抗α-胞衬蛋白多肽IgA抗体对干燥综合征的诊断价值

目的以α-胞衬蛋白(α-Fodrin)多肽为抗原,采用ELISA检测干燥综合征(Sjgren's syndrome,SS)患者血清抗α-Fodrin多肽IgA抗体(α-Fodrin-derived polypeptide antibody,αF5-IgA),并分析其与SS临床表现和其他实验室指标的关系。方法以固相法合成的α-Fodrin 37-59多肽(αF5)为包被抗原,ELISA定量检测169例原发性干燥综合征(primary Sjgren's syndrome,pSS)、31例继发性干燥综合征(secondary Sjgren syndrome,sSS)、221例其他结缔组织病患者及88名健康对照者血清抗α-Fodrin37-59多肽IgA(αF5-IgA)抗体水平,并分析其与SS患者临床表现及自身抗体、IgG、IgA、血沉及血常规等的相关性。结果 ELISA定量检测抗αF5-IgA抗体,pSS和sSS组的阳性率分别为73.4%和64.5%,而类风湿关节炎、系统性红斑狼疮和健康对照组的阳性率分别是27.3%、17.8%和2.3%,抗αF5-IgA抗体在SS患者的阳性率显著高于其他结缔组织病患者及健康对照组(χ2=114.5～234.1,P0.01)。抗αF5-IgA抗体对SS诊断的特异性为86.1%,在抗SSA、抗SSB抗体和ANA阴性的pSS患者中,抗αF5-IgA抗体的阳性率分别为48.9%、46.6%和57.1%。抗αF5-IgA抗体阳性pSS患者的肾脏受累率高于抗αF5-IgA抗体阴性患者(χ2=3.0,P0.05)。抗αF5-IgA抗体阳性pSS患者IgG、IgA升高,血沉增快,白细胞与血小板下降的概率明显高于抗体阴性的患者(χ2=17.9～73.5,P0.05)。结论 ELISA法可用于检测SS患者血清抗αF5-IgA抗体,该抗体为诊断SS较为特异的自身抗体之一,且抗αF5-IgA抗体对其他自身抗体阴性的SS的诊断有参考意义。     

抗着丝点抗体在原发性胆汁性肝硬化中的意义

目的研究抗着丝点抗体(ACA)在原发性胆汁性肝硬化(PBC)中的意义。方法用间接免疫荧光法在PBC患者中检测ACA,比较ACA阳性和阴性患者的差别。结果99例PBC患者中ACA阳性53例(53．5%),ACA阳性组发病比ACA阴性组晚[(52．6±1．5)岁vs(46．2±2．0)岁,P=0．012],性别比例和ACA阴性组差异无统计学意义。ACA阳性组出现消化道出血多于ACA阴性组(13．2% vs 0,尸= 0．014),其他临床症状如乏力、瘙痒、黄疸等在两组间差异无统计学意义。虽未达到统计学上的差异,但食管胃底静脉曲张发生率在ACA阳性组高于ACA阴性组(45．8% vs 10．0%,P=0．061)；门静脉宽度、脾大、腹水在两组间差异无统计学意义。肝生化指标中只有总蛋白水平在ACA阳性组低于ACA阴性组[(73．3 1．1)g/L vs(78．1 1．7)g/L,P=0．017]。ACA阳性组IgG水平低于ACA阴性组[(15．1±0．6)g/L vs(18．4±1．0) g/L,P=0．006]。核包膜型ANA在ACA阳性组低于ACA阴性组(16．7%vs 50．0%,P=0．002)。结论ACA在PBC患者中阳性率高,ACA阳性的PBC患者更易出现门静脉高压及消化道出血,ACA阳性PBC患者ANA呈现核包膜型者少。     

