Le tissu adipeux : un donneur de cellules souches ?

Several laboratories have shown that the cells from the stroma-vascular fraction of the human adipose tissue express, depending on cell culture conditions, biochemical markers of multiple cell lineages including adipogenic, osteogenic, chondrogenic, myogenic, endothelial, neuronal and epithelial cell lineage. Furthermore, various in vivo approaches revealed the ability of the cells derived from the stroma-vacsular fraction of adipose tissue to repair ischemic or damaged tissues. Altogether these data strongly suggest that the stroma-vascular fraction of the human adipose tissue contains cells that exhibit properties like stem/progenitor cells. However, the exact nature of the cells, their potentiality to lead to differentiated cells in vivo as well as the mechanisms involved in their repair capability remain to be characterized to consider their use in regenerative and reparative medicine.     

临床特点联合实验室指标对狼疮肾炎病理分型的预测研究

目的 通过临床及实验室指标,建立狼疮肾病理分型的预测模式。方法 2011-2015年我院住院有肾病理的系统性红斑狼疮 （systemic lupus erythematosus,SLE）患者,经糖皮质激素等治疗2月以上,尿蛋白仍阳性的患者201例,分析其临床及实验室指标,采用Epi Data 3.1 和SPSS 21.0软件进行统计。结果 Ⅱ型17例,Ⅲ型26例,Ⅳ型135例,Ⅴ型23例;单因素分析：增殖型年龄及发病年龄均小、SLEDAI高、贫血多、C3低、C1q（64.0%）及ds-DNA阳性率均高（53.4%）;膜型发病年龄大,ds-DNA阳性率低（13.0%）;系膜型卧位后尿蛋白转阴性率为67.4%。Logistic回归分析显示,相对于其它类型,系膜型SLEDAI低,卧位后尿蛋白转阴性率高;增殖型SLEDAI高、尿蛋白阳性率及抗 ds-DNA 阳性率均高;膜型发病年龄大、抗 ds-DNA阳性率低。结论 狼疮肾病理分型的预测模式：SLEDAI低,卧位后尿蛋白转阴性率高是Ⅱ型的强预测指标;SLEDAI高、尿蛋白阳性、抗 ds-DNA 阳性,是Ⅲ/Ⅳ型的预测指标;发病年龄大、抗 ds-DNA阳性率低是Ⅴ型的预测指标。     

CD137与系统性红斑狼疮

系统性红斑狼疮是自身免疫性疾病的原型,主要表现为T、B淋巴细胞功能异常,产生大量自身抗体,近年来发现,T细胞及其亚群和共刺激分子可能是SLE的发病机制的关键.本文就共刺激分子CD137的结构、配体、生物学功能及其在系统性红斑狼疮发生、发展中的作用作一综述.     

Le médecin, son malade et les kilos

Whereas health authorities are at concern with obesity pandemia which is developing worldwide, it seems that in private clinical settings both physician and overweight patients do not approach easily this topic.Psychological approach is focusing on the gap in medical and patients realities as regards body weight and food intake. This gap is preventing alliance between general practitioners and patients.Both of them are avoiding calling forth body weight as much as they consider failure of dieting as a lack of will power of fat people. The persistence of this prejudice results from misreading the paradoxal effects of cognitive restraint which bypasses physiological signals and may lead to paradoxal skids: the restrained subject is at risk to eat more that he could have eaten if he head not attempted to eat less.In order to fight against these prejudices worsening obesity it is important to provide general practitioners and their patients with realistic and balanced information, cleared from simplistic prejudices.     

