614例系统性红斑狼疮自身抗体检测结果分析

目的探讨抗核抗体(ANA)、抗ENA抗体和抗ds-DNA抗体对系统性红斑狼疮(SLE)的临床实用价值和特点.方法ANA和抗ds-DNA抗体采用间接免疫荧光法检测.ANA底物为小鼠肝肾印片;ds-DNA抗体的实验基质为血鞭毛虫属的绿蝇短膜虫;抗ENA抗体检测采用酶免疫斑点(条带)实验.结果ANA阳性率为98.05%,ds-DNA抗体阳性率为60.10%,抗Sm抗体阳性率为46.58%,均高于其他自身抗体的阳性率,x2检验有统计学意义(x2=17.00,P＜0.05).结论ANA作为SLE重要的一类抗体,ds-DNA抗体和抗Sm抗体是SLE的重要标志性抗体,三种抗体联合测定可提高SLE的检出率,对SLE病情的诊断、分型、治疗、追踪和预后判定均有重要价值.     

抗核抗体、抗ENA抗体、抗dsDNA抗体联合检测对SLE的诊断意义

为探讨抗核抗体(ANA)、抗ENA抗体、抗dsDNA抗体联合检测对SLE的诊断意义。对ANA和抗dsDNA抗体采用间接免疫荧光检测，抗ENA抗体检测采用酶免疫斑点(条带)试验。结果ANA在SLE患者阳性率为91．6％，dsDNA抗体阳性率为66．2％，SS—A抗体阳性率52．0％，SS—B抗体阳性率32．6％，Sm抗体阳性率为36．4％，nRNP／Sm抗体阳性率为44．2％，Sel-70抗体、Jo-1抗体阳性率均为5．6％。联合检测可避免因单项检测出现的漏诊情况，起到相互补充、相互印证，提高SLE确诊率的作用。     

ANA、抗dsDNA、ANCA、抗ENA多肽抗体联合检测在SLE诊断中的价值

为探讨ANA、抗dsDNA、ANCA、抗ENA抗体谱联合检测在SLE诊断中的价值。采用间接免疫荧光法(IIF)检测ANA、抗dsDNA、ANCA,采用免疫印迹法(IBT)检测抗ENA多肽抗体。结果:检测170例SLE患者ANA阳性率为88.2%,抗dsDNA阳性率为66.5%,ANCA阳性率为55.2%,抗ENA多肽抗体阳性率为73.5%。SLE患者组ANA、dsDNA、抗ENA多肽抗体、ANCA4项指标均显著高于正常对照组(P<0.01)。ANA、抗dsDNA、ANCA、抗ENA抗体联合检测在SLE诊断中具有互补性,并能提高对SLE诊断的阳性率和特异性,对SLE的诊断分型、治疗、预后均有重要的临床价值。     

系统性红斑狼疮(SLE)患者几项免疫指标的检测及其意义的探讨

本文报道采用LTT,EtRFCT, EaRFCT和PHA皮试对SLE患者进行细胞免疫功能测定.显示有不等程度的细胞功能低下和T淋巴细胞数的减少.体液免疫功能测定显示48多病例有IgG增高,血清ANA测定阳性串为81.1%,娥识阳性率达99.3%.滴度1≥80,病情活动者较多,斑点核型最常见.周边型、斑点线型和匀质型活动性较高.狼疮性肾病出现蛋白尿者尿ANA测定41.7%阳性.在累及中枢神经系统病例70%脑脊液ANA呈阳性.血清dsDNA间接血凝法测定29.89%阳性.¹²⁵I DNA同位索法测定结果基本上与之平行,这组病例病期较短,肾累及较多,采用PEG沉淀法测定CIC有43%增高,经解离分析CIC的主要内容为核抗原和抗核抗体复合物.CH₅₀和C₃测定有不等程度降低,最后作者对SLE的发病机理进行了讨论.     

系统性红斑狼疮患者抗HSP70和HSP60抗体的检测

目的 检测系统性红斑狼疮(SLE)患者抗热休克蛋白(HSP)70和HSP60抗体水平及与病情活动的关系.方法 采用Western印迹-酶联免疫吸附实验(ELISA)方法检测了60例SLE患者和45例正常对照组外周血抗HSP70、HSP60抗体水平和采用ELISA方法检测EB病毒抗体水平.结果 SLE活动期患者抗HSP70和HSP60抗体阳性率明显高于稳定期组,稳定期组的表达明显高于对照组;活动期的狼疮肾病患者抗HSP70抗体阳性率明显高于非狼疮肾病组;SLE患者中EB病毒感染阳性组抗HSP70和HSP60抗体阳性率均明显高于EB病毒感染阴性组.结论 抗HSP70和HSP60抗体可能在该病的发生与发展中起一定的作用.     

