.45pg/ml)(分别为P<0.05,P<0.01);⑶SLE患者的HSP90和IL-18水平与SLEDAI评分之间呈正相关(分别为r=0.80,P<0.01;r=0.49,P<0.01)。结论:SLE患者外周血单个核细胞HSP90和血浆IL-18水平均显著增高,并且与SLE的病情活动密切相关,可能在SLE的发病机制中发挥重要作用。     

Periodontal Treatment Reduces Chronic Systemic Inflammation in Peritoneal Dialysis Patients

Chronic systemic inflammation, a non traditional risk factor of cardiovascular diseases, is associated with increasing mortality in chronic kidney disease, especially peritoneal dialysis patients. Periodontitis is a potential treatable source of systemic inflammation in peritoneal dialysis patients. Clinical periodontal status was evaluated in 32 stable chronic peritoneal dialysis patients by plaque index and periodontal disease index. Hematologic, blood chemical, nutritional, and dialysis‐related data as well as highly sensitive C‐reactive protein were analyzed before and after periodontal treatment. At baseline, high sensitive C‐reactive protein positively correlated with the clinical periodontal status (plaque index; r = 0.57, P < 0.01, periodontal disease index; r = 0.56, P < 0.01). After completion of periodontal therapy, clinical periodontal indexes were significantly lower and high sensitivity C‐reactive protein significantly decreased from 2.93 to 2.21 mg/L. Moreover, blood urea nitrogen increased from 47.33 to 51.8 mg/dL, reflecting nutritional status improvement. Erythropoietin dosage requirement decreased from 8000 to 6000 units/week while hemoglobin level was stable. Periodontitis is an important source of chronic systemic inflammation in peritoneal dialysis patients. Treatment of periodontal diseases can improve systemic inflammation, nutritional status and erythropoietin responsiveness in peritoneal dialysis patients.     

51例系统性红斑狼疮患者妊娠结局

目的研究系统性红斑狼疮(systemic lupus erythematosus,SLE)患者妊娠不良结局的发生率及引起不良结局的相关因素。方法回顾性分析51例在本院风湿免疫科规律随访并最终在本院产科分娩的SLE患者的病历资料,总结患者的妊娠结局、新生儿情况以及妊娠期间服用药物、分娩前SLE疾病活动度评分(systemic lupus erythomatosus disease activity index,SLEDAI)。比较不同疾病活动度组患者在药物治疗、不良妊娠结局发生率方面的不同,并比较不良妊娠结局组(妊娠胎儿丢失、新生儿死亡)与活产组患者药物治疗及疾病活动情况。结果 51例SLE患者的平均年龄(28.0±3.9)岁,平均病程(4.7±4.5)年,妊娠期间26例(51.0%)应用羟氯喹治疗,31例(60.8%)应用糖皮质激素治疗,平均剂量为泼尼松5 mgd(0~30 mgd)。分娩(或引产)前51例患者的SLEDAI为(11.8±10.3)分,其中SLE中-重度活动组患者20例(39.2%),8例(15.7%)引产;病情缓解-轻度活动组患者31例,无1例引产。共出生新生儿45例(其中2对双胎),新生儿死亡2例(4.4%);活产43例新生儿中2例(4.7%)发生新生儿狼疮。与疾病缓解-轻度活动组患者相比,中-重度活动组患者的平均住院时间[(25.5±14.0)vs.(13.5±8.5)]、胎儿丢失率[10(50.0%)vs.0(0.0)]及早产率[9(63.6%)vs.9(21.4%)]均显著高于前者,差异有统计学意义(均P0.05);而应用糖皮质激素比例[8(40.0%)vs.23(60.7%)]及用药剂量[0(0,30)mg vs.6(0,20)mg]更低,但差异无统计学意义(P0.05)。不良妊娠结局(胎儿丢失及新生儿死亡)组分娩(或引产)前SLEDAI明显高于活产组[(21.3±8.9)vs.(7.1±7.9),P0.01],而妊娠期糖皮质激素应用比例少于活产组(30.0%vs.68.3%,P=0.032),但两组在羟氯喹应用剂量上无明显差别[0(0,20)mg vs.6(0,30)mg,P=0.096]。结论分娩前SLE活动度与妊娠不良结局(如胎儿丢失、早产及新生儿死亡)有关,疾病活动度高是发生妊娠不良结局的危险因素。     

系统性红斑狼疮相关性输尿管和膀胱病变

目的:分析系统性红斑狼疮(SLE)罕见的临床并发症?膀胱和输尿管病变,以引起临床医师的重视。方法:回顾性分析本院风湿科SLE患者33例,其中合并排尿异常(尿频、尿急、或排尿困难,但无尿痛)者11例为疾病组,并按1∶2比例选定排尿正常者22例为对照组。结果:11例疾病组均无尿路感染,9例(81.8%)患者排尿异常出现于病程1年以内。其中10例抗ds-DNA阳性(90.9%),4例抗rRNP阳性(36.3%),6例并发假性肠梗阻(54.6%),其发生率均明显高于对照组(P<0.05)。所有患者均给予免疫抑制治疗,其中8例临床症状好转(72.7%)。结论:膀胱和输尿管功能障碍是SLE罕见的并发症,主要见于女性,常与假性肠梗阻合并出现。及早诊断,肾上腺糖皮质激素和免疫抑制剂环磷酰胺联合治疗可改善患者预后。     

