Detection of circulating antibodies in the blood and immune complex precipitates of patients with autoimmune diseases (preliminary report)]

Antibodies against ENA (Extractable Nuclear Antigens), SSA/Ro and SSB/La were investigated in parallel in the serum and the immune complex precipitates of 41 patients with autoimmune disease (10 systemic lupus erythematosus, 23 discoid lupus erythematosus, 3 subacute cutaneous lupus erythematosus, and 5 progressive systemic sclerosis). It was demonstrated that in some cases the autoantibody spectrum of the serum did not coincide with that of the immune complex precipitate. In the majority of patients the protein content of isolated immune complexes was increased and the increase was attributed to IgG solely. In some patients antibodies appeared not only in the serum but also in immune complex, even in 4 patients (2 systemic lupus erythematosus, 1 subacute cutaneous lupus erythematosus, and 1 progressive systemic sclerosis) antibodies were detected only in the immune complex precipitate.     

Anti-lactoferrin antibodies in patients with connective tissue diseases

AIM: To study the prevalence of antineutrophil cytoplasmic antibodies against lactoferrin in patients with connective tissue diseases and to characterize the antibody response to lactoferrin in these patients. METHODS: Sera from 60 patients with systemic lupus erythematosus, 98 with rheumatoid arthritis, 11 with systemic sclerosis, and 6 with mixed connective tissue disease were studied. The presence of anti-lactoferrin antibodies was detected by enzyme-linked immunosorbent assay. The IgG subclass reactivity of antibodies to lactoferrin was analyzed by biotin-extravidin amplified enzyme-linked immunosorbent assay and monoclonal antibodies to human IgG subclasses. RESULTS: Anti-lactoferrin antibodies were found in 15 patients (5 patients with rheumatoid arthritis and 10 with systemic lupus erythematosus). IgG1 was the predominant subclass for antibodies to lactoferrin. CONCLUSION: Patients with connective tissue diseases are known to develop multiple auto-antibodies; anti-lactoferrin antibodies mainly of IgG1 isotype can also be found in patients with rheumatoid arthritis and more often in patients with systemic lupus erythematosus.     

系统性红斑狼疮心脏损害50例临床分析

目的分析系统性红斑狼疮并发心脏损害的临床特点,探讨心脏受累的相关危险因素。方法回顾性分析2005年3月至2013年5月我院系统性红斑狼疮合并心脏损害50例患者的临床资料。结果 139例中有50例存在心脏损害,占35.97%,其中ECG ST-T改变21例;心包积液15例,心肌损害8例,肺动脉高压8例,瓣膜病5例,心律失常4例。心脏损害组与无心脏损害组年龄、性别差异无统计学意义(P>0.05),病程差异有统计学意义(P<0.05)。结论系统性红斑狼疮并发心脏损害常见,可累及心脏各个部位,其中ST-T改变和心包受累最为常见。心脏损害与病程有关。     

Association of systemic lupus erythematosus and Sjögren's syndrome

INTRODUCTION: Systemic lupus erythematosus and Sj?gren's syndrome are multisystemic autoimmune diseases which can be associated to each other. OBJECTIVE: To investigate if there are any distinct clinical, laboratory or serologic features due to the association of the two diseases that can influence the follow up of these patients. PATIENTS AND METHODS: The authors proved the association of these two autoimmune diseases in 56 patients, and these patients' clinical, laboratory and immunoserologic alterations. 50 patients with Sj?gren's syndrome and 50 patients with systemic lupus erythematosus were used as control groups. RESULTS: Compared with Sj?gren's syndrome alone, in the cases of the association of the diseases, rheumatoid factor was present less frequently, Ro/SS-A, La/SS-B and DNA antibodies were present more frequently, such as antiphospholipid autoantibodies and antiphospholipid syndrome. Anaemia, leukopenia and lymphopenia were detected more often and the patients were younger than in Sj?gren's syndrome. Also, affection of the lung, kidney, skin, central nervous system and serous membranes are more common. The group with systemic lupus erythematosus differs in being older, having thyroiditis, Ro/SS-A, La/SS-B and DNA more frequently. CONCLUSION: Definitive clinical, laboratory and serological features make the difference between the association of the two diseases and the diseases observed alone.     