血清抗M型磷脂酶A2受体抗体与膜性肾病表现及治疗反应的关系

目的探讨血清抗M型磷脂酶A2受体(PLA2R)抗体与特发性膜性肾病(IMN)的临床表现、病理改变及治疗反应等的关系。方法选取经活检明确诊断为IMN患者56例,应用酶联免疫吸附法(ELISA)检测其血清抗M型PLA2R抗体,根据检测结果将患者分为抗PLA2R抗体阳性组和阴性组,回顾性分析两组临床和病理资料特点及对免疫抑制治疗的反应。结果 56例IMN患者中抗PLA2R抗体阳性率为71.43%;阳性组血清白蛋白水平低于阴性组、24 h尿蛋白水平高于阴性组(P<0.05)。阳性组中肾病综合征(NS)患者的比例高于阴性组(P<0.05)。阳性组肾组织Ig G1亚型荧光强度≥患者比例低于阴性组(P=0.015);Ig G4亚型荧光强度≥患者比例高于阴性组(P=0.022);PLA2R阳性表达者比例高于阴性组(P=0.015)。结论血清抗PLA2R抗体在IMN患者中阳性率较高,有助于协助IMN疾病的诊断。抗体阳性的IMN患者更易表现为NS,并与IMN的病情相关。血清抗PLA2R抗体阳性患者肾组织更多地表现为Ig G4亚型的强阳性沉积及PLA2R的阳性表达。但基线抗PLA2R抗体与IMN患者对免疫抑制治疗的反应无关。     

特发性炎性肌病肌炎特异性抗体谱的临床意义

目的研究特发性炎性肌病(IIM)患者血清肌炎特异性抗体(MSAs)水平与其临床特征、实验室指标及预后的相关性。方法收集178例IIM患者的临床资料,免疫印迹法检测患者血清中12种MSAs的水平,并分析其与患者临床特征、实验室指标和预后的相关性。进一步建立Logistic回归模型,分析MSAs亚型是否为患者临床症状的独立危险因素。结果12种MSAs中,抗氨基酰tRNA合成酶[ARS,包括组氨酰-tRNA合成酶(Jo-1)、PL-7、PL-12、EJ、OJ]抗体(34.8%)最常见,其次为抗黑色素瘤分化相关基因5(MDA5)抗体(32.6%)、抗转录中介因子γ(TIF1γ)抗体(11.8%)和抗信号识别颗粒(SRP)抗体(11.8%)。抗ARS抗体阳性组肺间质性病变和技工手的发生率高于阴性组(90.3%比66.4%,P<0.001;16.1%比4.3%,P=0.007);抗MDA5抗体阳性组较阴性组更易出现肺间质性病变、Gottron疹、面部红斑和关节炎(均P<0.05),肌无力和吞咽障碍发生率更低(55.2%比78.3%,P=0.001;8.6%比23.3%,P=0.018);抗TIF1γ抗体在≥65岁患者中的阳性率高于<65岁患者(25.9%比9.3%,P=0.032),该抗体阳性组肿瘤发生率比阴性组高(19.0%比3.2%,P=0.01);抗SRP抗体阳性患者肌无力发生率、肌酸激酶(CK)值、乳酸脱氢酶(LDH)值和谷草转氨酶(AST)值高于阴性组(均P<0.05)。抗Mi-2β抗体阳性组肺间质病变发生率低于阴性组(40.0%比77.9%,P=0.003)。Logistics回归分析显示,抗MDA5抗体和抗Jo-1抗体是肺间质性病变(ILD)发生的独立危险因素,抗TIF1γ抗体是吞咽障碍发生的独立危险因素。生存分析结果表明,抗MDA5抗体阳性患者比阴性患者生存时间更短(5.0月比14.0月,P=0.001)。结论抗ARS抗体是最常见的MSAs亚型,不同的MSAs亚型与特定的临床特征有关。检测MSAs水平有利于对不同患者进行分型,指导治疗并判断预后。     

抗毒蕈碱受体3多肽抗体测定在干燥综合征诊断中的意义

目的 建立酶联免疫吸附试验(ELISA)法检测抗毒蕈碱3受体多肽(M3RP)抗体的方法,探讨该抗体在干燥综合征(ss)诊断中的意义.方法 以固相合成的多肽M3RP为包被抗原,ELISA定量检测94例干燥综合征,160例其他结缔组织病及200名正常人血清中的抗M3RP抗体水平,并分析其与SS临床表现的相关性.结果 抗M3RP抗体在原发干燥综合征(pSS)、继发干燥综合征(sSS)患者中阳性率分别为84.6%和81.3%,在其他结缔组织病和正常对照组中的阳性率分别为8.8%和1%.M3RP抗体在SS患者中阳性率显著高于其他结缔组织病患者及正常对照组(P＜O.01).而且,M3RP抗体在pSS和sSS中的特异性均为91.3%.pSS患者与sSS患者抗M3RP抗体阳性率差异无统计学意义.抗M3RP抗体与SS患者临床表现和脏器受累情况无明显相关性.该抗体在抗α-胞衬蛋白、抗SSA、抗SSB和抗核抗体阴性的SS患者中抗M3RP抗体的阻性率分别为85%、89.3%、88.9%和95.2%.在pSS中,抗M3RP抗体阳性的患者血清中IgG水平明显高于抗体阴性的患者.结论 ①ELISA法可检测pSS和sSS患者血清中的抗M3RP抗体,该抗体为诊断SS的较为特异的自身抗体之一.②抗M3RP抗体对其他自身抗体阴性的SS诊断有参考意义.     

