神经精神性狼疮MRI检查的临床应用价值

目的：探讨神经精神性狼疮(NPSLE)MRI表现特点及其与临床的关系。方法：52例NPSLE患者在出现症状后1天～2个月内进行头部MR检查。另选取26例无神经系统症状的SLE患者和27例健康志愿者行MR检查并与NPSLE组比较。结果：NPSLE的MRI主要表现为斑点状和大片状脑炎样病变、出血、脑梗死和脑萎缩，额、顶叶和基底节区好发。表现为点状病灶的临床以精神障碍和头痛为主要表现，片状病灶以癫痫和偏瘫为主要表现。临床病情严重患者的片状病灶的发生率、病灶总面积较轻微组显著增高。片状的，边缘模糊的，T1WI等、略低信号，T2WI高信号的病灶变化迅速。结论：NPSLE的MRI检查有助于明确脑病性质及更准确的评估病情和预后，从而指导治疗和评价疗效。     

Phenotypic and genetic analyses of T-cell-mediated immunoregulation in patients with Type 1 diabetes.

AIMS: To investigate the contribution of regulatory T cells and co-stimulatory molecules in CD4(+) T cells to the development of Type 1 diabetes (T1D). METHODS: Twelve patients with T1D, nine patients with systemic lupus erythematosus (SLE), and 12 age-matched healthy control subjects participated. We analysed the proportions of CD25(+)CD4(+) T cells and natural killer T cells (NKT cells), and the expression levels of Foxp3, CTLA-4, CD28, ICOS, PD-1 and BTLA in peripheral blood mononuclear cells and purified CD4(+) T cells. RESULTS: There were no significant differences in the proportions of CD25(+) CD4(+) T cells or NKT cells among the three groups. PD-1 expression levels of peripheral CD4(+) T cells from T1D patients were significantly lower than those from healthy control subjects (P = 0.00066). In contrast, PD-1 expression levels were similar in SLE patients and healthy control subjects. The expression levels of Foxp3, CTLA-4, CD28, ICOS and BTLA were similar in the three groups. CONCLUSIONS: Decreased expression of the PD-1 gene in CD4(+) T cells may contribute to the development and/or maintenance of autoimmune T1D. As the population studied was small and heterogeneous, further studies are required to confirm the findings.     

Monospecific but not polyreactive human hybridoma rheumatoid factors exhibit preferential binding specificities for IgG3 and IgG4

Summary Among 38 human hybridoma-derived monoclonal rheumatoid factors (RFs) generated from patients with either rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE), two groups of RFs can be identified. Monospecific RFs were derived primarily from patients with RA and are characterized by a binding specificity for IgG3 and/or IgG4. Polyreactive RFs were derived largely from patients with SLE and show a broader pattern of reactivity to all four isotypes of IgG. Neither population of RFs was exclusive to either disease. The binding specificities identified appear to be different from the RFs isolated from patients with mixed cryoglobulinemia and may reflect a different antigen selection mechanism.     

COX-2在系统性红斑狼疮病人PBMC中的表达及意义

目的：检测环氧全酶-2(Cyclooxygenase-2，COX-2)蛋白在系统性红斑狼疮(Systemic lupus erythematosus．SLE)患外周血单核细胞(Peripheral blood monoeytes，PBMC)中的表达情况。探讨COX-2蛋白表达水平与SLE病情活动程度之间的关系。方法：从外周血中分离PBMC后涂片，用免疫组化染色的方法测定COX-2蛋白的表达情况。结果：COX-2蛋白在SLE实验组呈高表达状态，与SLE疾病的活动性之间呈正相关。结论：COX-2的表达与SLE的发病有关，可作为今后辅助治疗措施的目标和病情变化和疗效评价的参考指标之-。     

神经精神性红斑狼疮的脑部MRI表现

目的 分析神经精神性红斑狼疮（NP-SLE）的脑部MRI表现,探讨MRI对NP-SLE的诊断价值.方法 收集2000年1月～2005年4月符合NP-SLE临床诊断标准病例13例,均为女性,年龄10～40岁,平均30岁,病程30天～25年.采用Simens Impact 1.0T MR成像仪,SE序列行轴位T1WI、T2WI、矢状位T2WI及增强扫描,分析其脑部MRI表现.结果 13例20次MRI检查均有异常,阳性率为100%,表现为点状、斑片状长T1长T2异常信号,主要分布在大脑皮层、层下白质及基底节区,病灶周围无水肿,占位效应不明显.2例增强扫描病灶呈不规则强化,7例有脑萎缩.结论 MRI对NP-SLE脑部病变有较高的价值,但作出NP-SLE诊断需结合临床和实验室检查.     

