以温病治法辨证论治系统性红斑狼疮

系统性红斑狼疮（SLE）是一种多脏器、多系统损害,呈多种免疫异常的自身免疫疾病。一般认为因遗传、感染、内分泌、环境因素等综合作用引起。中医将该病归属为阴阳毒、阳毒发斑、蝴蝶斑、肉痹、脏腑痹、面游风等辨治范围,多数学者认为由内外两方面的因素所致,现代中医温病学将现代医学中具有温病临床特征的一些疾病也归入温病范围,利用中西医结合的方法,分阶段辨治SLE。     

系统性红斑狼疮尿潴溜一例

本文介绍了系统性红斑狼疮一例,望引起临床注意.     

初发性系统性红斑狼疮患者外周血及T、B淋巴细胞疾病相关基因的筛选及鉴定

目的寻找在SLE分子发病机制中起关键作用的致病基因的候选基因.方法通过高密度基因芯片技术,得到初发性SLE患者外周血单核细胞及T、B淋巴细胞亚群的基因表达谱,在差异表达显著的基因中挑选4个位于SLE易感区段的基因,通过TaqMan实时PCR技术在55例SLE患者中验证基因的差异表达.结果得到初发性SLE患者外周血单核细胞及T、B淋巴细胞亚群的基因表达谱,确定TRIM,KLRC1,IL-4R及EGR-1基因为SLE易感基因的候选基因,实时PCR结果证明SLE患者外周血单核细胞中,TRIM基因△Ct值显著低于正常人对照(P＜0.05),基因表达水平为正常对照的2.43倍,IL-4R基因与EGR1基因的△Ct值显著高于正常人对照(P＜0.05),基因表达水平分别为正常对照的0.33倍、0.26倍,KLRC1基因的△Ct值显著高于正常人对照(P＜0.01),基因表达水平为正常对照的0.56倍,在SLE患者外周血T细胞亚群中,TRIM基因△Ct值显著低于正常人对照(P＜0.01),基因表达水平为正常对照的2.94倍,IL4R基因与EGR1基因的△Ct值显著高于正常人对照(P＜0.01),基因表达水平分别为正常对照的0.32、0.21倍,LRC1基因的△Ct值显著高于正常人对照(P＜0.01),基因表达水平为正常对照的0.56倍.在SLE患者外周血B淋巴细胞亚群中,由于B细胞淋巴亚群所占淋巴细胞比率过低,基因检测数据不稳定,故未作统计学分析.结论在系统性红斑狼疮的发病中,患者外周血单核细胞及T、B淋巴细胞亚群细胞基因表达水平发生了改变,主要集中于一系列免疫相关基因,其中TRIM,KLRC1,IL-4R及EGR-1基因在患者群中变化显著,初步断定为SLE易感基因的候选基因.     

初发性系统性红斑狼疮患者外周血及T、B淋巴细胞疾病相关基因的筛选及鉴定

目的寻找在SLE分子发病机制中起关键作用的致病基因的候选基因。方法通过高密度基因芯片技术，得到初发性SLE患者外周血单核细胞及T、B淋巴细胞亚群的基因表达谱，在差异表达显著的基因中挑选4个位于SLE易感区段的基因，通过TaqMan实时PCR技术在55例SLE患者中验证基因的差异表达。结果得到初发性SLE患者外周血单核细胞及T、B淋巴细胞亚群的基因表达谱，确定TRIM，KLRCl，IL-4R及EGR-1基因为SLE易感基因的候选基因，实时PCR结果证明：SLE患者外周血单核细胞中，TRIM基因△Ct值显著低于正常人对照（P〈0．05），基因表达水平为正常对照的2．43倍，IL-4R基因与EGRl基因的△Ct值显著高于正常人对照（P〈0．05），基因表达水平分别为正常对照的0．33倍、0.26倍，KLRCl基因的△Ct值显著高于正常人对照（P〈0．01），基因表达水平为正常对照的0.56倍，在SLE患者外周血T细胞亚群中，TRIM基因△Ct值显著低于正常人对照（P〈0．01），基因表达水平为正常对照的2．94倍，IL4R基因与EGRl基因的△Ct值显著高于正常人对照（P〈0．01），基因表达水平分别为正常对照的0.32、0.21倍，LRCl基因的△Ct值显著高于正常人对照（P〈0．01），基因表达水平为正常对照的0.56倍。在SLE患者外周血B淋巴细胞亚群中，由于B细胞淋巴亚群所占淋巴细胞比率过低，基因检测数据不稳定，故未作统计学分析。结论在系统性红斑狼疮的发病中，患者外周血单核细胞及T、B淋巴细胞亚群细胞基因表达水平发生了改变，主要集中于-系列免疫相关基因，其中TRIM，KLRC1，IL-4R及EGR-1基因在患者群中变化显著，初步断定为SLE易感基因的候选基因。     