IgG型抗dsDNA抗体及其亚型与狼疮肾炎临床和病理关系探讨

目的比较狼疮肾炎（LN）患者和非LN的系统性红斑狼疮（SLE）患者血清IgG抗dsD-NA抗体及其亚型的分布,探讨抗dsDNA抗体与LN病理间的关系,为LN的早期诊断和制定治疗方案提供依据。方法以健康个体为正常对照组,病例组选自两所三甲医院住院的SLE患者,病例组又分为LN和非LN两组,采用双抗夹心酶联免疫吸附试验测定研究对象外周血IgG型抗ds-DNA抗体及其亚型,SPSS 10.0进行统计分析。结果SLE患者与正常对照相比,血清IgG型抗dsDNA抗体阳性率差异有显著性（χ2=31.16,P〈0.001）,但是SLE非LN患者与LN患者相比,血清IgG型抗dsDNA抗体阳性率差异无显著性（χ2=0.021,P=0.885）。血清IgG1（χ2=5.35,P=0.021）和IgG2（χ2=5.24,P=0.022）在非LN的SLE患者与LN患者两组中的分布差异具有显著性,而血清IgG3差异无统计学意义（χ2=0.09,P=0.755）,两组间均未检测到血清IgG4亚型。血清总IgG抗dsDNA抗体与狼疮肾炎活动性指标和慢性指标有关,在其亚型中,仅见IgG2亚型与狼疮肾炎活动性指标有关,而未见各亚型与慢性指标有关。结论IgG1和IgG2升高可能参与了LN的发病,且IgG2与其活动性呈正相关,可反映疾病的严重程度,在临床诊断上具有一定的价值。血清抗dsDNA抗体与LN临床活动性指数相关,可以作为LN活动的指标。     

可诱导共刺激分子配体在系统性红斑狼疮血清中水平及临床意义

目的 探讨可诱导共刺激分子配体（inducible costimulator molecule ligand,ICOSL）在系统性红斑狼疮（systemic lupus erythematosus,SLE）患者血清表达水平变化,并分析其临床意义。方法 纳入2015年3月1日~2015年8月31日安徽医科大学第一附属医院、第二附属医院的风湿科和肾脏科住院治疗的34例活动性SLE、15例非活动性SLE患者和33例年龄、性别相匹配的健康志愿者,酶联免疫吸附试验（enzyme-linked immunosorbent assay,ELISA）法检测血清标本可溶性ICOSL（sICOSL）水平。结果 与健康对照组相比,SLE、狼疮肾炎（lupus nephritis,LN）、活动组血清sICOSL水平降低（P₁=0.004;P₂=0.008;P₃=0.003）;但血清sICOSL水平与SLE疾病活动度、anti-dsDNA滴度、补体C3、补体C4、血沉、24小时尿蛋白、血肌酐、尿素氮均无相关性（均有P>0.05）,并且实验室指标阳性组与阴性组sICOSL的血清水平差异均无统计学意义（均有P>0.05）。此外,糖皮质激素或者免疫抑制剂的应用并未对血清sICOSL水平产生影响（t=-0.69,P=0.495）。结论 SLE患者血清ICOSL表达水平降低,提示其可能参与了SLE的发生、发展,但其具体机制尚未明确,需要进一步研究。     

Le processus du vieillissement : longévité et alimentation

Ageing and the nutrition knew two great evolutions recently. First of all, progress of the genetics of ageing which showed the genetic control of longevity. In addition, the important corpus of knowledge accumulated in the field of the food restriction, one of the rare interventions not-genetics known to increase the longevity of the mammals. This type of food mode being associated with a reduction in pathologies related to the age. The conjunction of these two targets of research made it possible to discover at animal models, mainly invertebrate, the subjacent genetic mechanisms binding the level of food and longevity. The comprehension of these genetic mechanisms will make it possible to open therapeutic new prospects connected to the processes of ageing. From yeast to mammals, a certain number of homologous genetic ways were shown. This rise of knowledge brings a beam, always growing, of data showing that the nervous system power station plays a part crucial in the perception of the requirements out of food also in the invertebrates.     