抗中性粒细胞胞浆抗体与抗核抗体联合检测在系统性红斑狼疮中的临床意义

目的:探讨系统性红斑狼疮(SLE)患者血清中抗中性粒细胞胞浆抗体(ANCA)及抗核抗体(ANA)联合检测的临床意义。方法:采用间接免疫荧光技术(IIF)检测并回顾性分析84例SLE患者和52例健康体检者(正常对照组)血清ANCA阳性率及荧光免疫模型,同时采用酶标免疫吸附法(ELISA)进行抗核抗体(ANA)检测。结果:84例SLE患者中,ANCA阳性28例(33.3%),正常对照组无ANCA阳性。28例AN-CA阳性组中,狼疮活动18例(64%),56例ANCA阴性组中狼疮活动22例(39.3%),两组阳性率差别有统计学意义(P<0.01);84例SLE患者中ANA检出58例(69.0%),正常对照组52例中2例ANA阳性,阳性率为(3.84%)。ANCA与ANA联合检测,ANCA阳性ANA阳性共70例,敏感性为83.3%,显著高于两者单独检测时的敏感性(P<0.01)。结论:联合ANCA、ANA检测有助于提高SLE的诊断的敏感性,ANCA与狼疮活动力具有相关性。     

Hyperprolactinemia in systemic lupus erythematosus. A prospective study of 38 cases

OBJECTIVE: To study prospectively the serum prolactin concentrations among patients with systemic lupus erythematosus and their possible relationship to disease activity and manifestations. METHODS: Serum prolactin levels were measured by radioimmunoassay in 38 patients with systemic lupus erythematosus and 22 age matched controls. Patients with known secondary causes for hyperprolactinaemia, such as pregnancy, lactation, prolactinoma and taking medications known to induce prolactin secretion, were excluded from the study. Demographic, clinical and laboratory features of the patients were obtained. Patients were divided into two subgroups according to their disease activity. Mean prolactin levels from both groups were compared using student test, and prolactin from patients with systemic lupus erythematosus was correlated with variables of disease activity, including the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). RESULTS: Mean prolactin levels were higher in patients with systemic lupus erythematosus (15.4) than healthy controls (9.83); however, the difference did not reach statistical significance (p=). Hyperprolactinemia was found in 24 patients with systemic lupus erythematosus and 5 controls. The frequency of hyperprolactinaemia in systemic lupus erythematosus group was higher than healthy controls. No significant difference in mean prolactin levels was found between patients with active versus inactive disease (18.9 vs 18.5). CONCLUSION: Hyperprolactinaemia occurred significantly in patients with systemic lupus erythematosus, but did not correlate with disease activity.     

Beneath the surface: derm clues to underlying disorders

When evaluating patients with suspected cutaneous lupus erythematosus, use multiple criteria--including histologic and immunofluorescent biopsy findings and American College of Rheumatology criteria--to rule out systemic disease.     

系统性红斑狼疮肾炎患者血清AnuA、抗dsDNA抗体检测的临床意义

目的探讨系统性红斑狼疮患者血清抗核小体抗体（AnuA）、抗dsDNA抗体检测的临床意义。方法分别采用酶联免疫吸附法（ELISA）、胶体金免疫渗滤法对108例系统性红斑狼疮（其中51例系统性红斑狼疮肾炎和57例系统性红斑狼疮无肾炎）患者血清进行AnuA、抗dsDNA抗体检测。结果51例系统性红斑狼疮肾炎（LN）患者，AnuA阳性30例，阳性率58．82％，抗dsDNA抗体阳性36例，阳性率70．58％。而57例SLE无肾炎患者组中，两者的阳性率分别为21．05％、31．58％。AnuA＋抗dsDNA抗体联合检测阳性率为86．27％。结论血清AnuA、抗dsDNA抗体与LN的发生密切相关，联合检测这两种抗体对LN的诊断和病情监测有重要意义。     

173例系统性红斑狼疮患者ANA﹑ENA和dsDNA抗体的联合检测分析

目的:探讨ANA、ENA和dsDNA抗体联合检测在系统性红斑狼疮诊断中的意义。方法:收集173例患者血清,采用间接免疫荧光法检测ANA和dsDNA,用免疫印迹法测定ENA。结果:女性患者三种抗体同时阳性的检出率明显高于男性;患者血清中ANA阳性率为94.8%,抗dsDNA抗体为45.1%,抗Sm抗体为32.2%。结论:ANA﹑ENA和dsDNA三类抗体在SLE中的敏感性有显著的差异。这三类抗体的联合检测对SLE具有诊断意义。     

Is the primary antiphospholipid syndrome a forerunner of SLE?