分型治疗红斑狼疮浅探

红斑狼疮是结缔组织疾病之一,是我国医学科研攻关项目以内的疾病。红斑狼疮分为局限性和系统性两种。临床发现系统性高于局限性的发病率,祖国医学对此病早有论述,虽不完全相符,大概属于猫眼疮的范畴,其发病原因,多为火毒内陷,湿热蕴结及肾阴亏虚,外受六淫之邪,内伤于七情,致使脏腑功能失调而发,其发病原因和下面几个方面有关     

系统性红斑狼疮合并弥漫性肺泡出血1例

系统性红斑狼疮是一类累计多器官的常见的风湿免疫系统疾病,该病并发弥漫性肺泡出血死亡率高。本文介绍了一例SLE合并DAH经激素冲击疗法及血浆置换成功救治病例。提示了风湿免疫科医生在对系统性红斑狼疮病人出现血红蛋白、红细胞压积明显下降,及影像学改变,但没有典型的咯血症状时应考虑到DAH的可能,运用激素冲击疗法及血浆置换可提高患者的生存率。     

首例高原大剂量甲基强的松龙短程冲击治疗系统性红斑狼疮合并狼疮肾

甲基强的松龙（ＭＰ）在生理状况下，增加肾小球滤过率，提高血中代稿浓度参与介导肾抗氧化酶活性增高缓解氧自由基对肾组织损害。对于临床表现为急性指数增高的病例，首先使用大剂量ＭＰ静脉冲击，可减轻间质水肿，大剂量短程冲击治疗时，可迅速完全抑制一些酶的活性，而达到最抗炎效果，大剂量ＭＰ短期治疗尤适用于活动性狼疮肾伴肾功能衰竭。     

科研人员发现系统性红斑狼疮的新易感基因miR-146a

中科院上海生命科学院／上海交大医学院健康研究所分子风湿病学研究组罗晓兵博士在沈南教授的指导下,找到了miR-146a参与狼疮发病的分子遗传学证据,这一研究成果发表在PloS Genetics上。系统性红斑狼疮（Systemic lupus erythematosus,SLE）是一种具有极强遗传倾向的系统性自身免疫病,Ⅰ型干扰素通路过度活化是其重要的分子表型。     

以温病治法辨证论治系统性红斑狼疮

系统性红斑狼疮(SLE)是一种多脏器、多系统损害,呈多种免疫异常的自身免疫疾病.一般认为因遗传、感染、内分泌、环境因素等综合作用引起.中医将该病归属为阴阳毒、阳毒发斑、蝴蝶斑、肉痹、脏腑痹、面游风等辨治范围,多数学者认为由内外两方面的因素所致,现代中医温病学将现代医学中具有温病临床特征的一些疾病也归入温病范围,利用中西医结合的方法,分阶段辨治SLE.     

检测免疫动物血清抗体中和试验

l、动物被动免疫这里既是利用生物药品厂生产的抗原物质疫苗、菌苗免疫动物注射等到一定时间动物机体产生特异性抗体，这种抗体往往可以从血液中分离提取即血清或血浆，在体外一定的pH值，温度，电解质，振荡，杂质等因素的作用下与相应的毒素，病毒受体结合而使病毒毒素失去毒性和感染力，其中中和试验(MNT)中活性抗体主要是1gG、1gM等，在将抗原抗体结合物注射到动物体内不能致死动物，证明该疫苗、菌苗能使机体产生对抗特异性细菌、病毒的抗体物质，而说明生物药品有效。2、应用该试验对校菌苗进行效力试验尤其是多联菌苗更显节约成本缩短检验时间，可改用小动物检验，较为准确简便、科学易行，易于了解菌苗、疫苗质量高低及其变化等诸多优点。     

Hepcidin and Ferritin: Important Mediators in Inflammation Associated Anemia in Systemic Lupus Erythematosus Patients