狼疮细胞对判断系统性红斑狼疮病情的临床价值研究

目的探讨特殊型狼疮细胞对判断系统性红斑狼疮（SLE）疾病严重性和活动性的临床价值。方法采用改良血块法对128例SLE患者特殊型狼疮细胞的观察,同时用SLE疾病活动性经典生物标记抗体：抗双链DNA（dsDNA）抗体、抗核小体抗体（AnuA）、补体及SLE活动指数（SLEDAI）作对照比较。结果狼疮细胞（LEC）存在多形态结构异常,均匀体小至笔尖大至巨核细胞出现裂隙不规则,细胞多聚集成片结构清晰可辨,有的似串葡萄、巨核细胞、双叶、多叶及降落伞等特殊形态。70例SLE患者特殊型狼疮细胞的检出与抗dsDNA抗体、AnuA和SLEDAI呈显著正相关（r=0.59,P〈0.05;r=0.76,P〈0.01;r=0.58,P〈0.05）,与C3和C4水平呈明显负相关（r=-0.65,P〈0.05;r=-0.59,P〈0.05）。结论特殊型狼疮细胞是SLE病情发展的特殊产物,经与SLE疾病活动性的经典生物标记抗体和SLEDAI比较研究,对SLE疾病的严重性和活动性判断具有更简便快速,准确可靠,经济优于生物抗体标记法的重要临床价值。     

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...     

Le blues du mangeur: Comment manger sans pécher ?

For human consumers, eating means more than simply obtaining nutrients. Following millenaries of food shortages, the present-day plethora associated with industrialized and globalized production has changed the food situation and exposed human consumers to dangers for which they are not prepared, among which obesity is the most obvious. Food behavior and weight “norms” recommended by experts might have done more harm than good. A consequence of the restrictive diets proposed by medical dietetics for over half a century is “cognitive restraint”, which favors eating disorders as well as weight gain, and compromises the quality of life of obese individuals confronted by social stigma. Nutrition specialists who have remained aware of human heterogeneity and complexity, denied by the orthodox dogma supported by international medical dietetics, have proposed promising options for both treatment and prevention.     

狼疮性肾炎患者医院感染的临床与病理特征研究

目的探讨狼疮性肾炎患者医院感染临床与病理特征,以提高临床诊治水平。方法选取2010年4月-2013年4月135例狼疮性肾炎患者为研究对象,对其中发生医院感染的病例从感染部位、临床分型、临床病理特点和相关影响因素进行分析,数据采用SPSS16.0软件进行处理。结果 135例狼疮性肾炎患者医院感染57例,感染率42.22%;其中下呼吸道感染24例占42.1%;感染类型以急进型肾炎综合征、急性肾炎综合征感染率最高,分别为81.82%、61.54%;Ⅲ型感染率最高,为72.73%;其中易感因素有24h尿蛋白≥3.5g、血清白蛋白<30g/L、血肌酐升高、小管间质病变≥20%、激素应用时间长≥6个月、住院时间长≥60d、激素+环磷酰胺冲击治疗。结论狼疮性肾炎患者医院感染发生率较高,感染和狼疮临床活动、病理和治疗等各个方面均有相关性。     

狼疮肾炎患者血清抗核小体抗体水平检测及其临床意义

目的 探讨血清抗核小体抗体(AnuA)水平与狼疮肾炎活动性、肾脏病理改变的关系及其治疗前后的变化.方法 用酶联免疫吸附法检测活动期狼疮肾炎患者40例(观察组)和同期健康体检者40例(对照组)血清AnuA水平,分析其与系统性红斑狼疮疾病活动指数(SLEDAI)、肾脏病理改变及其他实验室参数的相关性,并比较狼疮肾炎患者治疗前后血清AnuA水平的变化.结果 观察组治疗前血清AnuA水平为(110.23±80.48) kU/L,较对照组的(10.45±8.20) kU/L明显升高(P＜0.05);40例狼疮肾炎患者均行肾穿刺活检,Ⅱ型4例,Ⅲ型8例,Ⅳ型23例,V型5例.经Kruskal-Wallis秩和检验显示,各病理类型间血清AnuA水平比较差异有统计学意义(P＜0.05),其中Ⅳ型血清AnuA水平显著高于其他病理类型(P＜0.05);血清AnuA水平与SLEDAI、尿蛋白定量及抗双链DNA(dsDNA)抗体滴度呈正相关性(r=0.462、0.521、0.394,P＜ 0.05),与补体C3、C4水平呈负相关性(r=-0.403、-0.489,P＜ 0.05);观察组治疗后血清AnuA水平为(32.45±18.31) kU/L,较治疗前[(110.23±80.48) kU/L]明显降低(P＜0.05).结论 血清AnuA水平不仅与狼疮肾炎活动性相关,而且在一定程度上能反映肾脏病变程度,检测血清AnuA水平可以为临床治疗及判断预后提供重要依据.     