Mycobacterium Tuberculosis Infection Incidence in Hospitalized Renal Transplant Patients in the United States, 1998–2000

The incidence, risk factors, and prognosis for Mycobacterium tuberculosis (MTB) infection have not been reported in a national population of renal transplant recipients. We performed a retrospective cohort study of 15,870 Medicare patients who received renal transplants from January 1, 1998 to July 31, 2000. Cox regression analysis derived adjusted hazard ratios (AHR) for factors associated with a diagnosis of MTB infection (by Medicare Institutional Claims) and the association of MTB infection with survival. There were 66 renal transplant recipients diagnosed with tuberculosis infection after transplant (2.5 cases per 1000 person years at risk, with some falling off of cases over time). The most common diagnosis was pulmonary TB (41 cases). In Cox regression analysis, only systemic lupus erythematosus (SLE) was independently associated with TB. Mortality after TB was diagnosed was 23% at 1 year, which was significantly higher than in renal transplant recipients without TB (AHR, 4.13, 95% CI, 2.21, 7.71, p < 0.001). Although uncommon, MTB infection is associated with a substantially increased risk of mortality after renal transplantation. High-risk groups, particularly those with SLE prior to transplant, might benefit from intensified screening.     

红斑狼疮皮损中CD4^＋和CD8^＋T细胞的表达

目的检测红斑狼疮皮损区T淋巴细胞亚群CD4 和CD8 T细胞的表达情况。方法采用免疫组织化学法对红斑狼疮皮损区淋巴细胞进行检测,并与正常皮肤作对照。结果红斑狼疮患者皮损CD4 T细胞百分数明显高于正常对照组。CD8 T细胞百分数明显低于正常对照组。结论红斑狼疮患者可能存在CD4 T细胞活性增强,CD8 T细胞功能抑制,从而导致免疫紊乱而发病。     

Lupus vulgaris in a patient with systemic lupus erythematosus and persistent IgG deficiency

We present the case of a patient with juvenile onset systemic lupus erythematosus (SLE) who developed a persistent, acquired hypogammaglobulinaemia with IgG deficiency. The hypogammaglobulinaemia was probably a complication of high dose corticosteroid treatment. The serum IgG level remained subnormal despite intravenous immunoglobulin therapy. Lupus vulgaris, which developed on the nasal cartilage in this patient with SLE, is not an expected finding. This patient is probably the first reported case of SLE associated with lupus vulgaris.     

Characterization of anti-endothelial cell antibodies in systemic lupus erythematosus (SLE).

IgG anti-endothelial antibodies (AEA), as measured by ELISA or immunoblotting technique could be detected in serum samples of 56 out of 64 patients with SLE (88%) and mainly occurred in monomeric form. AEA were not cell specific, because the binding reactivity was absorbed partially by both fibroblasts and peripheral blood mononuclear cells. No correlation was found between the presence of AEA and anti-nuclear antibodies. Immunoblotting revealed reactivity of AEA against endothelial antigens ranging in size from 15 to 200 kD. AEA titres were significantly higher in patients with joint or skin abnormalities, compared with patients without these abnormalities. A significant correlation was found between nephritis in SLE and the presence of AEA reactivity against endothelial membrane antigens of 38, 41 and 150 kD. These data show that the pattern of AEA reactivity in serum of SLE patients is heterogeneous, and suggest that AEA against a limited number of antigens may be involved in the pathogenesis of nephritis in SLE.     

Antibody Mediated Complete Congenital Heart Block in the Fetus

Complete congenital heart block (CCHB) affects 1:20,000–25,000 live births and is usually an atrioventricular block; 30–50% of fetuses with CCHB will have a structural anomaly, though recently attention has focused on the etiological influence of autoimmune disease, such as systemic lupus erythematosus. The diagnosis is established by detailed two-dimensional ultrasound scanning of the heart to exclude anomaly coupled with M-mode echocardiography and Doppler blood velocity patterns in the major vessels to detect the uncoupling of atrial and ventricular rhythms. Risk factors for an affected child are discussed. A previously affected child, high titers of anti-Ro antibodies, the presence of anti-Ro (SS-A) and anti-La (SS-B), and maternal HLA DR3 confer high risk. Antibody mediated CCHB is irreversible. Plasmapheresis and immunosuppression have been attempted in affected mothers, with limited success, to reduce the likelihood of the fetus being affected, and steroids have been used to reduce the inflammatory reaction in the heart. In many cases the underlying pathology of the immune system adversely affects utero-placental function requiring careful monitoring of fetal well-being. CCHB renders fetal heart rate monitoring virtually useless, in the antenatal and intrapartum periods. Alternatives are explored.