Systemic Lupus Erythematosus is an autoimmune disease with female preponderance. Anemia is found in 50% of Systemic Lupus Erythematosus patients. This is a cross sectional case control study with 30 female Systemic Lupus Erythematosus patients having inflammation associated anemia (Hemoglobin < 10.0 gm/dl) and 30 age matched controls with the aim to measure serum hepcidin and ferritin levels, correlate and study their role as homeostatic regulators of iron metabolism and utility as markers. Serum transferrin, ferritin, iron, total iron binding capacity, hsCRP, liver enzymes and renal parameters were analyzed by using automated analyser. Hepcidin levels were estimated by Sandwich-ELISA method. There was significant decrease in Iron (p < 0.0001), Iron Binding capacity (p < 0.0001), Transferrin (p < 0.0001) in patients, and a significant increase in inflammatory markers: hs-CRP (p < 0.0001), ESR (p < 0.0001) compared to controls. Significant increase in both Hepcidin (p < 0.0001) and Ferritin (p < 0.0001) was observed in patients with significant positive correlation (r = 0.711) with each other. Additionally, ferritin and hepcidin significantly positively correlated with hs-CRP and ESR (r = 0.526, 0.735); (r = 0.427, 0.742) respectively. Negative correlation with hemoglobin, iron, total iron binding capacity and transferrin with hepcidin (r = ? 0.80, ? 0.307, ? 0.553, ? 0.584) and ferritin (r = ?0.722, ? 0.22, ? 0.654, ? 0.728) was observed respectively. On ROC analysis both hepcidin and ferritin has sensitivity of 96.7%, specificity of 100% at cut-off values of 110 and 49 respectively. AUC of hepcidin was 0.993 and ferritin was 0.978. We have established a positive linear correlation between Hepcidin and Ferritin levels in disease activity and the changes correlated with the inflammatory state and anemia in patients, making them important mediators and potential markers of inflammation associated anemia.     

Association of Oxidative Stress with Disease Activity and Damage in Systemic Lupus Erythematosus: A Cross Sectional Study from a Tertiary Care Centre in Southern India

To study oxidative stress in systemic lupus erythematosus (SLE) by estimating serum oxidised LDL (OxLDL), 8-hydroxy-2′-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and total anti-oxidant status and to correlate with SLE disease activity and disease damage. Eighty SLE patients satisfying the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) 2012 criteria and 80 healthy controls were studied. Exclusion criteria were infections, renal insufficiency, other connective tissue diseases, drug-induced lupus, smoking, alcohol consumption. Disease activity was measured by SLE disease activity index-2 K (SLEDAI), disease damage was quantified by SLICC-Damage Index (SDI). Sera was tested for OxLDL, 8-OHdG, and total antioxidant status (TAS) by double-antibody sandwich ELISA; MDA measured by Colorimetric assay. Oxidative stress markers were compared between group1- controls, group 2-mildly active SLE (SLEDAI ≤ 5), group 3- moderate to highly active SLE (SLEDAI ≥ 6). SLE patients had significantly higher MDA, 8-OHdG and lower TAS when compared to healthy controls, while OxLDL was similar in the three groups. MDA, 8-OHdG were significantly higher, TAS lower in group 3 compared to group 2. MDA had positive correlation with SLEDAI, TAS negatively correlated with SLEDAI. SLE with neuropsychiatric manifestations, vasculitis, anti-sdDNA antibodies had higher MDA, MDA/TAS ratio. SLE patients with thrombocytopenia, and vasculitis had higher OxLDL. Only OxLDL was significantly higher in those patients who have SDI > 1. SLE patients have increased oxidative stress measured by increases in MDA, 8-OHdG, and lower total antioxidant status that was associated with disease activity and some disease manifestations. However only OxLDL was associated with damage.     

Comparison of hyaluronic acid in patients with rheumatoid arthritis,systemic sclerosis and systemic lupus erythematosus

IntroductionThe aim of the present study was to determine and compare the concentration of hyaluronic acid (HA) in rheumatoid arthritis (RA), systemic sclerosis (SSc) and systemic lupus erythematosus (SLE), and its correlation with parameters of disease activity and duration. The hypothesis was that HA should be increased in rheumatic diseases. We also expected that HA could be a marker of disease activity and inflammation in some of these diseases.Materials and methodsThe study group comprised 149 patients with RA, SSc and SLE hospitalized in the Department of Rheumatology and Internal Diseases, Medical University of Bialystok (Bialystok, Poland) and 30 healthy controls. The concentrations of HA, C-reactive protein (CRP) and rheumatoid factor (RF) were measured using Architect ci8200; haemoglobin, platelets on Sysmex XS-800i; and erythrocyte sedimentation rate (ESR) on Sediplus S 2000 analysers. Statistical analysis was performed using Statistica 13.3 PL.ResultsHyaluronic acid was increased in RA, SLE and SSc when compared to controls (P < 0.001, P = 0.011, and P = 0.015, respectively). There were no differences in HA between rheumatic diseases (P = 0.840). Hyaluronic acid positively correlated with SLE activity (P = 0.025). In RA, HA positively correlated with ESR (P = 0.028) and CRP (P = 0.009). However, HA was not found to correlate with the duration of rheumatic diseases.ConclusionsHyaluronic acid concentration undergoes changes in rheumatic diseases with no difference between RA, SLE and SSc. In RA, HA concentration can be a marker of inflammation, while in SLE patients an indicator of disease activity.     