逆转狼疮性肾炎肾功能不全的一体化治疗

目的 观察逆转狼疮性肾炎（LN）肾功能不全的一体化治疗效果。方法 55例可逆性狼疮性肾炎肾功能不全的患者分二组（观察组28例，对照组27例）进行治疗。对照组27例，常规血液透析，强的松标准疗程和环磷酰胺冲击疗法。观察组28例，在对照组治疗方案基础上，采取血液净化、免疫抑制剂治疗、中药、免疫支持及对症治疗等多方面优化组合的一体化治疗方案。结果 观察组白细胞低下感染发生率低于对照组，2年后观察组平均血肌酐低于对照组，观察组总有效率高于对照组，二组差异有显著意义（P〈0．05）。结论 一体化治疗逆转狼疮性肾炎肾功能不全疗效好、安全性高，并且比单用常规治疗在改善疾病远期疗效及减少不良反应等方面更，明显。     

Névirapine et risque cardiovasculaire

Taking into account long-term adverse effects of antiretroviral treatment has become a major concern for physicians managing HIV infected patients. More specifically, cardiovascular risk is the fourth cause of death in this population. Nevirapine, when used in antiretroviral naive patients or as a substitution for tritherapy, has constantly proven superior to other combinations for HDL-c lipid disorders. The main metabolic process responsible for this protective effect is the increased A1 apolipoprotein production. International cohort studies such as DAD or SMART suggest that a very limited risk of cardiovascular morbidity might be associated to nevirapine exposure. This data should be considered when choosing antiretroviral treatment, especially for initiation of treatment in patients with cardiovascular risk factors or when substituting for an efficient tritherapy.     

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。     

他克莫司联合激素诱导治疗弥漫增生性狼疮性肾炎的临床研究

目的 探讨他克莫司联合激素诱导治疗弥漫增生性狼疮性肾炎的疗效和安全性.方法 将38例弥漫增生性狼疮性肾炎患者按随机数字表法分为研究组和对照组,每组19例,分别采用他克莫司联合激素治疗和环磷酰胺联合激素治疗,观察两组治疗前后的实验室指标变化以及用药期间的不良反应.结果 两组治疗9个月后的狼疮疾病活动性指数、尿蛋白定量、尿沉渣红细胞计数和抗dsDNA阳性率较治疗前均显著下降,差异有统计学意义(P＜0.05);而血清白蛋白、C3和C4较治疗前均显著升高,差异有统计学意义(P＜0.05);研究组尿蛋白定量较对照组下降更为显著,而血清白蛋白升高则更为显著,差异均有统计学意义(P＜0.05).研究组的有效率为94.7%(18/19),显著高于对照组的68.4%(13/19),差异有统计学意义(P＜0.05);研究组获得完全缓解、部分缓解的时间均显著短于对照组,差异有统计学意义(P＜0.05).两组均未发生因药物不良反应严重而停药者,研究组一过性血肌酐升高、糖代谢异常的发生率均高于对照组,而感染和一过性肝酶升高发生率则低于对照组.研究组未出现月经紊乱和血白细胞减少者,但上述不良反应的发生率组问比较差异均无统计学意义(P＞0.05).结论 他克莫司是诱导治疗弥漫增生性狼疮性肾炎的一种有效的免疫抑制剂,起效快,不良反应轻.