INTRODUCTION: Antiphospholipid syndrome is a multi-organ autoimmune disorder, characterized by arterial and venous thrombotic events, and a well-defined group of recurrent foetal wasteage due to pathologic antibodies against phospholipids and protein co-factors. Antiphospholipid antibodies can be formed in primary antiphospholipid syndrome, but also in other conditions, most often in systemic lupus erythematosus. This may modify the outcome of lupus increasing the risk for thrombotic complications. Less is known about the outcome in primary antiphospholipid syndrome, whether it may precede the development of systemic lupus. AIMS: Authors hereby describe the case of four patients with primary antiphospholipid syndrome in whom the disease progressed to systemic lupus erythematosus. RESULTS: Lupus followed the primary antiphospholipid syndrome within around a three-year period. It was indicated by the appearance of different antinuclear autoantibodies and clinical complications, such as polyarthritis, nephritis and hematologic disturbances. All of the patients presented cerebrovascular accident as the thrombotic manifestation. All but one, were around forty years old, and had a milder form of lupus. Symptoms of the antiphospholipid syndrome determined the outcome. On the other hand, a typical lupus developed in the youngest patient. CONCLUSIONS: According to present cases antiphospholipid syndrome may be considered as the initiative phase of SLE, but APS being a separate entity also may associate to lupus. Present observations indicate the importance of follow-up the patients with APS by immunologic respect. Future prospective, multi-centre studies with larger number of cases are needed to provide further evidence on the fact that patients with APS may acquire other autoimmune disorder.     

系统性红斑狼疮患者皮肤损伤和狼疮性肾炎生物标志物的鉴定

目的 探索系统性红斑狼疮(systemic lupus erythematosus,SLE)患者皮肤损伤和狼疮性肾炎(lupus nephritis,LN)的蛋白质生物标志物,为SLE的诊断和控制提供依据.方法 采用高通量蛋白质芯片技术检测SLE患者血清蛋白质生物标志物,针对皮肤损伤和LN这2种并发症对生物标志物进行单...     

联合检测抗核小体抗体和抗dsDNA抗体对SLE疾病活动和脏器损害的意义

目的探讨联合检测抗核小体抗体(AnuA)、抗dsDNA抗体对系统性红斑狼疮(SLE)疾病活动和脏器损害的意义。方法69例SLE分为疾病活动和疾病稳定组、狼疮肾炎(LN)和非狼疮肾炎组(NLN)。测定AnuA和抗dsDNA抗体水平,比较组间抗体水平差异,分析其与免疫指标的相关性。结果AnuA和抗dsDNA抗体阳性率为55.1%和47.82%,疾病活动组显著高于疾病稳定组(P<0.001)。抗dsDNA抗体阴性SLE中有16.6%AnuA阳性。两抗体与SLE疾病活动指数(SLEDAI)、IgG、球蛋白水平显著正相关,与C3、C4、白蛋白水平显著负相关。LN组两抗体水平均显著高于NLN。结论AnuA和抗dsDNA抗体都是SLE疾病活动指标,与LN相关,AnuA检测是对抗dsDNA抗体的有益补充。     

Undifferentiated connective tissue disease: clinical and serological profile of 578 patients followed for five years: disease course, prognosis and therapy

INTRODUCTION: Evolution of immunopathological diseases is usually slow and progressive. The term the undifferentiated connective tissue disease (UCTD) is used to describe the phase preceding a defined connective tissue diseases (CTD). AIMS: The objective of this work was evaluate the clinical and serological profile of patients with UCTD, who had been followed between 1994-1999. They have investigated the frequency and the type the developed autoimmune diseases from UCTD. PATIENTS: A total of 578 UCTD patients were evaluated. RESULTS: In 143/578 patients (24.7%) with the UCTD differentiated to systemic connective tissue diseases (28 systemic lupus erythematosus, 26 mixed connective tissue disease, 19 progressive systemic sclerosis, 3 polymyositis/dermatomyositis, 45 Sj?gren syndrome, and 22 systemic vasculitis). 86.7 percent (124/143) of the systemic connective disease developed in first two years of UCTD. The condition of 435/578 (75.2%) remained UCTD after 5 years, among them in 82 patients with UCTD was regression of the symptoms. The presence of the fever and anti-DNS antibodies correlated with SLE (P = 0.0104, Fisher exact test), arthritis/arthralgia and anti-RNP antibodies with MCTD (P = 0.0302), Raynaud phenomenon and ANA positivity with PSS (P = 0.0144), xerostomia/xerophtalmia and anti-SSA/SSB antibodies with Sj?gren syndromes (P = 0.0144). CONCLUSIONS: The UCTD in our patients seem to represents an dynamic phase, one part of the patients show progression to definite connective tissue diseases, one part show regression, and on part of the patients stay in UCTD phase.     

