系统性红斑狼疮患者并发心律失常的类型及相关危险因素分析

目的 分析系统性红斑狼疮（SLE）患者并发心律失常的类型及相关危险因素。方法 回顾性分析2003年11月至2013年2月期间经本院确诊为SLE的559例住院患者（男60例,女499例）,将其分为心律失常组和非心律失常组,收集各项检查检验指标,采用多因素分析SLE并发心律失常的独立危险因素。结果 559例SLE患者中有142例（25. 4%）并发心律失常。其中以窦性心动过速所占比例最高（56. 34%）,其次为窦性心动过缓（16.9%）,再其次为I度房室传导阻滞和室性早搏（均为6. 34%）,其余为其他心律失常（0. 7% ~3. 5%）。单因素分析显示,SLE患者合并心律失常的危险因素有合并多系统损害、其他结缔组织病、心包积液、左房扩大、高甘油三酯、高血糖、低高密度脂蛋白、低血浆白蛋白、低钙血症、高C反应蛋白、抗Sm阳性及抗RNP阳性（P〈0. 05）。多因素分析显示,独立危险因素有抗RNP阳性、左房扩大及低血浆白蛋白（P〈0. 05）。结论 SLE患者可并发各种类型心律失常,其中以窦性心动过速最为常见;独立危险因素有抗RNP阳性、左房扩大及低血浆白蛋白。     

血压节律改变对中风患者左室肥厚的影响

目的 探讨中风患者血压节律改变对左室肥厚的影响.方法 中风患者64例,根据24 h动态血压结果,按照夜间血压下降率分为＜10％为非杓型组与≥10％为杓型组.测量左心室质量指教(LVMI),男性＞134 g/m2,女性＞110 g/m2诊断为左室肥厚.结果 在非杓型组中夜间平均血压、LVMI及左室肥厚的发生率均高于杓型组(P＜0.05或P＜0.01),非杓型组的夜间血压下降率低于杓型组(P＜0.01);LVMI与夜间收缩和舒张压下降率呈负相关(相关系教分别为-0.41、-0.38,P＜0.05).结论 血压节律异常的中风患者左室肥厚的发生率更高.     

老年高血压病患者左室肥厚独立相关因素的研究

目的通过筛选老年高血压病(EH)患者左室重量指数(LVMI)的独立相关因素,来寻找延缓或逆转EH患者左室肥厚(LVH)的途径。方法对年龄在65～89(76.00±5.00)岁的302名老年EH患者进行问卷调查、体格检查、24h动态血压检测、心脏超声检查和实验室检测,运用多元线性回归分析筛选EH患者LVMI的独立相关因素。结果老年EH患者LVMI的独立相关因素包括24h平均收缩压(β=0.332,P<0.05)和血尿酸(β=0.079,P<0.01)。结论降低24h平均收缩压水平和血尿酸浓度,可能是延缓或逆转老年EH患者LVH的重要途径。     

系统性红斑狼疮患者动脉僵硬度及其相关危险因素的研究

目的 评价系统性红斑狼疮(SLE)患者动脉僵硬度,并探讨其相关危险因素.方法 本研究为横断面研究,共纳入中国系统性红斑狼疮研究协作组(CSTAR)的SLE患者135例.利用动脉僵硬度检测仪测定患者臂踝脉搏波传导速度(baPWV),同时采集心血管相关的传统危险因素以及SLE相关因素.利用SAS软件进行统计分析.结果 (1)动脉僵硬度增高的SLE患者其年龄、心血管疾病家族史、平均动脉压和糖化血红蛋白与动脉僵硬度正常的SLE患者比较差异有统计学意义(P均＜0.05).动脉僵硬度增高的SLE患者其肌酐清除率低于动脉僵硬度正常的SLE患者,病程和羟氯喹使用疗程长于动脉僵硬度正常的SLE患者(P均＜0.05),静脉使用环磷酰胺的比例高于动脉僵硬度正常的SLE患者[OR =3.04,95％ CI:1.230 ～7.514,P=0.013].(2)对上述混淆因素进行调整后,年龄[OR=4.56,95％ CI:1.863 ～ 11.130,P=0.000]、平均动脉压[OR=1.12,95％CI:1.055～1.196,P=0.000]、SLE病程[OR=1.20,95％ CI:1.050 ～1.367,P =0.007]以及静脉使用环磷酰胺比例[OR=2.86,95％ CI:1.364 ～5.979,P=0.005]是SLE患者动脉僵硬度增高的独立危险因素.结论 传统心血管危险因素及SLE特异性相关因素均与SLE患者动脉僵硬度增高相关.     