抗酿酒酵母细胞抗体在原发性胆汁性肝硬化患者中的临床意义

目的 检测原发性胆汁性肝硬化(PBC)患者血清抗酿酒酵母细胞抗体(ASCA),探讨其在PBC中的阳性状况和临床意义.方法 采用酶联免疫吸附试验(ELISA)检测162例PBC患者、44例自身免疫性肝炎(AIH)患者、41例肝病对照组(LDC)患者、144例炎症性肠病(IBD)患者及35名健康体检者血清ASCA的IgA和IgG亚型.采用χ2检验和非参数U检验进行分析.结果 ASCA-IgA在PBC患者中的阳性率为24.1%,高于溃疡性结肠炎(UC)组11.6%(χ2=5.5,P＜0.05)和健康对照组0(χ2=10.5,P＜0.01),与AIH组(20.5%)、LDC组(14.6%)和克罗恩病(CD)组(34.5%)比较,差异无统计学意义(P＞0.05);ASCA-IgG在PBC患者中的阳性率为11.1%,明显低于CD组27.6%(χ2=8.9,P＜0.01),高于健康对照组0(χ2=10.5,P＜0.01),与AIH组(15.9%)、LDC组(7.3%)和UC组(8.1%)比较,差异无统计学意义(P＞0.05);ASCA-IgA和IgG同时阳性的PBC患者仅占6.2%,显著低于CD组17.2%(χ2=6.3,P＜0.05);ASCA-IgA或IgG阳性的PBC患者占29.0%,显著低于CD组44.8%(χ2=4.8,P＜0.05),高于UC组(χ2=5.9,P＜0.05)和健康对照组(χ2=13.3,P＜0.01).抗GP210抗体阳性的PBC患者ASCA阳性率高于抗GP210抗体阴性PBC患者(38.6%和23.8%,χ2=3.9,P＜0.05);抗线粒体抗体(AMA)、抗SP100抗体阳性和阴性PBC患者间ASCA的阳性率差异无统计学意义.ASCA-IgA阳性PBC患者总胆红素、直接胆红素、总胆汁酸、乳酸脱氢酶(LD)、IgA、IgM、红细胞沉降率(ESR)高于ASCA-IgA阴性PBC患者,而白蛋白(ALB)、白蛋白/球蛋白和胆碱酯酶低于ASCA-IgA阴性PBC患者(P均＜0.05).ASCA-IgG阳性PBC患者与阴性患者间肝功能损伤指标和免疫功能指标差异均无统计学意义.结论 ASCA并不是IBD特异性自身抗体,在PBC患者有较高的阳性率,且以IgA亚型为主.ASCA-IgA与PBC患者肝功能损伤指标和免疫活动指标改变有关,而ASCA-IgG与PBC患者肝功能损伤指标和免疫活动指标改变无关.     

抗环瓜氨酸肽抗体与系统性红斑狼疮关节炎的相关性研究

目的 研究抗环瓜氨酸肽(CCP)抗体在系统性红斑狼疮(SLE)患者中的临床意义,探讨抗CCP抗体与SLE患者关节炎及骨侵蚀的关系.方法 采用酶联免疫吸附试验(ELISA)方法检测138例SLE患者血清中抗CCP抗体水平,并与SLE患者关节表现及其他临床指标进行相关性分析.结果 抗CCP抗体在SLE患者中的阳性率为13.8%(19/138).SLE患者关节炎的发生率为50.7%,关节炎组抗CCP抗体阳性率(20%)高于非关节炎组(7.4%)(P＜0.05).在SLE关节炎患者中,抗CCP抗体阳性者类风湿因子(RF)阳性率显著高于抗CCP抗体阴性者(71.4%与14.3%)(P＜0.01).而且,抗CCP抗体与RF之间显著相关(r=0.36,P=0.002).抗CCP抗体阳性的SLE患者关节炎的发生率明显高于抗CCP抗体阴性者(73.7%与47.1%,P＜0.05).138例SLE患者中有8例出现受累关节的影像学改变,与抗CCP抗体阴性患者相比,抗CCP抗体阳性患者表现出侵蚀性关节炎的比例显著为高(35.7%与5.4%,P＜0.01).在8例表现为侵蚀性关节炎的患者中有2例患者抗CCP抗体和RF均阴性,而抗RA33抗体阳性.此8例患者均满足美国风湿病学学会(ACR)1987年类风湿关节炎(RA)的分类标准.SLE相关其他临床指标分析显示,关节炎组.与非关节炎组、抗CCP抗体阳性组与阴性组之间差异均无统计学意义.结论 13.8%的SLE患者体内存在抗CCP抗体.抗CCP抗体的出现与SLE患者关节炎和骨侵蚀密切相关,并对判断SLE关节炎的预后具有重要的临床价值.     