136例SLE患者自身抗体检测分析

为进一步观察自身抗体在系统性红斑狼疮(SLE)患者的诊断和疗效观察方面的特异性和敏感性,我们回顾性分析了本院门诊和住院的136例SLE患者ANA、抗ds-DNA抗体、抗ENA多肽抗体检测结果。结果ANA阳性124例占91.18%;抗ds-DNA抗体阳性69例占50.74%;抗Sm抗体阳性41例占30.15%。ANA敏感性较高,抗ds-DNA抗体特异性较高。两者效价与SLE患者病情活动性相关。     

系统性红斑狼疮患者抗HSP70和HSP60抗体的检测

目的：检测系统性红斑狼疮（SLE）患者抗热休克蛋白（HSP）70和HSP60抗体水平及与病情活动的关系。方法：采用Western印迹一酶联免疫吸附实验（ELISA）方法检测了60例SLE患者和45例正常对照组外周血抗HSP70、HSP60抗体水平和采用ELISA方法检测EB病毒抗体水平。结果：SLE活动期患者抗HSP70和HSP60抗体阳性率明显高于稳定期组，稳定期组的表达明显高于对照组；活动期的狼疮肾病患者抗HSP70抗体阳性率明显高于非狼疮肾病组；SLE患者中EB病毒感染阳性组抗HSP70和HSP60抗体阳性率均明显高于EB病毒感染阴性组。结论：抗HSP70和HSP60抗体可能在该病的发生与发展中起一定的作用。     

活动期系统性红斑狼疮患者血清抗中性粒细胞胞浆抗体的临床意义

目的探讨抗中性粒细胞胞浆抗体(ANCA)在活动期SLE患者中临床意义.方法通过间接免疫荧光法及免疫印迹法检测60例处于活动期的SLE的血清ANCA、ANA、抗dsDNA抗体、抗ENA多肽,了解ANCA与SLE临床表现及与其它实验室检查的关系.结果 ANCA与SLE疾病活动程度不相关,与各自的具体脏器累及也无明显相关,但多系统损害的患者ANCA阳性组明显高于ANCA阴性组,在ANCA阳性组各种自身抗体,包括抗dsDNA抗体、抗Sm抗体、抗心磷脂抗体的阳性率明显升高.结论在SLE活动期ANCA阳性提示SLE病情相对复杂,但与某一特殊的临床表现不相关.     

系统性红斑狼疮患者血清抗中性粒细胞胞浆抗体及抗血管内皮细胞抗体检测

探讨血清抗中性粒细胞胞浆抗体(ANCA)及抗血管内皮细胞抗体(AECA)在系统性红斑狼疮(SLE)发病中的作用和意义.收集SLE患者和正常人群血清,用间接免疫荧光技术检测血清中ANCA和AECA,并分型.50例SLE组ANCA阳性率为52%(26/50),其中核周型ANCA(P-ANCA)21例,阳性率42%,胞浆型ANCA(C-ANCA)5例,阳性率10%.与正常对照组比较差异有显著性(P≤0.05).AECA阳性率为62%(31/50),其中IgG-ANCA阳性19例,阳性率为38%,IgM-AECA阳性21例,阳性率42%,与正常对照组比较有显著性差异(P<0.01).患者中伴有浆膜炎和肾脏受累的,ANCA阳性组高于阴性组(P<0.05);伴有雷诺现象、网状青斑及肾脏损害的AECA阳性组高于阴性组(P<0.05);而在皮肤损害、低补体、抗核抗体阳性等方面ANCA及AECA阳性组与阴性组的差异均无显著性(P>0.05).ANCA及AECA都参与了SLE的发病,对SLE患者血清ANCA及AECA检测,有助于了解SLE血管及肾脏病变的发病机制.     

局限性硬皮病的抗核抗体

作者报告了用间接免疫荧光法测定22例局限性硬皮病患者的抗核抗体(ANA)的结果,发现用Hela细胞作底物阳性率达72.7%(16/22),其中硬斑病为50%(2/4);泛发性硬斑病为100%(6/6);线状硬皮病为66.7%(8/12).而用小鼠肾作底物时阳性率为50%(11/22),其中泛发性硬斑病为100%(6/6),线状硬皮病为33.3%(4/12),硬斑病为25%(1/4).所有病例均未发现抗Sm,nRNP,Scl-70和SS-B抗体.4例泛发性硬斑病抗双链DNA抗体阳性,但结合活性比SLE要低得多.用组蛋白重结合技术检测抗组蛋白抗体,全部病例阴性.     

