A case of limited cutaneous systemic sclerosis developing anti-mitochondria antibody positive primary biliary cirrhosis after acute myocardial infarction

In this report, we present a 63-year-old woman who had limited cutaneous systemic sclerosis and subsequently developed typical primary biliary cirrhosis after an acute myocardial infarction. The patient initially developed Raynaud’s phenomenon, and 4 years later visited the clinic in 1994 complaining of abdominal distress, xerostomia, and xerophthalmia. A diagnosis of limited cutaneous systemic sclerosis was based on Raynaud’s phenomenon, sclerodactyly and anti-centromere antibodies. She was also found to have anti-inositol 1,4,5-trisphosphate receptor 3 (IP₃R3) antibodies, but anti-mitochondrial antibodies were only weakly positive. Seven years later, she developed vertigo and nausea, and was hospitalized due to complaints of an oppressive sensation of the anterior chest. Electrocardiogram results showed a reduction of R waves and ST segment elevation in II, III, and aVf leads. Coronary angiography showed 99% obstruction of the left anterior descending artery and 50% of stenosis of the right coronary artery. Three years later, the patient was noted to have anti-mitochondrial antibodies. Retrospective analysis of the patient’s sera showed that IP₃R3 antibodies were decreasing. Since myocardium is particularly rich in mitochondria, it is thought that myocardial infarction may have been the triggering event that initiated antigen-presenting cells to selectively induce an anti-mitochondrial antibody response.     

奥拉西坦治疗脑梗死急性期的临床研究

目的探究奥拉西坦治疗脑梗死急性期的临床疗效。方法选取2012年6月—2014年6月在天津市武清区人民医院接受治疗的脑梗死急性期患者200例,随机分为对照组和治疗组,每组100例。对照组采用常规方法治疗,治疗组在对照组治疗的基础上静脉滴注奥拉西坦注射液,4 g/次加入到250 m L生理盐水中。两组均连续治疗3周。治疗后,观察两组的临床疗效,同时比较两组治疗前后血管损伤因子抗心磷脂抗体(ACA)、高敏C反应蛋白(hs CRP)、同型半胱氨酸(Hcy)、NIHSS评分、Barthel指数的变化。结果治疗后,对照组和治疗组总有效率分别为79.0%、96.0%,两组总有效率比较差异有统计学意义(P0.05)。治疗后,两组ACA、hs CRP、Hcy、NIHSS评分均较同组治疗前显著降低,Barthel指数显著升高,同组治疗前后差异具有统计学意义(P0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异有统计学意义(P0.05)。结论奥拉西坦治疗脑梗死急性期具有较好的临床疗效,可降低神经功能损伤和血管损伤因子的相关指标,同时还可提高患者的Barthel指数,在临床具有一定的推广应用价值。     

溶血磷脂酸与抗心磷脂抗体联合检测在妊高症患者中的临床意义

目的 探讨溶血磷脂酸（lysophosphatidic acid,LPA）与抗心磷脂抗体（anti-cardiolipin antibody,ACA）联合检测预测妊高症疾病发展及妊娠结局的价值.方法 分别采用生化法、酶联免疫法测定142例妊高症患者（其中妊娠期高血压53例,轻度子痫前期46例,重度子痫前期43例）及正常妊娠晚期孕妇（对照组58例）血浆LPA水平及抗心磷脂抗体阳性率,分析两者在不同程度妊高症患者中的差异及相关性,同时评价其与妊娠预后的关系.结果 妊高症患者血浆LPA水平随病情发展依次升高,且均高于对照组（P＜0.05）;重度妊高症组抗心磷脂抗体阳性率高于其他组（P＜0.05）.重度妊高症患者抗心磷脂抗体阳性组血浆LPA水平明显升高,且发病孕周小,围产儿体重低,新生儿Apgar评分低,与阴性组比较,差异均有统计学意义（P＜0.05或0.01）.结论 妊娠期高血压疾病病情程度与血浆LPA水平相关,病情越重,LPA水平也越高.抗心磷脂抗体与重度妊高症的发病有关.LPA与ACA联合检测可早期预测妊高症的病情程度及妊娠结局,有望成为病情监测及预后判断的指标.     