特异性抗膜突蛋白抗体在结缔组织病肺部受累早期诊断中的意义

目的 探讨特异性的自身抗体对结缔组织病(CTD)相关肺部损伤的临床意义.方法 以重组膜突蛋白作为抗原,应用酶联免疫吸附试验(ELISA)和免疫印迹法检测40例系统性硬化症(SSc)患者和38例混合性结缔组织病(MCTD)患者外周血抗膜突蛋白抗体.比较不同肺脏受累的CTD患者之间抗膜突蛋白抗体的差异.结果 ELISA和免疫印迹法检测发现21例(52%)SSc患者和15例(39%)MCTD患者抗膜突蛋白抗体阳性.CTD合并肺脏受累组抗膜突蛋白抗体的滴度均显著高于无肺脏受累组(0.23±0.14与0.12±0.35,P=0.001).在肺功能检查方面,抗膜突蛋白抗体阳性患者组与阴性患者组比较,肺总量[(82±10)%与(90±14)%,P=0.027],用力肺活量[(76±13)%与(85±17)%,P=0.040],一氧化碳弥散量[(58±16)%与(72±23)%,P=0.014]均显现显著降低.结论 抗膜突蛋白抗体在SSc和MCTD患者中具有较高的阳性率,并与CTD合并肺脏受累显著相关,可能早期提示结缔组织病肺脏损害.     

抗磷脂抗体各亚型在1021例原发性肾小球疾病中的表达研究

目的探讨原发性肾小球疾病中抗磷脂抗体(APA)及各亚型表达情况。方法选取2015年6月至2017年7月,在浙江大学医学院附属第一医院肾脏病中心行肾穿刺活检,并确诊为原发性肾小球疾病的患者1021例(包括膜性肾病303例,IgA肾病483例,系膜增生性肾小球肾炎76例,微小病变肾病119例,局灶性节段性肾小球硬化40例),检测抗心磷脂抗体(ACL)不同亚型(IgG、IgM和IgA型)和抗β2糖蛋白1(β2GP1)抗体不同亚型(IgG、IgM和IgA型),并进行比较。结果膜性肾病组APA阳性率最高为17.5%,微小病变型肾病组最低为11.8%,组间比较差异无统计学意义。IgA肾病和系膜增生性肾小球肾炎ACL阳性率分别为11.4%和14.5%,均显著高于抗β2GP1抗体阳性率(P0.001,P=0.009);膜性肾病组抗β2GP1抗体阳性率为11.2%,与ACL阳性比差异无统计学意义,但显著高于其余4组患者。系膜增生性肾小球肾炎组ACL-IgM阳性率为13.2%,明显高于其余4组(P0.05)。IgA肾病组ACL-IgA阳性率为5.8%,明显高于其余4组,差异有统计学意义(P0.05)。结论原发性肾小球疾病患者中存在抗磷脂抗体阳性,其亚型在不同病理类型肾炎患者中阳性率差异有统计学意义,可有助于疾病鉴别诊断以及治疗。     