高血压患者左室肥厚与冠脉狭窄程度的关系分析

目的探讨高血压患者左心室肥厚(LVH)与冠状动脉狭窄程度之间的相关关系.方法顺序入选104例住院高血压病患者,男72例,女32例,平均年龄59.15±7.68岁.104例病人均进行冠状动脉造影(CAG)检查,并常规进行空腹血糖(GLU)、三酸甘油酯(TG)、总胆固醇(TC)、12导心电图(ECG)以及超声心动图(UCG)等检查,其中59例病人做了活动平板运动试验(TEST).统计学处理采用Spearman等级相关和多元逐步回归法,分析LVH的程度与冠状动脉狭窄支数之间的相关关系.结果 Spearman法显示室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左室质量指数(LVMI)与CAG狭窄病变的支数间均有显著等级相关性(r分别为0.25,0.21和0.24;P均<0.01).多元逐步回归分析显示TEST阳性、GLU、性别(Sex)、TC、LVPWT以及LVMI与CAG呈显著相关性(F分别为7.41,8.16,7.36,6.55,5.55和6.36;P分别为0.0021,0.0028,0.0277,0.0403,0.0057和0.0098).结论提示高血压患者除Sex、TC、GLU 、TEST结果阳性与冠脉狭窄病变间有显著相关性外,IVST、LVPWT以及LVMI与冠脉狭窄病变的支数间有明显的等级正相关,即左室壁越厚、LVMI越大者,冠脉狭窄累及的支数越多.     

应用超声心动图评价克山病患者的左室肥厚及左室重构

目的应用超声心动图观察克山病左室质量（LVM）及左室质量指数（LVMI）,从而评价克山病患者的左室肥厚及左室重构情况。方法在黑龙江省克山病病区,对53例经病史、查体、X线摄影和心电图检查确认为克山病的患者行超声心动图检查,观察其左室质量及左室质量指数的变化,结果与对照组比较。结果克山病患者的LVM及LVMI明显增大（P〈0.01）。患者的左室肥厚比例明显增高（P〈0.01）。超声心动图对克山病患者的左室肥厚的检出率明显高于心电图（P〈0.01）。结论克山病患者的LVM及LVMI明显增大,克山病患者中普遍存在着左室肥厚及左室重构。超声心动图能直观地观察克山病的LVM及LVMI,对克山病患者的左室肥厚及左室重构做出准确的评价。     

影响系统性红斑狼疮生存率的相关因素

近年,随着对系统性红斑狼疮(SLE)疾病认识的深入,早期诊断手段的增多和治疗水平的提高,SLE的生存率已有很大改善且有逐年增高的趋势.目前国内外对SLE生存率的相关因素的研究表明:感染、脏器损害、治疗方式的选择与应用、以及妊娠、心理、性别、年龄、种族、社会经济文化状况等都对SLE的生存率产生一定的影响.     

原发性高血压患者血浆可溶性ST2浓度与左室肥厚的关系

目的探讨原发性高血压患者血浆可溶性ST2浓度与左室肥厚的关系。方法采用横断面调查研究,选择2017年6~12月在新乡市中心医院门诊就诊的原发性高血压患者260例,分为高血压组132例、合并左室肥厚组128例,同期健康体检者140例为对照组。测定室间隔厚度、左心室后壁厚度、左室舒张末内径和血浆可溶性ST2浓度,计算左室质量指数。结果3组血浆可溶性ST2浓度比较差异有统计学意义(P<0.05);合并左室肥厚组明显高于高血压组,高血压组明显高于对照组(均P<0.05);相关分析显示可溶性ST2与收缩压、左室质量指数呈正相关。Logistic回归分析显示收缩压和基线可溶性ST2浓度是原发性高血压患者发生左室肥厚的独立预测因素。结论可溶性ST2浓度是原发性高血压患者发生左室肥厚的一种很好的生物学标志物。     