Genomic and genetic studies of systemic sclerosis: A systematic review

Systemic sclerosis is an autoimmune rheumatic disease characterised by fibrosis, vasculopathy and inflammation. The exact aetiology of SSc remains unknown but evidences show that various genetic factors may be involved. This review aimed to assess HLA alleles/non-HLA polymorphisms, microsatellites and chromosomal abnormalities that have thus far been associated with SSc. PubMed, Embase and Scopus databases were searched up to July 29, 2015 using a combination of search-terms. Articles retrieved were evaluated based on set exclusion and inclusion criteria. A total of 150 publications passed the filters. HLA and non-HLA studies showed that particular alleles in the HLA-DRB1, HLA-DQB1, HLA-DQA1, HLA-DPB1 genes and variants in STAT4, IRF5 and CD247 are frequently associated with SSc. Non-HLA genes analysis was performed using the PANTHER and STRING₁₀ databases. PANTHER classification revealed that inflammation mediated by chemokine and cytokine, interleukin and integrin signalling pathways are among the common extracted pathways associated with SSc. STRING₁₀ analysis showed that NFKB1, CSF3R, STAT4, IFNG, PRL and ILs are the main “hubs” of interaction network of the non-HLA genes associated with SSc. This study gathers data of valid genetic factors associated with SSc and discusses the possible interactions of implicated molecules.     

卵巢功能减退者抗卵巢抗体和抗心磷脂抗体水平以及对恢复卵巢功能提示作用

目的探讨卵巢功能减退者抗卵巢抗体（AOAb）、抗心磷脂抗体（ACA）水平检测的意义及对恢复卵巢功能提示作用。方法对卵巢功能减退患者的 AOAb、ACA 进行测定,同时将 AOAb 与 ACA 测定结果显示阳性的患者,予以免疫抑制剂和阿司匹林治疗的预处理,同时检测排卵情况和卵泡刺激素（FSH）、促黄体生成素（LH）和雌二醇（E2）水平。结果两组 AOAb 和 ACA 阳性率比较：两组 AOAb 和 ACA 总阳性率比较,差异有统计学意义（ P <0.05）;治疗组患者卵巢有优势卵泡出现,其中中有3例 AOAb 抗体阳性者在地塞米松停止治疗后第2~3周来月经;1例 AOAb 阳性患者自然行经2次后妊娠;2例 AOAb 阳性患者恢复月经规律,月经第3天 FSH 降至正常范围。治疗组治疗前后 E2比较,差异无统计学意义（ P >0.05）,FSH、LH 比较,差异有统计学意义（ P <0.05）。结论对 AOAb 与 ACA 检测呈现阳性的患者采用免疫抑制剂和阿司匹林干预治疗对卵巢功能的恢复具有积极意义。     

免疫球蛋白联合黄体酮和人绒毛膜促性腺激素治疗抗心磷脂抗体阳性复发性流产的临床疗效

目的 探讨免疫球蛋白联合黄体酮和人绒毛膜促性腺激素治疗抗心磷脂抗体阳性复发性流产的临床疗效。方法 选取2013年8月—2018年5月在东莞市第三人民医院诊治的ACA阳性复发性流产患者72例作为研究对象,根据治疗方法将患者分为对照组和观察组,每组各36例。对照组患者给予传统方法治疗,从确诊为早孕开始治疗,肌注黄体酮注射液,20 mg,1次/d。隔日1次肌注注射用绒促性素,2 000 U,直至孕12周。观察组患者在对照组治疗的基础上给予免疫球蛋白治疗,妊娠前卵泡期给予静注人免疫球蛋白2 mL,妊娠后立即再用1次,隔日1次肌注注射用绒促性素2 000 U,以后每隔4周1次,直至孕12周停药。比较两组患者的黄体生成激素（LH）、睾酮（T）、抗缪勒管激素（AMH）与肿瘤坏死因子相关蛋白12（CTRP12）水平、妊娠情况。结果 两组治疗后的血清LH与T水平都显著低于治疗前,同组比较差异具有统计学意义（P<0.05）;治疗后,观察组性激素水平显著低于对照组,两组比较差异具有统计学意义（P<0.05）。治疗后,两组患者血清AMH水平显著低于治疗前,CTRP12水平显著高于治疗前,同组比较差异具有统计学意义（P<0.05）;治疗后,观察组血清AMH和CTRP12水平显著优于对照组,两组比较差异具有统计学意义（P<0.05）。治疗后,观察组的妊娠成功率为86.1%,显著高于对照组的47.2%,两组比较差异具有统计学意义（P<0.05）。结论 免疫球蛋白治疗ACA阳性复发性流产能改善机体的性激素分泌平衡,提高患者生育功能与妊娠成功率,且安全性好。