抗α-胞衬蛋白抗体在干燥综合征诊断中的意义及与临床表现的相关性

目的α-胞衬蛋白(α-fodrin)是干燥综合征(SS)患者涎腺组织中的一种特异性自身抗原,本研究应用重组人类α-fodrin抗原、酶联免疫吸附试验定量测定患者血清中的抗α-fodrin抗体,了解抗α-fodrin抗体在SS诊断中的意义及与临床表现的相关性。方法以重组人类α-fodrin为包被抗原,酶联免疫吸附试验定量检测42例原发性干燥综合征(pSS)、24例继发性干燥综合征(sSS)、40例其他结缔组织病、42名正常人血清中的抗α-fodrin抗体。结果以x±5s为标准,α-fodrin抗体在pSS、sSS患者阳性率分别为59.5%、37.5%,在其他结缔组织病和对照组阳性率分别为35.0%、11.3%;抗α-fodrin抗体在SS患者的特异性为79.4%;pSS患者与sSSα-fodrin抗体阳性率差别无统计学意义(P>0.05);SS患者与其他结缔组织病阳性率差别无统计学意义(P>0.05);在结缔组织病中的阳性率明显高于非结缔组织病和正常人(P<0.01)。抗α-fodrin抗体与pSS或sSS患者临床表现、其他自身抗体无明显相关性,抗α-fodrin抗体阳性患者血IgG水平、血沉(ESR)较抗α-fodrin抗体阴性患者高,P值分别为0.044和0.03。抗SSA抗体和抗核抗体(AN A)均阴性的SS患者抗α-fodrin抗体也均阴性。结论①抗α-fodrin抗体对于pSS或sSS的诊断有一定意义,但是它的特异性和敏感性并不理想。②抗α-     

A clinical analysis of primary Sjögren's syndrome with anticentromere antibodies

OBJECTIVE: To investigate the clinical manifestations, immunological features and prognosis of primary Sj?gren's syndrome (pSS) with anticentromere antibodies (ACA). METHODS: Sixty pSS patients with ACA in our hospital between 1985 and 2006 were screened retrospectively and compared with those without ACA. RESULTS: The mean age at the onset of pSS with ACA was higher than that of those without ACA [(48 +/- 11) yr vs (41 +/- 12) yr, P =0.000]. There was no difference in sex ratio, dry mouth, dry eyes and positive salivary gland biopsy between the two groups (P > 0.05). Compared with those without ACA, patients with ACA presented a higher prevalence of liver involvement (68.3% vs 37.0%, P = 0.000), while a lower prevalence of renal involvement (13.3% vs 30.9%, P = 0.009), neuropathy (1.7% vs 11.5%, P = 0.025) and hypergammaglobulinemia (20.8% vs 45.7%, P = 0.002). The difference was not significant between the two groups in Raynaud's phenomenon, articular involvement, myositis, hematologic involvement, lung involvement, and thyroiditis. While both groups showed the same prevalence of antinuclear antibody (ANA), the patterns of ANA-IF were different and the discrete speckled pattern was the most frequent in patients with ACA and occurred in 61.7%. Different from those without ACA, patients with ACA presented a lower prevalence of anti-SSA, anti-SSB, rheumatoid factor, and anti-U1RNP, while showed a higher prevalence of antimitochondrial antibodies (AMA) and AMA-M2. The most frequent cause of death was the complications associated with cirrhosis, notably bleeding varices (3/5 cases). CONCLUSION: Patients with ACA present a high risk of liver involvement. Because of the remarkable difference in the mean age of disease onset and also differences in systemic damage, immunological and antibody features, pSS with ACA may be a special subtype of pSS.     

原发性干燥综合征患者肺部病变的临床分析

目的 探讨原发性干燥综合征(pSS)患者肺部病变的临床特点.方法 回顾性分析1985至2005年在北京协和医院确诊的pSS患者522例,按肺部病变[肺部影像学异常、肺功能下降或超声心动图肺动脉收缩压隐隐约约≥40 mm Hg(1 mm Hg=0.133 kPa)]将522例患者分为肺部病变组和无肺部病变组,对两组的临床特点进行分析.采用SPSS 13.0统计学软件包对正态分布的计量资料行t检验,偏态分布的计量资料行非参数检验,计数资料行卡方检验.结果 (1)522例患者中有肺部病变者221例(42.3%),多见于发病后48个月.肺部病变组发病年龄[(43±13)岁]晚于无肺部病变组[(37±14)岁](t=-5.445,P=0.000);肺部病变组口干、眼干及猖獗齿较无肺部病变组更常见(分别为89.6%,/35 81.1%,χ2=7.145,P=0.008;78.7%vs 66.4%,χ2=9.472,P=0.002;55.2%vs42.2%,χ2=8.647,P=0.003).(2)522例患者中最常见的pSS肺部病变是问质性肺病(116例,23.2%),其次是肺动脉高压(44例,12.5%).(3)11例行肺组织病理检测患者中5例为非特异性间质性肺炎,3例为淋巴细胞间质性肺炎.(4)肺部病变组更常出现雷诺现象、低热、关节肿、抗U1RNP抗体及高γ球蛋白血症(分别为26.7% vs 13.0%,χ2=15.77,P=0.000;20.4%vs 13.0%,χ2=5.175,P=0.023;29.4%vs21.6%,χ2=4.164,P=0.041),而肾小管酸中毒少见(5.4%vs12.6%,χ2=7.616,P=0.006).(5)pSS肺部病变可增加死亡风险达5.5倍,感染是最常见的死亡原因(9例).结论 肺部病变是pSS常见的系统损害,严重影响疾病预后,因此,确诊pSS的患者均应进一步明确肺部病,变情况.     