系统性红斑狼疮患者心血管疾病危险因素分析

目的 探讨系统性红斑狼疮(SLE)患者高血压、糖尿病、血脂异常患病情况及血脂水平的影响因素.方法 入选2010年3月至2013年3月在北京协和医院住院的成年SLE患者540例作为SLE组,按1∶2比例在体检中心选取与SLE组患者年龄和性别相匹配的健康体检者1 080例作为对照组,进行回顾性分析.比较两组高血压、糖尿病、血脂异常的患病率及血脂水平,并对SLE患者血脂水平的影响因素进行分析.结果 SLE组高血压、糖尿病、血脂异常、总胆固醇(TC)升高、甘油三酯(TG)升高、高密度脂蛋白胆固醇(HDL-C)减低及低密度脂蛋白胆固醇(LDL-C)升高比例均高于对照组,SLE组TC、TG、LDL-C水平均高于对照组,HDL-C水平低于对照组(P均＜0.01).多元线性回归分析显示,TC和LDL-C水平与狼疮肾炎(β值分别为0.695、0.437)、激素治疗(β值分别为1.195、0.715)、补体C4水平(β值分别为4.817、3.382)、24h尿蛋白量(β值分别为0.112、0.078)呈正相关(P均＜0.01),与血浆白蛋白水平(β值分别为-0.107、-0.077)、高敏C反应蛋白水平(β值分别为-0.021、-0.014)呈负相关(P均＜0.01);TG水平与狼疮肾炎(β=0.359)和24 h尿蛋白量(β=0.045)呈正相关(P均＜0.05),与男性(β=-0.605)、年龄(β=-0.014)和血浆白蛋白水平(β=-0.053)呈负相关(P＜0.01或0.05);HDL-C水平与年龄(β=0.007)、狼疮肾炎(β=0.188)、激素治疗(β=0.342)、血脂测定前30 d激素总量(β＜0.001)及补体C3水平(β=0.351)呈正相关(P均＜0.01),与高敏C反应蛋白水平(β=-0.005)呈负相关(P＜0.01).血脂水平与SLE病程、病情活动、激素治疗时间、血脂测定前激素日剂量、血清肌酐水平及红细胞沉降率无相关性(P均＞0.05).结论 住院SLE患者高血压、糖尿病及血脂异常的患病率较高,血脂水平与多种因素有关.     

系统性红斑狼疮与早发动脉粥样硬化及其相关危险因素

目的 研究绝经期前系统性红斑狼疮（SLE）女性患者动脉粥样硬化的发病情况，并与正常对照组进行比较，进一步探讨传统心血管疾病危险因素在此过程中的作用。方法 采用颈动脉超声检测110例绝经前SLE女性患者及40名健康女性颈部动脉粥样硬化斑块发生情况。所有人选对象均要求无临床心血管疾病史。在此基础上对高血压、血脂情况、吸烟、肥胖等传统的心血管疾病危险因素与颈动脉斑块之间的相关性进行研究。结果 在111例SLE组患者中有16例（14．4％）存在颈动脉斑块，而在40名正常对照组中无一例存在颈动脉斑块（P=-0．007）。与对照组相比，SLE组患者中高血压患病率明显增高（P〈0．01），血清总胆固醇（TC）（P=-0．022）、甘油三酯（TG）明显增高（P〈0．01）。SLE病程、患高血压及体重指数是SLE患者发生颈动脉斑块的独立预测指标。结论 在绝经前SLE患者中颈动脉粥样硬化斑块的发生率明显高于正常对照组。SLE病程、高血压及体重指数是SLE患者发生颈动脉斑块的危险因素。     

Systemic lupus erythematosus in patients with sickle cell disease

Sickle cell disease (SCD) is a prevalent genetic disorder that includes sickle cell anemia (hemoglobin SS), hemoglobin SC, and hemoglobin Sb-thalassemia. Patients with SCD present with a defective activation of the alternate pathway of the complement system that increases the risk of capsulate bacteria infection and failure to eliminate antigens, predisposing these patients to autoimmune diseases. The authors describe three patients with SCD that developed systemic lupus erythematosus (SLE). In all patients, SLE diagnosis was delayed because symptoms were initially attributable to SCD. Physicians should be alerted to the possible development of SLE in patients with SCD to not delay the diagnosis and start appropriate treatment.     