Adult discoid lupus erythematosus

BACKGROUND: Discoid lupus erythematosus is a particular form of systemic lupus in which manifestations are confined to the skin. AIM: Our purpose was to evaluate the epidemiology trends, presenting clinical manifestations, therapeutic features and outcome of patients with discoid lupus erythematosus (DLE). METHODS: It's a retrospective study, done in the dermatology department of Habib Thameur Hospital over an 8 years period. We included only the cases of DLE confirmed by the histology and/or the direct immunofluorescence. RESULTS: We identified 26 patients mean aged 46.19 years. All of them were adults. The lesions were localized on the face for 25 patients, neck (7 patients), scalp (6) and hands (6). Eleven patients presented a generalized DLE. The mean period of follow-up was 3 years raging from 1 month to 20 years. After a 15 year evolution, 1 patient presented degeneration in squamous cell carcinoma of 2 lesions. CONCLUSION: Unfortunately, there is still in our country a long delay before the first consultation, which, added to an absence of adequate photoprotection, can obscure the prognosis of DLE.     

Lupus hepatitis

We report the case of 42 year-old man who presents an acute polyarthritis associated with systemic manifestation and immunologic disorders related to systemic lupus erythematosus. Hepatic tests show cholostase and cytolysis. Hepatic involvement is linked with systemic lupus erythematosus after exclusion of hepatotoxic drugs, viral hepatitis and absence of anti mitochondrial and anti muscle antibodies. Lupus hepatitis seems to be correlated with autoantibodies to ribosomal P protein. Its treatment remains to be defined.     

以狼疮脑疮为首发表现的SLE临床及脑部MRI分析

目的分析以系统性红斑狼疮脑病为首发表现的系统性红斑狼疮（SLE）的临床特点及脑部MRI特点。方法回顾性分析12例以脑病为首发表现的临床诊断为系统性红斑狼疮的临床及脑部MRI资料。结果12例系统性红斑狼疮脑病患者临床无特异性表现，可表现为头痛、呕吐、智能障碍、癫痫、肢体瘫痪；头部MRI检查无特异，可表现为高颅压、脑萎缩、脑实质多发片状长T1、长T2信号等。结论以系统性红斑狼疮脑病为首发表现的SLE临床及脑部MRI均无特异性，易首诊误诊，应注重神经系统外的内科系统体格检查，提高对SLE的早期诊断。     

硫唑嘌呤治疗系统性红斑狼疮急腹症1例

目的:探讨硫唑嘌呤治疗系统性红斑狼疮急腹症的效果。方法:回顾性分析1例系统性红斑狼疮急腹症患者的临床资料。结果:使用硫唑嘌呤后未再出现急腹痛。结论:硫唑嘌呤可以减少系统性红斑狼疮急腹症的复发率。     

重症系统性红斑狼疮伴肾功能衰竭患者的护理

目的 探究重症系统性红斑狼疮伴随肾功能衰竭患者的护理体会。方法 将86例重症系统性红斑狼疮伴随肾功能衰竭患者随机分为2组,每组各43例;对照组实行常规护理,观察组实行人性化护理。结果 观察组患者各项指标改善效果均显著优于对照组。结论 重症系统性红斑狼疮伴随肾功能衰竭患者实行人性化护理的效果良好。     

抗α-胞衬蛋白抗体在干燥综合征诊断和鉴别诊断中的作用

目的 探讨抗α-胞衬蛋白(Fodrin)抗体在干燥综合征诊断和鉴别诊断中的作用.方法 应用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)定量检测72例原发性干燥综合征(pSS),32例继发性干燥综合征(sSS),78例系统性红斑狼疮(SLE),120例类风湿关节炎(RA)患者和60例正常健康体检者血清中抗α-Fodrin IgA、IgG抗体.结果 pSS中的抗α-fodrin IgA和IgG抗体阳性率高于sSS (P＜0.05);pSS和sSS患者中抗α-Fodrin IgA、IgG抗体的阳性率均显著高于SLE和RA患者(P＜0.05).抗α-Fodrin IgA抗体诊断干燥综合征的灵敏度为55.8％,特异性为97.5％;而抗α-Fodrin IgG抗体诊断干燥综合征的灵敏度为44.2％,特异性为99.0％.结论 抗α-Fodrin抗体特异性很好,对干燥综合征的诊断和鉴别诊断具有重要的临床意义,尤其对于ANA、抗SS-A抗体、抗SS-B抗体均阴性的患者,常规筛查抗α-Fodrin抗体,有利于干燥综合征的早期诊断.     

初次发病狼疮脑病的MRI表现及临床分析

目的：探讨初次发病狼疮脑病的MRI表现及临床特点,以提高对该病的诊断水平。方法回顾性分析15例临床确诊的狼疮脑病患者的MRI常规平扫及增强图像,归纳分析其MRI特点。结果狼疮脑病患者行MRI检查的阳性率为73.3%,8例MRI表现为多发弥漫性异常信号,3例表现为局灶性病变。结论初次发病的狼疮脑病患者的MRI有特征性表现,对于狼疮脑病的早期诊断有一定的临床价值。