Auditory disorders in patients with systemic lupus erythematosus: Relation to clinical parameters

Aim of the workTo evaluate the hearing disorders in SLE patients with particular regard to their frequency and relationship to disease duration and activity.Patients and methodsTwenty female SLE patients were enrolled in the study. Assessment of disease activity was done using the SLE disease activity index (SLEDAI). Another 20 otologically healthy subjects of matched age and sex served as controls. Auditory assessment was performed and included otoscopic examination, pure tone audiometry (PTA), acoustic immittance testing and speech audiometry.ResultsThe PTA was abnormal in 13 (65%) patients; 4 had tinnitus and 1 vertigo. The PTA results showed a highly significant statistical difference from the control (p < 0.001). Otoscopic examination, acoustic immittance testing and speech audiometry of all patients were normal. A significant difference was found in the age at disease onset between those with and without abnormal PTA (p = 0.023). Moreover, there was a significantly lower hearing level (right ear) at 12,000 Hz in juvenile-onset (N = 6) (20.83 ± 3.76 db) compared to adult-onset cases (32.5 ± 15.66 db) (p = 0.02). No significant difference was present in the audiovestibular manifestations (p = 0.114), clinical, laboratory parameters or disease activity between those with or without hearing loss. However, hearing levels were significantly lower in those with lupus nephritis and those receiving hydroxychloroquine.ConclusionPure tone audiometry revealed SNHL in 65% of SLE patients. Absence of audiovestibular manifestations does not exclude inner ear affection. Age at disease onset is remarkably associated with hearing loss in SLE. Lupus nephritis and hydroxychloroquine use are associated with lower hearing levels and possible early hearing loss.     

儿童系统性红斑狼疮患者外周血淋巴细胞亚群与疾病活动的研究

目的探讨儿童系统性红斑狼疮(SLE)患儿外周血中淋巴细胞亚群的变化及临床意义。方法采用流式细胞术检测59例SLE患儿及52名健康对照组患儿的外周血淋巴细胞亚群T细胞、B细胞、Th细胞、Tc细胞、NK细胞和总淋巴细胞数,并对结果进行比较,同时分析SLE患儿外周血淋巴细胞亚群与SLE疾病活动指数(SLEDAI)的相关性及其与狼疮肾炎、补体的相关关系。结果与健康对照组相比,SLE患儿Th细胞和Th百分比、NK细胞和NK细胞百分比及Th/Tc比值明显降低,而B细胞百分比、Tc细胞百分比增高,差异均有统计学意义(P<0.05);SLE患儿B细胞与SLEDAI评分呈正相关,NK细胞百分比与SLE评分呈负相关(P<0.05);狼疮肾炎组患儿的T细胞、Tc细胞计数和Tc细胞百分比均明显高于无狼疮肾炎的患儿,而狼疮肾炎组患儿Th细胞百分比、Th/Tc比值和NK细胞、NK细胞百分比明显低于无狼疮肾炎的患儿(P<0.05);补体降低组患儿的B细胞和B细胞百分比及SLEDAI评分均明显高于补体正常组(P<0.05)。结论 SLE患儿外周血淋巴细胞亚群存在异常,淋巴细胞亚群与SLEDAI评分、狼疮肾炎和补体之间存在显著的相关性,表明淋巴细胞亚群可能反映SLE患儿病情的严重程度。     

Anti-nucleosome antibodies in systemic lupus erythematosus patients: Relation to anti-double stranded deoxyribonucleic acid and disease activity

Aim of the work

To measure the level of anti-nucleosome (anti-NCS) antibodies in systemic lupus erythematosus (SLE) patients and to evaluate their relation with anti-double stranded deoxyribonucleic acid (anti-dsDNA) antibodies and SLE disease activity.

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??Abstracts?? Objective To investigate the morbidity and clinical manifestation of thyroid dysfunction in juvenile systemic lupus erythematosus??JSLE?? individuals?? to determine if there are correlations between thyroid dysfunction in JLSE individuals and SLE activity as well as autoantibodies. Methods Thyroid function was examed in 162 JSLE children who were identified between January 2010 to August 2013?? TG-Ab?? TM-Ab as well as thyroid B ultrasound were performed to the individuals with thyroid dysfunction. SLEDAI and ANAs titrate were compared between JSLE individuals with abnormal thyroid function and those with normal thyroid function. Results Totally 61 of 162 JSLE children were found with abnormal thyroid function?? 4 of who were identified as Graves disease and 57 were only found subnormal T3. TG-Ab and TM-Ab was positive in some of the patients with abnormal thyroid function . There was a significant difference of SLEDAI between the children with normal thyroid function and those with abnormal thyroid function??P<0.05??. There was no significant difference of ANAs titrate between the two group patients. Conclusion The prevalence of subnormal thyroid function is found higher in JSLE children than in normal individuals?? and most of them are identified with decreased T3 without significant clinical features?? and the others are identified as Graves disease. It is also found that SLEDAI is higher in individuals with subnormal thyroid function compared to these with normal thyroid functions?? and more attention and active therapy are required. It is very important to monitor TG-Ab??TM-Ab and thyroid function in JSLE children.     