Systemic lupus erythematosus and pregnancy

Summary This article critically analyses the data in the literature on pregnancy in women with systemic lupus erythematosus. Based on the results of recent controlled prospective studies, it is apparent that the long-standing opinion that pregnancy induces exacerbation of the disease should be revised. The presence of active disease and/or a significant loss of renal function at conception are not only associated with a high risk of maternal complications, but also with high frequencies of loss of the fetus, as well as pre- and dysmaturity. Recently, the presence of antiphospholipid antibodies, notably the lupus anticoagulant and anticardiolipin antibodies, has been recognized as being important for the occurrence of death of the fetus, in particular, late in the pregnancy. This is probably due to thrombosis occurring in the placental vessels. However, the results of randomized studies on treatment with antithrombotic drugs and/or procedures lowering, antibody levels must be available before we will know whether the presence of these antibodies should be coupled to specific instructions or not. Although there is a strong association between the neonatal lupus syndrome and the presence of anti-SSA antibodies in maternal blood, the finding of anti-SSA antibodies has up to now had no therapeutic implications. It is concluded that pregnancy in SLE deserves extensive preconceptional counseling and close cooperation between the internist, rheumatologist, obstetrician and the neonatologist.     

Systemic lupus erythematosus in Egyptian children

The aim of the study was to study the characteristics of systemic lupus erythematosus (SLE) in the Egyptian population, comparing it to other populations. We retrospectively studied 207 patients with SLE diagnosed between 1990 and 2005. We obtained clinical features and laboratory data and analyzed them statistically. We studied 151 female and 56 male SLE patients. The female to male ratio was 2.7 to 1 and the mean age at presentation was 10 ± 2.7 years (range 2–16). The mean disease duration was 6.47 ± 3.74 years. At diagnosis, musculoskeletal, constitutional and mucocutaneous manifestations were the commonest features. During follow-up, the prevalence of nephritis (67%), hematological manifestations (44.9%), photosensitivity (44%), arthritis (39%), malar rash (38.2%), serositis (32.9%) and neuropsychiatric manifestations (24.25%) increased significantly. Those whose age of onset of the disease was ≤5 years (nine patients) had significantly more common hematological affection (P value = 0.0005). The characteristics of SLE in Egyptian patients show some similarities to other series of Middle Eastern countries, but with a lower female to male ratio. Disease onset below 5 years is extremely rare (4.35%), commonly presenting with hematological manifestations. The kidney was the commonest major internal organ involved, and also an important cause of death.     

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a typical autoimmune disease that leads to multiple organ damage. For over half a century, SLE has been treated mainly with nonspecific glucocorticoids and immunosuppressants, and the development of molecular target drugs with few adverse reactions is awaited. The treatment goal is remission without systemic symptoms or organ damage. An anti-B-cell activating factor antibody belimumab and an anti-type I interferon receptor antibody anifrolumab are used for patients with active SLE who respond poorly to standard of cares. Additionally, as many susceptibility genes for SLE are associated with signal transduction of dendritic and B cells, cytokines and signaling molecules that bridge the innate and adaptive immune systems are the current focus of attention. Promising approaches include the development of a Janus kinase inhibitors targeting tyrosine kinase deucravacitinib, plasmacytoid dendritic cell-targeted drugs, proteasome inhibitors (e.g., iberdomide), type II anti-CD20 antibody, and obinutuzumab.     

Systemic lupus erythematosus in North Indian Asians

Summary One hundred and one patients with systemic lupus erythematosus (SLE) from North Indian stock are presented. The clinical manifestations, laboratory parameters, causes of death, and survival are compared and contrasted with the other major reported series. SLE of North Indian Asians has several features comparable to those reported from the West, but other features are more similar to the SLE seen in Mongoloid races.     