Hyperhomocysteinaemia and Risk of Thrombosis in Systemic Lupus Erythematosus Patients

Hyperhomocysteinaemia is strongly associated with increased relative risk of occlusive vascular disease, mainly of the carotid and coronary arteries. The aim of our study was to assess whether raised plasma homocysteine is a risk factor for thrombotic events in patients with systemic lupus erythematosus (SLE), a condition known to be associated with premature atherothrombotic complications. The study included 34 consecutive consenting SLE patients who were seen in the Rheumatology Unit of Al-Amiri hospital, one of the main teaching hospitals in Kuwait. Twenty consenting healthy subjects were included in the control group. Twenty-four patients were grouped as SLE without thrombosis and 10 had different types of thromboses. Vitamin B₁₂, folate, anticardiolipin antibodies (IgG and IgM), activated partial thromboplastin time (APTT) and total homocysteine level were measured for both patients and controls. A raised homocysteine concentration was defined as plasma homocysteine level above 9.4 mmol/l. Hyperhomocysteinaemia was found in 21 (61.8%) SLE patients. Low levels of folate and vitamin B₁₂ were significantly associated with high concentrations of plasma homocysteine (r = −0.35 and −0.39, respectively, P<0.01). SLE patients with elevated homocysteine concentration have a threefold increase in odds ratio of thrombotic events after adjusting for other risk factors (male sex, shortened APTT, treatment with prednisone, low folate and vitamin B₁₂ levels). We concluded that homocysteine is an independent risk factor for thrombosis in patients with SLE and is potentially modifiable. Received: 27 December 2001 / Accepted: 14 April 2002 Correspondence and offprint requests to: Dr I. H. Al-Salem, PO Box 16434, Al-Qadeseyah 35855, Kuwait. Tel: 965 2532025; Fax: 965 2666205; E-mail: driqbalham@hotmail.com     

系统性红斑狼疮患者动脉脉搏波速度的临床研究

目的:研究系统性红斑狼疮(SLE)患者动脉脉搏波速度及其影响因素。方法:选择66例SLE患者(SLE组)和33例正常对照者(正常对照组)应用脉搏波速度(PWV)测量仪测定颈动脉—股动脉PWV(C-F PWV)及颈动脉—桡动脉PWV(C-R PWV)作为反应动脉扩张性的指标。SLE患者同时记录疾病活动情况及治疗相关参数。结果:C-F PWV和C-R PWV在SLE组显著升高,分别为(8．4±1．5)m/s,(9．8±1．9)m/s,正常对照组的C-F PWV和C-R PWV分别为(7．5±1．1)m／s,(8．0±1．0)m／s,P值分别为0．0007,0．0001,SLF组脉压明显高于正常对照组,分别为(43．0±8．5)mmHg,(38．4±6．2)mmHg,P值为0．0074。结论:本研究首次显示了SLE患者的PWV显著升高,提示SLE患者存在动脉扩张性的降低。     

系统性红斑狼疮合并心力衰竭的发病机制及病因

系统性红斑狼疮患者合并心力衰竭较普通人群常见,在不同年龄、性别和种族之间的发病风险存在较大差异。炎症和免疫反应可能是系统性红斑狼疮合并心力衰竭的主要发病机制。冠心病、高血压、糖尿病和瓣膜性心脏病是其发病的重要原因。     

系统性红斑狼疮男性患者临床及免疫学特征

目的 分析142例男性系统性红斑狼疮(SLE)患者起病时首发及发病过程中临床表现特征、自身抗体分布以及其他实验室指标改变特征,探讨SLE男性患者的临床及免疫学特征.方法 收集1994年4月至2010年4月于本院风湿免疫科住院的男性SLE患者142例,年龄12 ～ 68岁,平均年龄31.9岁;同期住院女性SLE患者320...     

43例系统性红斑狼疮病人的心电图分析

目的 分析系统性红斑狼疮病人的心电图表现。方法 对汕头大学医学院第一附属医院收治的107例系统性红斑狼疮病人，应用心电图仪行常规心电图检查，并分类统计。结果 107例系统性红斑狼疮病人中心电图异常43例，其中窦性心动过速24例（22．4％）．ST-T改变11例（10．3％）其他8例；期前收缩1例（0．9％）；低电压9例（8．4％）；左室高电压2例（1．9％）；房室传导阻滞3例（2．8％）。结论 系统性红斑狼疮的心电图改变常见。提示临床可将心电图作为系统性红斑狼疮心脏损害的常规检查。     

系统性红斑狼疮伴视网膜中央动脉阻塞和脑出血1例报告及文献复习

目的：提高对系统性红斑狼疮合并视网膜中央动脉阻塞的认识。方法：报道1例系统性红斑狼疮合并视网膜中央动脉阻塞,并且复习有关文献。结果：确诊系统性红斑狼疮合并视网膜中央动脉阻塞1例,该患者血清抗核抗体高滴度阳性,抗心磷脂抗体阳性,予以糖皮质激素、免疫抑制剂、改善微循环及对症支持治疗,期间患者出现脑出血,手术后病情稳定。结论：系统性红斑狼疮同时出现视网膜血管阻塞与脑循环障碍,提示病情严重,可能与抗磷脂抗体存在重要关联。