Epidemiology,characterization, and diagnosis of neuropsychiatric events in systemic lupus erythematosus

Introduction: Neuropsychiatric systemic lupus erythematosus (NPSLE) is characterized by a heterogeneity of clinical manifestations. The absence of diagnostic criteria and the lack of clinical trials is a challenge in clinical practice.

Areas covered: A literature review was performed to describe epidemiology, characterization (clinical, immunological, and imaging), diagnosis and treatment of NPSLE. Classification criteria have been the first step towards a uniform definition. More recently, different attribution models have been developed to help to determine if the NP event is due to SLE. Disease activity is a major risk factor for NP events. Cytokines and autoantibodies are associated with NP events, however, only a few studies have identified risk factors for individual NP events.

Expert opinion: Further research needs to search for and validate biomarkers for NPSLE and individual NP events, including neuroimaging findings, attribution models, and serologic markers. This will be a fundamental step in planning randomized control trials in the treatment of NPSLE to improve outcome.     

SLE患者淋巴细胞膜上IL-2R表达的动态分析

本实验采用Wu Tac单克隆抗体的间接荧光抗体法,动态观察了系统性红斑狼疮(SLE)患者和正常供血员(对照组)的外周血淋巴细胞经PHA刺激后,于不同时间(0、24、48、72小时)内细胞膜上白细胞介素2受体(IL-2R)的表达。结果表明在给予PHA刺激培养24、48和72小时后,与对照组比较SLE患者淋巴细胞的IL-2R表达明显下降,提示了SLE的T淋巴细胞反应性降低可能与被激活的T细胞表面IL-2R的表达功能缺陷有关。此结果将有助于进一步探讨SLE的免疫调节紊乱的发生机制。     

SLF伴AIHA临床和实验分析

目的：通过回顾性总结,了解系统性红斑狼闻（ＳＬＥ）伴自身免疫性溶血性贫血（ＡＩＨＡ）的临床表现和实验室检查。方法：６００例ＳＬＥ患者中２４例直接Ｃｏｏｍｂ’ｓ试验阳性与２４例非阳性者进行对照分析。结果：直接Ｃｏｏｍｂ’ｓ试验阳性组,浆膜炎、血尿发生率明显低于对照组;血清总蛋白、球蛋白、ＩｇＧ、Ｃ３明显低于阴性组（Ｐ〈０．０５）,余临床表现、实验室检查两组无明显差异（Ｐ〈０．０５）。     

Pseudotumour cerebri in SLE

Summary A 29 year-old woman with SLE was admitted to our department due to severe remitting headaches. Following investigation a high degree of intra cranial pressure was determined.Several years ago a similar finding was diagnosed, and the disease was brought into remission by the administration of periodical pulses of high dose intravenous immunoglobulins.Benign intracranial hypertension (BIH) is an uncommon presentation of neuropsychiatric SLE. In this patient several risk factors of BIH (obesity, steroid therapy, and SLE) assembled and elicited a severe presentation of the disorder which became more resistant to therapy. Several pathogenic pathways tie BIH with SLE as thrombotic obliteration of cerebral arteriolar and venous systems and immune complex deposition within the arachnoid villi (that are responsible for CSF absorption). As shown in this case report of BIH, clinical findings do not always parallel various imaging techniques as MRI and CT brain scans.     

SLE患者血浆维生素C、E水平的变化研究

目的：探讨血浆维生素C、E水平与SLE疾病之间的关系及可能采取的相应对策。方法：对33例确诊为SLE患者及对等匹配的正常人的血浆维生素C及维生素E含量进行测定。结果：SLE组血浆维生素C含量为37．98±15．64mol／L,维生素E含量为14．86±6．53mol／L,均明显低于对照组（P＜0．01）。结论：维生素C、E含量检测可作为反映SLE病变严重程度的一组参考指标。     

系统性红斑狼疮心电图改变及中西医结合疗效分析

目的观察系统性红斑狼疮(SLE)的心电图改变特点及中西医结合治疗的临床疗效.方法对106例 SLE患者进行常规心电图检查,并对其中62例出现心电图异常改变者进行中西医结合治疗 30d.结果 44例心电图恢复正常,18例无效,总有效率70.96%.结论中西医结合治疗能有效地改善 SLE患者的心电图异常.     

DNA甲基转移酶1和CD11a基因在SLE患者中的表达

目的检测SLE患者外周血单核细胞(peripheral blood mononuclear cells,PBMC)中DNA甲基转移酶1(DNA methylatransferase1,DNMT1)和CD11a基因的表达水平,探讨DNMT1表达异常在SLE发病中的作用。方法提取8例SLE患者及12例正常人外周血单核细胞,以RT-PCR法检测DNMT1和CD11a基因的转录水平,采用两样本均数t检验比较分析SLE患者与正常人之间DNMT1与CD11a基因表达的差异;统计分析两种基因表达的相关性。结果正常人PBMC中DNMT1表达的均值为0.289±0.092,CD11a基因表达的均值为0.430±0.143;SLE患者PBMC中DNMT1表达均值为0.167±0.046,CD11a表达均值为0.875±0.331。SLE患者PBMC中DN-MT1表达水平明显低于正常人(T=3.479,P=0.003);CD11a基因表达水平明显高于正常人(T=4.196,P=0.001)。在正常人PBMC中,DNMT1与CD11a基因的表达没有相关性;在SLE患者PBMC中DNMT1与CD11a基因表达呈负相关性(r=-0.714 53,P=0.046 4),DNMT1表达下降与CD11a表达增加有相关性。结论SLE患者PBMC中DNMT1表达降低可能是造成DNA低甲基化的一个重要原因,因而与CD11a基因的过度表达有重要关系,进而导致SLE的发病。因此可以推测DNMT1可能是SLE发病机制中一个重要的内源性因素。     

范永升教授诊治系统性红斑狼疮经验

范永升教授认为系统性红斑狼疮的病因病机以肾虚为本,热毒、瘀血为标;在辨病辨证基础上,以解毒祛瘀滋肾为大法并结合西药综合治疗,取得了较好疗效。     

发热 贫血 血小板减少 神经系统异常

患儿男,13岁7个月。2010-11-04以发热伴面色苍白1周为主诉入住中国医科大学附属第一医院儿科病房。患儿1周前开始无诱因发热伴颈部包块,无触痛,咳嗽无痰,体温最高达39℃,同时伴有面色苍白、乏力,无皮肤黄染,尿色略黄。曾于当地医院就诊,静滴抗炎类药物3d(具体药物不详),病情无好转,化验发现贫血严重。患儿病来时有烦躁,无水肿,睡眠可,精神差,进食差,鼻衄2次,黑便1次,无明显腹痛及尿量减少。