Glomeruloid haemangioma is not always associated with POEMS syndrome

Glomeruloid haemangioma is considered a specific marker of POEMS ( p olyneuropathy, o rganomegaly, e ndocrinopathy, M -protein and s kin changes) syndrome and it is usually but not always associated with multicentric Castleman's disease. We report a 78-year-old man who presented with a single, red-violet soft nodule with superficial telangiectases on the scalp. Histopathologically, the lesion consisted of lobules of coiled aggregated capillaries that involved the lumina of dilated vascular structures, mimicking renal glomeruli. A collagenous stroma separated the capillary lobules, and eosinophilic, periodic-acid–Schiff positive globules of varying sizes and shapes were seen within the cytoplasm of endothelial cells. Immunohistochemical studies with antibodies against IgA and IgG, and against the kappa and lambda light chains of immunoglobulins showed immunoreactivity within the eosinophilic globules. Results of complete blood count, liver, renal and thyroid function tests, fasting blood sugar measurement, serum levels of oestradiol, testosterone, prolactin and cortisol, serum protein electrophoresis, immunoelectrophoresis and immunofixation yielded normal or negative results. No Bence–Jones proteinuria was found in a sample from a 24-h urine collection. To our knowledge, only two cases of glomeruloid haemangioma have been previously reported in patients without POEMS syndrome. We describe the third case of glomeruloid haemangioma in a patient without features of POEMS syndrome.     

高温高强度高心理压力下训练的阅兵队员运动性蛋白尿流行病学调研

目的探讨高温高强度高心理压力训练下运动性蛋白尿的发生率。方法留取参加国庆60周年大庆武警阅兵方队部分队员训练前后的尿样化验尿常规并行尿A1b、α1—MG及β2-MG检查,同时化验血尿素氮、肌酐水平,并与同期进行常规训练的武警驻京某部战士进行比较。结果阅兵方队组运动性蛋白尿的发生率明显高于驻京部队组（78．1％VS33．3％,P〈0．05）。两组训练后尿微量白蛋白、α1-MG、β2-MG水平明显高于训练前（P〈0．05）;两组训练前后血尿素氮、肌酐水平无明显差异（P〉0．05）。结论高温高强度高心理压力训练下运动性蛋白尿的发生率明显增加,必须采取有效的措施进行预防。     

Central blood pressure and chronic kidney disease

In this review, we focused on the relationship between central blood pressure and chronic kidney diseases (CKD). Wave reflection is a major mechanism that determines central blood pressure in patients with CKD. Recent medical technology advances have enabled non-invasive central blood pressure measurements. Clinical trials have demonstrated that compared with brachial blood pressure, central blood pressure is a stronger risk factor for cardiovascular (CV) and renal diseases. CKD is characterized by a diminished renal autoregulatory ability, an augmented direct transmission of systemic blood pressure to glomeruli, and an increase in proteinuria. Any elevation in central blood pressure accelerates CKD progression. In the kidney, interstitial inflammation induces oxidative stress to handle proteinuria. Oxidative stress facilitates atherogenesis, increases arterial stiffness and central blood pressure, and worsens the CV prognosis in patients with CKD. A vicious cycle exists between CKD and central blood pressure. To stop this cycle, vasodilator antihypertensive drugs and statins can reduce central blood pressure and oxidative stress. Even in early-stage CKD, mineral and bone disorders (MBD) may develop. MBD promotes oxidative stress, arteriosclerosis, and elevated central blood pressure in patients with CKD. Early intervention or prevention seems necessary to maintain vascular health in patients with CKD.     

输血前患者血HBsAg、抗HCV、抗HIV和梅毒抗体检测结果临床研究

目的:观察输血前患者血乙肝表面抗原(HBsAg)、丙肝抗体(抗HCV)、艾滋病抗体(抗HIV)和梅毒抗体检测结果。方法:取医院输血治疗患者3542例,治疗前对患者采用化学发光免疫测定(CLIA)法和ELISA法检测血清标本中血HBsAg、抗HCV、抗HIV和梅毒抗体指标,分析其检测结果并提出相应的解决对策。结果:3542例输血患者中704例血HBsAg阳性,52例抗HCV阳性、3例抗HIV阳性,200例梅毒抗体阳性;男性血HBsAg、抗HCV、抗HIV和梅毒抗体感染率,高于女性(P0.05)。3542例输血患者中不同年龄段均存在血HBsAg、抗HCV、抗HIV和梅毒抗体感,对于血HBsAg、抗HCV多发生在21~40岁年龄段;抗HIV多发生在41~60岁年龄段;梅毒抗体发生在41~60岁年龄段。959例血HBsAg、抗HCV、抗HIV和梅毒抗体感染病例分布科室较多,排在前三位分别为消化内科、普外科及肿瘤科,分别占33.98%、20.96%及17.00%。结论:输血前加强患者血HBsAg、抗HCV、抗HIV和梅毒抗体指标检测,能降低血液传染性疾病发生率,值得推广应用。     

