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。     

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。     

The role of interleukins 4, 17 and interferon gamma as biomarkers in patients with Systemic Lupus Erythematosus and their correlation with disease activity

Aim of the workThis work was designed to study the production of proinflammatory cytokines in SLE patients and their correlation with disease activity and study if they can be used as biomarkers for renal activity in lupus nephritis patients.Patients and methodsThis study was carried out on 70 subjects divided into two groups: Group I (SLE group) which included 40 SLE patients and Group II (Control group) which included 30 apparently healthy controls. The patients were subjected to full history taking and complete clinical examination. Assessment of disease activity in SLE patients by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Sera of patients and controls were screened for the level of cytokine expression of T helper cells including interleukin 17 (IL-17), interleukin 4 (IL-4) and interferon gamma (IFN-γ).ResultsSerum levels of IL-4 were significantly lower while both IL-17 and IFN-γ were significantly higher in SLE patients than in the control group. The most powerful predictor and correlated cytokine with the SLEDAI in SLE patients was IL-17. Higher serum level of IFN-γ was associated with more pyuria and hematuria, while higher IL-17 was associated with more pyuria and proteinuria in SLE patients.ConclusionThe serum level of IL-17 and IFN-γ was proven to be significantly higher in SLE patients and can be used as biomarkers of renal activity.     

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。     

系统性红斑狼疮患者动脉粥样硬化的研究进展

目的 近年来很多研究证明系统性红斑狼疮患者的心血管疾病发生率及死亡率均高于普通人群.除传统因素外,系统性红斑狼疮患者动脉粥样硬化的发生与血清自身抗体、炎症反应、氧化抗氧化失衡、药物等因素有密切关系.早期检测及干预对系统性红斑狼疮患者动脉粥样硬化的预后具有重要的临床意义.     

自体外周血造血干细胞移植治疗难治性系统性红斑狼疮

目的:探讨自体外周血造血干细胞移植(APBSCT)治疗难治性系统性红斑狼疮(SLE)的临床疗效。方法:用APBSCT治疗4例难治性SLE。干细胞动员应用环磷酰胺(CTX)4g/m2,分两天应用和粒细胞集落刺激因子(G-CSF)5~10μg/kg·d-1;预处理方案包括CTX(50mg/kg·d-1,-6、-5、-4、-3d),抗胸腺细胞球蛋白(ATG15~20mg/kg·d-1,-2、-1、 1、 2d)。结果:4例患者均获得造血重建,中性粒细胞>0.5×109/L,血小板>20×109/L的中位数时间分别是9d,10d;SLE的临床表现明显减轻,尿蛋白减少或消失,自身抗体转阴或滴度减低,泼尼松用量<10mg/d;无移植相关死亡。结论:APBSCT治疗难治性SLE近期疗效显著,造血重建恢复迅速,安全有效,远期疗效尚需进一步观察。