SLE活动期血清白蛋白、球蛋白比例变化的临床意义

检测28例系统性红斑狼疮（SLE）患者治疗前后的血清白蛋白（A）、球蛋白（G）、抗dsDNA、补体C3,观察上述指标在病情活动期与非活动期的差异及A／G比例与SLE疾病活动指数（SLEDAI）、抗dsDNA和补体C3的相关性;并与正常对照组比较。结果SLE活动期与非活动期、对照组比较,血清A、G、A／G比例、抗dsDNA、补体C3均有显著统计学差异（P〈0．01）;病程中A／G比例与SLEDAI、抗dsDNA和补体C3均相关,认为SLE活动期血清A／G比例显著性降低,能反映SLE病情变化。     

Clinical significance of interleukin-36 alpha and gamma in systemic lupus erythematosus patients: Potential relation to disease activity and subclinical arthritis

Aim of the workTo assess serum of interleukin-36 alpha (IL-36α) and interleukin-36 gamma (IL-36γ) levels in systemic lupus erythematosus (SLE) patients and to explore their association with clinical and laboratory features of SLE and with ultrasound evidence of subclinical hand arthritis.Patients and methodsThe study included 84 SLE patients without overt arthritis and 84 matched controls. The serum levels of IL-36α and IL-36γ were measured and compared between patients and controls. The hands and wrists of all patients underwent musculoskeletal ultrasound evaluation for evidence of subclinical arthritis and tenosynovitis. The SLE disease activity score was assessed for all patients.ResultsThe mean of serum IL-36α (65.5 ± 38.9 pg/ml) and IL-36γ (468.9 ± 315.9 pg/ml) were significantly higher in SLE patients compared to controls (37.9 ± 17.2 pg/ml and 151.1 ± 73.4 pg/ml; p < 0.001 each). IL-36α and IL-36γ had the ability to discriminate between SLE patients and controls with an AUC of 0.69 and 0.83 respectively. Serum IL-36α was significantly correlated with SLEDAI score (p = 0.04), synovitis (p < 0.001),Us erosion score (p = 0.01) and PD signals score (p = 0.002). Serum IL-36γ was significantly correlated with serum creatinine level (p = 0.04). SLE patients with arthralgia had significantly higher IL-36α serum level than patients without (p = 0.04). SLE patients with proteinuria had significantly higher IL-36γ than those without (p = 0.04). The linear regression analysis model revealed that the US evidence of synovitis was the strongest factor associated with the serum level of IL-36α meanwhile proteinuria was the strongest factor associated with the serum level of IL-36γ.ConclusionIL-36αserum level was significantly associated with SLEDAI score, arthralgia and US evidence of subclinical arthritis. IL-36γ serum level was significantly associated with proteinuria.     

小剂量激素联合甲氨蝶呤、羟氯喹治疗系统性红斑狼疮的临床观察

目的评价单独糖皮质激素及小剂量的糖皮质激素联合羟氯喹、MTX治疗方案对于轻度到中度活动性系统性红斑狼疮（SLE）患者的疗效及副作用。方法入选70例病人,随机分为A组（35例）,单独糖皮质激素（0.5~0.6 mg/kg.d）及B组（35例）小剂量的糖皮质激素（≤0.2 mg/kg.d）联合羟氯喹、MTX,观察记录两组患者疗效、药物不良反应,为期1年。结果两组均能明显改善患者临床症状及降低SLIDA评分,两组间差异无统计学意义,两组疗效相当。但A组较B组在激素减量过程中更易复发,两组间比较差异有统计学意义（P〈0.05）。且A组出现副作用较多,两组间差异有统计学意义（P〈0.05）。结论对于没有严重内脏累及的轻到中度SLE患者,0.2 mg/kg.d的强的松,联合羟氯喹和MTX,可有效控制病情的发展及反复,且比单纯激素组副作用更小,是值得推广的联合治疗方法。