Anticentromere antibodies identify patients with Sjögren's syndrome and autoimmune overlap syndrome

OBJECTIVE: To assess the prevalence and clinical and immunological significance of anticentromere antibodies (ACA) in patients with primary Sj?gren's syndrome (pSS). METHODS: We retrospectively investigated the prevalence of ACA in patients with SS. We compared ACA-positive SS patients with ACA-negative pSS patients. RESULTS: The prevalence of ACA among patients with pSS was 4.7% (10/212). Among the patients with SS and an associated autoimmune disease, 10 patients had ACA and limited cutaneous sclerosis (SSc). Clinical and immunological patterns did not differ between the 10 pSS patients with ACA alone and the 10 SS patients with ACA and SSc, except for presence of limited cutaneous SSc (lcSSc). Moreover, all ACA-positive sera recognized centromere protein-B on ELISA, regardless of the presence of SSc. The entire SS-ACA group (n = 20) showed greater frequency of Raynaud's phenomenon, objective xerophthalmia, peripheral neuropathy, and additional autoimmune disorders, especially primary biliary cirrhosis, compared to pSS patients without ACA (p = 0.005, p = 0.04, p = 0.001, p = 0.05, p < 0.0001, respectively). SS patients with ACA less frequently showed anti-SSA or anti-SSB antibodies than those without ACA (p = 0.0002, p = 0.01, respectively) but greater prevalence of autoantibodies other than anti-SSA/SSB or ACA (p = 0.001). CONCLUSION: Clinical and immunological features of SS were largely similar among SS patients with ACA with and without SSc. However, the presence of ACA among patients with SS allows identification of a subset of patients with "SS overlap syndrome," who show a wide diversity of autoimmunity, encompassing but not limited to SSc.     

Cryoglobulinaemia associated with hepatitis C virus: influence of HCV genotypes, HCV-RNA viraemia and HIV coinfection

To determine whether the clinical and immunological expression of patients with cryoglobulinaemia associated with chronic hepatitis C virus (HCV) infection varied according to HCV-RNA load, HCV genotype or human immunodeficiency virus (HIV) coinfection. We studied 340 HCV patients (188 women and 152 men, with a mean age of 49 years) consecutively diagnosed with cryoglobulinaemia between 1993 and 2003 in our hospital. HCV infection was confirmed by serum HCV-RNA determination in all patients. Two hundred and forty-eight (73%) patients had asymptomatic cryoglobulinaemia and 92 (27%) presented cryoglobulinaemic symptoms. Patients with genotype 1 had a higher mean age at diagnosis of cryoglobulinaemia (48.2 vs 40.2 yrs, P < 0.001) and a higher prevalence of cryoglobulinaemic symptoms (25%vs 10%, P = 0.02), especially of vasculitic features (19%vs 5%, P = 0.014). In comparison with monoinfected HCV patients, those with HIV coinfection had a lower mean age at diagnosis of cryoglobulinaemia (40.4 vs 52.8 years, P < 0.001), a lower prevalence of cryoglobulinaemic symptoms (15%vs 34%, P < 0.001), vasculitis (10%vs 28%, P < 0.001), associated systemic autoimmune disease (3%vs 14%, P = 0.001), rheumatoid factor (30%vs 70%, P = 0.001) and hypocomplementaemia (50%vs 78%, P = 0.01). In HCV-HIV patients, a high viral load was associated with a high frequency of symptomatic cryoglobulinaemia, especially in patients with a high viral load of the two viruses (50%vs 7%, P = 0.001) A higher frequency of cryoglobulinaemic symptoms (especially vasculitis) was found in patients with HCV monoinfection and in those carrying HCV genotype 1. In contrast, patients with HIV coinfection presented a threefold lower prevalence of vasculitis. Associated HIV infection significantly attenuated the clinical and immunological expression of cryoglobulinaemia, except in coinfected patients with high viral loads for the two viruses.     