Abstract：

Objective To investigate the efficacy and safety of tacrolimus combined with glucocorticoid for inductive therapy of diffuse proliferative lupus nephritis. Methods Thirty-eight patients with diffuse proliferative lupus nephritis were randomly divided into study group (19 cases) and control group (19 cases) ,and they received the treatment of tacrolimus combined with glucocorticoid and cyclophosphamide combined with glucocorticoid respectively. The changes of laboratory tests and adverse reactions before and after treatment were observed. Results After treatment for 9 months, the systemic lupus erythematosus disease activity index, urinary protein quantitation, urinary sediment RBC count and anti-dsDNA positive rate in two groups were significantly decreased than those before treatment (P ＜0.05). While serum albumin, complement C3 and G4 levels were significantly increased than those before treatment (P＜0.05). Urinary protein quantitation in study group decreased more significantly than that in control group, while serum albumin increased more significantly than that in control group, and the differences were statistically significant(P＜ 0.05). The effective rate in study group[94.7%(18/19)] was significantly higher than that in control group[68.4%(13/19)](P＜ 0.05). The duration to obtain complete remission and partial remission in Emaii:mashangminpl@163.comstudy group was significantly shorter than that in control group(P＜ 0.05). Nobody withdrawed from the study due to serious side effects of drug. The incidence rate of transient increase in SCr and abnormal glucose metabolism in study group was higher than that in control group, and the incidence of infection and elevated liver enzymes was lower than that in control group. In addition, menstrual disorders and reduction of blood WBC did not occur in study group, but the incidence rate of side effects between two groups had no significant difference (P＞ 0.05). Conclusion Tacrolimus is an effective immunosuppressant for inductive therapy of diffuse proliferative lupus nephritis with quick response and less adverse effects.     

Le syndrome métabolique : une entité à haut risque métabolique et cardiovasculaire

The association between abdominal obesity, insulin-resistance, type 2 diabetes, arterial hypertension and dyslipidemia has been known for many years. Metabolic syndrome has been recently recognized by both WHO and NCEP ATP III with the definition including a cluster of metabolic abnormalities. Metabolic syndrome is common with its prevalence increasing with age. Metabolic syndrome represents an averse metabolic state since it confers an increased risk for both type 2 diabetes and cardiovascular disease. Targeting physical inactivity and obesity with lifestyle changes is the cornerstone of the prevention and treatment of the metabolic syndrome. Further studies are warranted to better determine the value of therapies directed specifically at insulin-resistance in individuals with metabolic syndrome.     

系统性红斑狼疮患者自杀意念的心理易感性

目的 了解我国系统性红斑狼疮(SLE)患者自杀意念的发生比例,探讨其自杀意念形成的心理易感因素。方法 对合肥市324例SLE住院患者采用一般资料与自杀意念问卷、艾森克人格问卷和特质应对方式问卷开展调查,采用t检验将患者的人格特征和应对方式与常模进行比较,调整社会人口学变量,采用logistic回归计算人格特征与应对方式对SLE患者自杀意念影响的OR(95％CI)值。结果 108例(33.3％)患者在接受调查前1个月内产生过自杀意念;SLE患者神经质标准分(49.81±10.03)与精神质标准分(49.84±9.73)均高于全国心理常模（神经质：41.27±9.42;精神质：48.14±9.74）（t神经质=15.327,t精神质=3.142,P值均＜0.01）。内外向标准分(50.43±9.90)低于常模(57.75±8.26)(t=-13.317,P＜0.01);SLE患者的积极应对评分(34.36±7.86)和消极应对评分(28.87±7.79)均高于女性健康组常模(积极应对：29.32±8.96;消极应对：22.34±7.47)（t值分别为11.543、15.102,P值均＜0.01）和患者组常模(积极应对：29.15±9.28;消极应对：25.36±8.42)（t值分别为11.932、8.122,P值均＜0.01）。调整社会人口学变量后,神经质倾向人格（OR=1.110,95％ CI:1.072～1.149）和消极应对方式（OR=1.069,95％ CI:1.030～1.109）对SLE患者自杀意念的影响有统计学意义。结论 我国SLE患者自杀意念的发生比例较高。神经质倾向和消极应对方式是SLE患者形成自杀意念的心理易感因素。     