Synergetic Interaction of HLA-DRB1*07 Allele and TNF-Alpha − 863 C/A Single Nucleotide Polymorphism in the Susceptibility to Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an inflammatory autoimmune disease which is characterized by dysregulation of various cytokines propagating the inflammatory processes that is responsible for tissue damage. Tumor necrosis factor alpha (TNF-α) is one of the most important immunoregulatory cytokines that has been implicated in the different autoimmune diseases including SLE. Two hundred and two patients with SLE and 318 controls were included in the study. The TNF-α gene promoter region (from − 250 to − 1000 base pairs) was analyzed by direct Sanger’s DNA sequencing method to find promoter variants associated with South Indian SLE patients. We have analyzed six TNF-α genetic polymorphisms including, − 863C/A (rs1800630), − 857C/T (rs1799724), − 806C/T (rs4248158), − 646G/A (rs4248160), − 572A/C (rs4248161) and − 308G/A (rs1800629) in both SLE patients and controls. We did not find association of TNF-α gene promoter SNPs with SLE patients. However, the − 863A (rs1800630) allele showed association with lupus nephritis phenotype in patients with SLE (OR: 1.62, 95%CI 1.04–2.53, P = 0.034). We found serum TNF-α level was significantly elevated in SLE cases as compared to control and found no association with any of the polymorphisms. The haplotype analysis revealed a significant protective association between the wild TNF-α alleles at positions − 863C, − 857C, − 806C, − 646G, − 572A and − 308G (CCCGAG) haplotype with lupus nephritis phenotype (OR 0.53, 95% CI 0.35–0.82, P = 0.004). Additionally, the TNF-α − 863 C/A (rs1800630) polymorphism and HLA-DRB1*07 haplotype showed significant differences between SLE patients and controls (OR 4.79, 95% CI 1.73–13.29, P = 0.0009). In conclusion, TNF-α − 863A allele (rs1800630) polymorphism is associated with increased risk of nephritis in South Indian SLE patients. We also found an interaction between HLA-DRB1*07 allele with TNF-α − 863 C/A promoter polymorphism giving supportive evidence for the tight linkage disequilibrium between TNF-α promoter SNPs and MHC class II DRB1 alleles.     

108例病毒性肝炎患者血清补体的研究

报告１０８例病毒性肝炎患者血清总补体（ＣＨ＿（５０））和Ｃ＿３值的检测结果：急性肝炎的ＣＨ＿（５０）为６８．４±６．１３单位／ｍｌ，Ｃ＿３为１３０．２±６．６７ｍｇ％，均高于正常组（ＣＨ＿（５０）为４８．５±５．７５单位／ｍｌ，Ｃ＿３为１０２±５ｍｇ％），Ｐ＜０．０１；其他类型的肝炎患者组的补体均低于正常组，Ｐ＜０．０１．补体的含量与Ｔ细胞花环（Ｅｔ花环）呈中度相关，与ＧＰＴ呈高度相关，因此测定ＣＨ＿（５０）和Ｃ＿３可作为衡量患者机体免疫功能和判断病毒性肝炎预后的指标之一。     

Evaluation of Serum Vitamin B12 Levels and Its Correlation with Anti-Thyroperoxidase Antibody in Patients with Autoimmune Thyroid Disorders

Vitamin B12 deficiency has been reported in patients with Autoimmune thyroid disorders. However there is limited data on exact prevalence of low B12 and its correlation with anti-thyroperoxidase antibody (anti-TPO) levels in these patients. The aim of our study was to estimate serum vitamin B12 levels in autoimmune thyroid disorders and to correlate B12 levels with anti-TPO. 350 patients were selected by convenient sampling. Vitamin B12 levels and thyroid parameters were estimated using fully automated chemiluminescence method on Access 2. Results of our study shows that using the manufacturer’s cut-off of 145 pg/mL, the prevalence of low serum vitamin B12 was found to be 45.50 %. Higher prevalence (55 %) was seen based on the published cut-off of 200 pg/mL The study however did not demonstrate any significant correlation between vitamin B12 levels and anti-TPO (r = −0.11 and p value of 0.30).