长航人员体检微量蛋白尿情况分析

目的 对亚丁湾护航官兵体检时部分人员出现的微量蛋白尿现象加以分析,找出相关原因.方法 通过统计学方法,对尿蛋白阳性与尿常规正常两组人群相关因素进行对比,同时将蛋白尿与已知相关危险因素分析,找出相关人员出现微量蛋白尿原因.结果 提示体检蛋白尿阳性人员与其他人员在相关因素对比中无统计学差异,同时经单因素和多因素（OR）分析表明,与蛋白尿常见危险因素年龄、肥胖、高血压、血脂紊乱、高空腹血糖、高尿酸不相关.结论 此次体检出现的部分任务官兵微量蛋白尿考虑为生理性蛋白尿,与远洋航海特殊环境有关,同时存在假阳性结果可能。     

SLE患者外周血中CD16的水平与疾病的关系

目的研究系统性红斑狼疮(SLE)患者外周血CD16的变化,并与病情活动性及脏器损害等临床资料进行相关性分析,探讨CD16在SLE发病中的作用。方法选择35例SLE患者,根据SLEDAI评分及有无蛋白尿、肾功能损害等进行分组;同时选择35例健康者为对照组,采用流式细胞术检测外周血中CD16的水平。结果 SLE患者外周血CD16的水平低于健康对照组,差异有统计学意义(P<0.05);活动组SLE患者外周血中CD16阳性细胞较非活动组降低不明显(P>0.05);狼疮性肾炎(LN)组较非LN组的外周血CD16阳性细胞下降明显(P<0.05),且LN组中已出现肾功能损害者CD16阳性细胞明显低于尚未出现肾功能损害组(P<0.05)。结论 CD16可能参与SLE的发病过程,且与其肾脏病变程度相关。     

Urticarial vasculitis associated with a monoclonal IgM gammopathy: Schnitzler''s syndrome

We describe two cases of Schnitzler's syndrome presenting with urticarial vasculitis, in which there was a monoclonal IgM of kappa light-chain isotype. Skin histology showed a perivascular leucocytic infiltrate and leucocytoclasis. One patient had an abnormal complement profile and positive rheumatoid factor while the other had antibodies to unidentified soluble nuclear antigens, anti-cytoplasmic antibodies and circulating immune complexes. In addition, in the first case deposits of IgM, C3 and, to a lesser degree, of IgG were observed in the walls of small blood vessels.     

An atypical cutaneous presentation of vasculitis with features of Churg–Strauss syndrome,associated with anti‐neutrophil cytoplasmic antibodies and anti‐glomerular basement membrane antibodies

We report the case of a 59‐year‐old woman who presented with a persistent papular and nodular cutaneous eruption and new‐onset asthma, with normal renal function but persistent haematuria and proteinuria. Investigations revealed eosinophilia, both antineutrophil cytoplasmic antibodies and antiglomerular basement membrane antibodies on serological testing (double‐positive vasculitis), and a focal necrotizing glomerulonephritis on renal biopsy. Histological examination of a skin biopsy showed a dense neutrophilic infiltrate with focal fibrinoid necrosis and few eosinophils. The clinical and pathological features suggested a double‐positive vasculitis/Churg–Strauss overlap syndrome presenting with a predominantly neutrophilic dermatosis. Specific cutaneous features in patients with double‐positive vasculitis have not been documented previously. The patient has responded extremely well to immunosuppressive treatment and her disease is currently in remission.     

Antibodies eluted from lymphoid cell membrane. Occurrence in certain varieties of scleroderma.

By means of acid elution two antibodies could be removed successfully from the circulating lymphocytes of 11 patients with certain varieties of scleroderma. One was specifically directed against nuclear antigen(s) of endothelial cells (NEC) of the dermal blood vessels, and another against nuclear antigen(s) of epidermal basal cells (NBC) of the involved and uninvolved skin of the patients. In two cases of acroscleroderma, the eluates failed to react with either endothelial or basal cells of involved or uninvolved skin. In none of 20 healthy controls involved in this study could an antibody be eluted from the circulating lymphocytes. The aforementioned antibodies do not bind complement in vitro and do occur in the serum of four patients. Circulating antinuclear antibody (speckled type) was detectable in two cases of scleroderma.