雷诺现象在系统性红斑狼疮中的意义

目的 探讨雷诺现象在系统性红斑狼疮(SLE)中的意义.方法 对112例SLE患者的临床资料进行回顾性分析,比较有和无雷诺现象患者在临床表现、实验室检查等方面的异同.结果 有雷诺现象患者肺动脉高压、肺间质病变、心包炎、乏力、肺栓塞、深静脉血栓形成的发生率明显高于无雷诺现象患者[ 89.3％( 25/28)比2.4％( 2/84)、57.1％(16/28)比16.7％( 14/84)、75.0％(21/28)比39.3％(33/84)、67.9％( 19/28)比33.3％(28/84)、21.4％(6/28)比4.8％(4/84)、14.3％(14/28)比1.2％(1/84) ](P＜ 0.05);抗心磷脂抗体、抗RNP抗体、抗Sm抗体、狼疮抗凝物试验阳性率明显高于无雷诺现象患者[46.4％(13/28)比9.5％ (8/84)、75.0％(21/28)比33.3％(28/84)、57.1％(16/28)比23.8％(20/84)、17.9％(5/28)比2.4％(2/84)] (P＜ 0.05),白细胞计数减少发生率明显低于无雷诺现象患者[7.1％(2/28)比45.2％(38/84) ](P=0.001).结论 SLE出现雷诺现象患者易发生心、肺及血管病变,尤其肺动脉高压、肺间质病变、心包炎、肺栓塞等,且抗心磷脂抗体、抗RNP抗体、抗Sm抗体、狼疮抗凝物试验阳性率高于无雷诺现象患者.     

Long-term immunogenicity of a quadrivalent human papillomavirus vaccine in systemic lupus erythematosus

ObjectivesTo evaluate the 5-year immunogenicity of a quadrivalent human papillomavirus (HPV) vaccine (GARDASIL) in patients with systemic lupus erythematosus (SLE).MethodsFemale SLE patients and controls, aged 18–35 years, who received GARDASIL in 2011 and sero-converted 12 months post-vaccination were followed for persistence of immunogenicity. Antibody measurement to HPV serotypes 6, 11, 16, 18 was repeated at 5 years. The rate of sero-reversion was compared between patients and controls, and factors associated with sero-reversion of the anti-HPV antibodies were studied.Results50 SLE patients and 50 controls were vaccinated with GARDASIL. Among subjects who sero-converted at 1 year and consented for this study, antibodies to HPV serotypes 6, 11, 16 and 18 at 5 years were persistent in 24/27 (89%), 26/31 (84%), 32/34 (94%) and 24/25 (96%) of the SLE patients; and 32/33 (97%), 32/33 (97%), 32/32 (100%) and 23/24 (96%) of the controls, respectively. Antibody titers to HPV-6 and 16 were significantly lower in patients than controls. Seven (21%) SLE patients had sero-reversion of ≥1 anti-HPV antibodies. Sero-reverted patients experienced significantly more SLE flares, particularly renal, and had received significantly higher cumulative doses of prednisolone, mycophenolate mofetil and tacrolimus than those with persistent immunogenicity. The cumulative doses of prednisolone correlated inversely and significantly with the anti-HPV 6, 11, and 16 titers at 5 years.ConclusionsImmunogenicity of the quadrivalent HPV vaccine was retained in a high proportion of SLE patients at 5 year. Patients with more SLE renal flares and had received more immunosuppression were more likely to have sero-reversion of the anti-HPV antibodies.Clinical trial registration number: US ClinicalTrials.gov (NCT00911521 & NCT02477254).