外周血CXC型趋化因子配体13检测在原发性干燥综合征患者中的临床意义

目的:探讨外周血CXC型趋化因子配体13(CXCL13)检测在pSS患者中的临床意义。方法:纳入60例研究对象,其中30例初诊的pSS患者为疾病组,30名健康体检者为对照组,采用ELISA法检测血清CXCL13水平,并采用Pearson相关系数及Spearman相关系数,分析其与外周血B细胞比例、免疫球蛋白(Ig)G、IgM、IgA、C3、C4、自身抗体等免疫相关指标、腺体结构和功能指标,以及SS疾病相关指数EULAR干燥综合征疾病活动度指数(ESSDAI)和EULAR干燥综合征患者报告指数(ESSPRI)的相关性。结果:pSS组患者外周血CXCL13水平明显高于对照组[(139±94)pg/ml和(36±20)pg/ml],差异有统计学意义(t=5.838,P<0.01)。pSS患者外周血CXCL13水平与外周血B细胞比例(r=0.364,P=0.048)、IgG水平(r=0.369,P=0.045)、唇腺淋巴细胞浸润程度(r=0.592,P=0.001),以及ESSDAI(r=0.415,P=0.023)、ESSPRI评分(r=0.431,P=0.017)均呈正相关;与未刺激状态下唾液流率呈负相关(r=-0.381,P=0.038)。pSS患者中有系统累及者24例,有系统累及的pSS患者血清CXCL13水平较无系统累及者明显升高,且差异有统计学意义(Z=-2.256,P=0.024),但与系统累及数无明显相关性(r=0.344,P=0.062)。结论:pSS患者外周血中CXCL13的检测有助于疾病活动程度及腺体破坏程度的判断。     

经颅多普勒超声检测一侧颈内动脉闭塞患者血流动力学的分析

目的探讨一侧颈内动脉闭塞患者患侧大脑半球血流速度及血管搏动指数的改变与颅内Willis环主干、颈内-外动脉侧支循环开放的相关性.方法选用彩色多普勒血流显像（CDFI）及经颅多普勒超声（TCD）诊断一侧颈内动脉颅外段闭塞,而另一侧正常或狭窄50%以下且颅内动脉无狭窄的患者112例作为闭塞组;以颈内动脉颅外段和颅内动脉检测结果均正常的112例非脑血管病患者作为对照组.采用TCD检测双侧大脑中动脉（MCA）、大脑前动脉（ACA）及大脑后动脉（PCA）的收缩期峰值流速（PSV）和MCA的血管搏动指数（PI）,比较两组患者双侧MCA、ACA、PCA的PSV和PI的差异,计算并分析患侧MCA的PSV、PI差值（PSVD、PID）.结果①闭塞组患者双侧MCA的PSV和PI差值明显高于对照组（PSV相差61 cm/s,PI相差≥70%,P=0.000、P=0.000）.②闭塞组患者患侧MCA、ACA的PSV和PI较健侧明显降低（P=0.000）,患侧PCA的PSV较健侧增高,PI相对降低（P=0.000）,患侧MCA的PSV下降率明显高于ACA的PSV下降率.③闭塞组患者患侧MCA的PSV与双侧ACA及患侧PCA的PSV直接相关（P=0.000、P=0.000、P=0.006）.结论对双侧MCA的PSV、PI及ACA、患侧PCAPSV的差值分析,可以提高TCD对一侧颈内动脉闭塞性病变患者血流动力学异常的认识和鉴别.     

Subclinical articular involvement in primary Sjögren's syndrome assessed by ultrasonography and its negative association with anti-centromere antibody

Objectives. To evaluate the subclinical articular involvement in patients with primary Sjögren's syndrome (pSS) using musculoskeletal ultrasound (MSUS), and to correlate the findings with laboratory results and clinical manifestations.

Methods. Forty-eight consecutive patients with pSS were enrolled. The bilateral metacarpophalangeal, proximal interphalangeal, and interphalangeal joints were examined using MSUS, and the synovial hypertrophy and power Doppler signal were recorded for each joint using semi-quantitative scores (0 = normal, 1 = mild change compared with undamaged joint, 2 = moderate change, and 3 = severe change).

Results. Mild or moderate synovial hypertrophy was found in 151 (15.7%) and 2 (0.2%) out of 960 hand joints, respectively, and power Doppler signals were present in 19 (2.0%) of the 960 joints. While anti-centromere antibody (ACA) was found in 10 patients (20.8%), none of the patients with MSUS-confirmed synovitis was positive for ACA. No other autoantibodies, laboratory tests, or clinical manifestations correlated with MSUS-confirmed synovitis.