Systemic lupus erythematosus associated with sarcoidosis: Case report

BackgroundThe association between systemic lupus erythematosus (SLE) and sarcoidosis has been considered as extremely rare. Most often, sarcoidosis coexists with Sjögren's syndrome. Researching the literature, it seems that the association of SLE and sarcoidosis is much more frequent than previously thought.Aim of the workWe present a case of a Serbian woman who was diagnosed with coexisting sarcoidosis and long-standing SLE.Case presentationThe 40 years old SLE patient was in long-standing remission on oral prednisolone (10 mg/day) and hydroxychloroquine (HCQ) (400 mg/day). She presented with fatigue, chest pain, and dry cough. Chest computerized tomography (CT) showed hilar and mediastinal lymphadenopathy. The biopsy had been performed and results showed sarcoidosis. Diagnosis has been confirmed: eosinophilic granulomas without central necrosis morphologically corresponding to chronic granulomatous lymphadenitis like sarcoidosis. Thereafter, the patient was hospitalized. No new symptoms appeared, and the physical examination was unremarkable. Serum calcium was elevated (2.75 mmol/l), anti-nuclear antibody (ANA), anti-double stranded deoxyribonucleic acid (anti-dsDNA) and anti-Ro antibodies were positive. Angiotensin converting enzyme (ACE) level was high normal (51 IU/L) and QuantiFERON-TB Gold test negative. The dose of prednisolone was increased to 40 mg/day with HCQ and the patient was discharged from hospital. On follow-up the patient improved with reduction of the steroid dose.ConclusionThe association of SLE and sarcoidosis should be considered even though it is reported to be extremely rare. May be the real incidence of these combinations is underestimated. More research about genetics and pathogenesis is needed to completely understand these conditions.     

Antinuclear antibodies measured by enzyme immunoassay in patients with systemic lupus erythematosus: relation to disease activity

To evaluate the correlation between measurements of antinuclear antibodies serum levels by enzyme immunoassay (ANA-EIA), and the degree of systemic lupus erythematosus disease activity. To retest the performance of the test compared to measurement of antinuclear antibodies by immunofluorescence (ANA-IIF). Eighty-five sera from 71 patients with SLE were tested. Demographic, clinical, laboratory, and SLEDAI status were collected. The sera were tested for ANA-EIA and by ANA-IIF at 1:40 and 1:160 dilutions. Serum levels of ANA-EIA were compared to the overall SLEDAI score and to each of its components. A SLEDAI score of ≥6 was considered clinically significant. The sera of fifty-one healthy volunteers served as controls. Serum levels of ANA-EIA were significantly higher in patients with a SLEDAI score of ≥6 compared to the group of patients with a SLEDAI score of <6 (P = 0.004). High serum levels of ANA-EIA correlated significantly with elevated anti DS-DNA antibodies (P < 0.001), low C₃ or C₄ levels (P < 0.001), pyuria (P < 0.011), arthritis (P = 0.019), and new rash (P = 0.019). Levels of ANA-EIA were significantly higher in patients tested positive by IIF compared to those who tested negative. Higher serum levels of ANA-EIA correlated with clinically significant disease activity in patients with SLE. Higher serum levels of ANA-EIA also correlated with some single items of the SLEDAI. The results also reiterated the validity of ANA-EIA testing in patients with SLE. Further longitudinal studies are needed in order to test the hypothesis that serum ANA-EIA levels might reflect fluctuations in disease activity.     

Atherosclerosis biomarkers in female systemic lupus erythematosus patients with and without cardiovascular diseases

Background

Cardiovascular diseases (CVD) and atherosclerosis are over presented in patients with systemic lupus erythematosus (SLE).

系统性红斑狼疮合并妊娠19例分析

目的　探讨系统性红斑狼疮 (SLE)患者合并妊娠后的病情恶化率以及妊高征发生率及妊娠期处理。方法　对1998～ 2 0 0 3年收治的 19例SLE合并妊娠的临床资料进行回顾性分析。结果　SLE合并妊娠后的病情恶化率及妊高征发生率分别为 5 2 6 %及 31 6 % ,与SLE病情活动和缓解有关。结论　SLE合并妊娠后病情容易加重 ,也易并发妊高征 ,应加强妊娠期监测和处理。     

Systemic amyloidosis and sacroiliitis in a patient with systemic lupus erythematosus

We report a case of a 25-year-old female with juvenile onset systemic lupus erythematosus who developed systemic secondary amyloidosis with renal and gastrointestinal involvement. She has also had radiological signs of bilateral asymptomatic sacroiliitis without lower back pain or HLA-B27 antigen. Received: 13 July 1998 / Accepted: 14 December 1998