Electronic supplementary material

The online version of this article (doi:10.1007/s12291-014-0418-4) contains supplementary material, which is available to authorized users.     

Serum Vitamin D Levels in Indian Patients with Multiple Sclerosis

Low serum vitamin D level has an increased association with risk of multiple sclerosis (MS).There has been no published data on the levels of this vitamin in Indian population with MS. Hence we decided to undertake this study to document if there is evidence of vitamin D deficiency in patients with MS in our population. 26 patients with diagnosis of MS by modified Mc Donald’s criteria were enrolled in this study. Serum vitamin D (1,25 hydroxy) levels were measured by electro-chemiluminescence in our biochemistry lab. An age-matched control group of 202 patients who did not have a diagnosis of MS were included. In our study group 76.9 % had vitamin D level less than 20 ng/ml compared to 65.5 % of control group (p value of 0.019). Our study revealed a trend towards low vitamin D values in Indian MS patients.     

伤寒免疫学诊断方法的研究现状

对近年伤寒免疫学诊断方法结合作者的研究工作进行了评价。伤寒免疫学诊断可分检测早期病人体液中抗原及测定患者血清中抗体两个方面。检测抗原以SPA-CoA与ELISA(包括Dot-ELISA)较为敏感和特异,而DRLAT则有简便的优点。测定抗体以PHA最为简便与快速。使用LPS-PHA可作伤寒的早期快速诊断,而Vi-PHA可作伤寒病后带菌者的初筛。ELISA有较PHA更高的敏感性,其中LPS-IgM-ELISA亦可作伤寒病人的早期诊断,而LPS-IgG-ELISA可用于该病的追溯诊断和血清流行病学调查。Vi-ELISA还可作伤寒病后带菌者初筛。不同条件实验室可根据取得试剂情况选择使用。     

A Comparative Study of Bone Scan Findings and Serum Levels of Tumor Marker CA15-3 in Patients with Breast Carcinoma

Breast cancer is one of the most frequent malignancies in the world. Available staging procedures to detect breast cancer are bone scan, chest X-ray, liver ultrasonography, computerized tomography, estimation of tumor markers like carbohydrate antigen (CA15-3) and carcino embryonic antigen. These procedures are expensive and may not be required in all cases. Out of 70 patients studied, 55 had normal CA15-3 and 15 had elevated levels of Ca15-3. Eight (14.5%) of the 55 patients with normal CA15-3 had abnormal bone scan. Fifteen patients had CA15-3 levels above the normal range and among these 9 (60%) had abnormal bone scan. While prime facie it would appear that a high level of CA15-3 correlate with abnormal bone scan, it is also true that the numbers are small at present and conclusions about the validity of CA15-3 as marker of bone metastasis may be premature.     

微柱法及果糖胺法测定糖尿病患者HbA_(1c)、HbA_1及Gpp的比较研究

采用Trivelli等报道的Bio-Rex70阳离子交换树脂微柱层析法和Roger等报道的果糖胺法(两法均作了适当修改),分别对73例糖尿病患者及61例正常人进行了HbA_(1c)、HbA_1及糖基化血浆蛋白(Gpp)的测定.结果显示患者与正常人之间HbA_(1c)、HbA_1、Gpp均值有非常显著性差别.患者空腹血糖均值与HbA_(1c)、HbA_1、Gpp均值之间均有极显著的相关性.患者HbA_(1c)与HbA_1之间相关系数有极显著意义.证明HbA_(1c)、HbA_1与Gpp均可作为糖尿病控制较准确的客观指标.作者在提高微柱法分离度的关键问题上作了改进,找出了恰当的洗脱液Ⅰ与Ⅱ的Na~+浓度,分别为0.020mol/L与0.070mol/L.分离HbA_(1a+b)与HbA_(1c)结果尚称满意,柱间CV分别为3.1％与2.2％.在降低洗脱液Ⅰ、Ⅱ、Ⅲ中剧毒物质氰化钾的浓度问题上也作了研究,找出了较文献报道低2.5倍的氰化钾浓度,即由0.010mol/L降低到0.004mol/L.在果糖胺法中,采用5min与15min两次比色,用10％冰醋酸终止反应,提高了此法的精密度与重复性,批内CV为2.3％,批间CV为2.7％.