Conclusion. MSUS is useful for detecting subclinical synovitis in pSS patients. MSUS showed that ACA-positive pSS patients had a low prevalence of synovitis.     

Clinical significance of chronic hepatitis B virus infection in patients with primary Sj?gren's syndrome

The role of hepatitis B virus (HBV) infection in patients with primary Sj?gren's syndrome (pSS) remains unclear. Therefore, we investigated the prevalence and clinical significance of HBV infection in Taiwanese patients with pSS. One hundred seventy-five patients with pSS who fulfilled the 2002 American-European Revised Classification Criteria were enrolled. Eighteen (10.3%) patients were positive for hepatitis B surface antigen (HBsAg). There were 4 males and 14 females, with the mean age of 54.4 years. The main immunological feature was rheumatoid factor (13 of 18, 72.2%), which was significantly higher than those negative for HBsAg (28.1%, p < 0.001). Twelve (66.7%) patients developed liver dysfunction, which was significantly different from the 15.3% of patients who were negative for HBsAg (p < 0.001). There was no significant difference in extraglandular features between patients positive and negative for HBsAg, except patients positive for HBsAg had a lower rate to develop pulmonary involvement than those negative for HBsAg (5.6% vs. 29.9%, p = 0.027). The mortality rate of pSS patients positive for HBsAg during follow-up was 12.0% and the presence of HBV infection did not influence the survival rate (p = 0.730). pSS patients with liver cirrhosis presented shorter median overall survival compared to those with without liver cirrhosis (p < 0.001). Our findings suggest that HBV infection may protect individuals from pSS and reduce pulmonary involvement.     

835枚结直肠进展期腺瘤的病例资料特点及漏诊原因分析

目的分析结直肠进展期腺瘤(advanced colorectal adenoma,ACA)在不同年龄患者中的特点,探讨影响其漏诊及再发的因素。方法收集2012年1月至2017年12月在上海交通大学医学院附属瑞金医院北部院区接受肠镜检查的患者,共纳入符合条件的ACA 835枚,分析这些患者的年龄、性别、检出ACA基数、大小、形态、位置、肠道准备情况,初步了解中青年(≤60岁)及老年(>60岁)患者的ACA特点,探讨其漏诊及再发的相关因素。结果在漏诊的中青年ACA中,性别、肠道准备情况组间比较,差异有统计学意义(P<0.05),男性及肠道准备欠佳者易出现漏诊情况(P=0.001、P=0.000),而肠镜ACA基数、大小、位置组间比较,差异无统计学意义(P>0.05)。在再发的中青年ACA中,性别组间比较差异有统计学意义(P=0.005)。在漏诊的老年ACA中,男性、多发ACA、扁平或宽蒂的结直肠ACA、肠道准备欠佳者易出现漏诊情况(P=0.002、P=0.023、P=0.001、P=0.000),而ACA大小、位置组间比较,差异无统计学意义(P>0.05)。在再发的老年ACA中,同中青年ACA,性别组间比较差异有统计学意义(P=0.040),而肠镜ACA基数、大小、形态、位置、肠道准备情况差异无统计学意义(P>0.05)。对ACA的漏诊及再发相关因素进行Logistic回归分析发现,患者的年龄(OR=0.608,P=0.007)、性别(OR=2.553,P=0.000)、Boston评分(OR=0.464,P=0.000)是影响ACA漏诊的独立危险因素,而患者的性别(OR=1.589,P=0.018)是影响ACA再发的独立危险因素。结论年龄越大、男性、肠道准备差会导致ACA的漏诊,而男性ACA的再发风险更高。     

原发性干燥综合征患者检测血清糖类抗原125的临床意义

目的探讨原发性干燥综合征（pSS）患者血清糖类抗原125（CA125）升高的发生情况。方法对101例pSS患者的临床资料进行回顾性分析,定义血清CA125〉35U／ml者21例为升高组,其余CA125正常者80例为正常组。结果两组在性别分布、发病年龄、病程、病情活动、自身抗体阳性、高球蛋白血症、低补体血症、外分泌腺受累、心包积液及盆腔积液方面,差异均无统计学意义（P〉0．05）。升高组患者单克隆蛋白阳性率与胸腔积液发生率皆高于正常组（P均〈0．05）,尿β2-微球蛋白升高及腹腔积液发生率明显高于正常组（P均〈0．01）。结论pSS患者伴血清CA125升高的发生率为20．8％,此类患者更易合并单克隆蛋白阳性、尿β2-微球蛋白升高、胸腔积液及腹腔积液。