Search

Lupus Ischemic Bowel Disease Presenting as Acute Abdominal Pain——Diagnostic Value of Spiral CT

ObjectiveTo evaluate the value of spiral CT in diagnosing ischemic bowel changes in systemic lupus erythematosus (SLE) patients presenting with acute abdominal pain. MethodsThe clinical data and spiral CT imaging files of 23 SLE patients presenting with acute abdominal pain were retrospectively reviewed. Sixteen had contrastenhanced spiral CT scanning of the abdomen, the rest had plain CT study. Observation emphasis was placed on the changes of bowel wall (wall thickness, enhancement pattern, lumen size) and mesentery (mesenteric edema, engorgement of mesenteric vessels and their abnormal arrangement pattern). Other abnormal findings (e.g. fluid accumulation, changes of abdominal solid organs, lymphadenopathy) were also observed. ResultsNineteen patients had intestinal wall thickening (19/23, 82.6%), with the “target sign” in 12 patients (12/16, 75.0%); Bowel lumen dilatation was present in 16 patients (16/23, 69.6%). Mesenteric swelling with increased density of adipose tissue was noticed in 21 patients (21/23, 91.3%); 18 patients had engorgement of mesenteric vessels (18/23, 78.3%), with comb like arrangement in 4 patients (4/16, 25.0%). Other abnormal findings included ascites, hydrothorax, hydropericardium, hepatosplenomegaly and so on. ConclusionThe most common CT findings in SLE patients presenting with acute abdominal pain are the signs associated with ischemic bowel disease. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.

系统性红斑狼疮合并急性肺血栓栓塞症一例

人工全髋关节置换术治疗系统性红斑狼疮继发股骨头缺血性坏死五例

目的 总结人工全髋关节置换术（total hip arthroplasty，THA）治疗系统性红斑狼疮继发股骨头缺血性坏死（avascular necrosis of the femoral head，ANFH）患者的手术注意事项及围手术期处理。 方法 2007 年3 月－2009 年4 月，对5 例系统性红斑狼疮继发ANFH 患者症状严重侧行THA 治疗。男1 例，女4 例；年龄46 ～ 58 岁。系统性红斑狼疮病程4 ～ 24 年，手术时均处于红斑狼疮静止期。双侧ANFH 根据Ficat 分期均为Ⅳ期，病程2 ～ 12 年。术前Har ris 评分为（30.8 ± 5.4）分。 结果 5 例均顺利完成手术，围手术期输血量为1 200 ～ 2 200 mL。术后出现切口皮肤变态反应性炎症、血肿形成、浅部感染、切口窦道形成各1 例，均经对症处理后愈合；1 例切口Ⅰ期愈合。3 例术后出现反复发热，经对症处理后症状消退。术后患者均获随访，随访时间6 ～ 30 个月，平均14.4 个月。髋关节术前症状均显著缓解。术后Harris 评分为（86.5 ± 3.8）分，与术前比较差异有统计学意义（P lt; 0.001）。 结论 系统性红斑狼疮继发ANFH 患者行THA 术后并发症发生率较高，应注意准确掌握手术适应证，加强围手术期护理，以获得较好疗效。

Combining Intravenous Immunoglobulin for Patients with Systemic Lupus Erythematosus: A Meta-analysis

Objective　To assess the effects of combining intravenous immunoglobulin for systemic lupus erythematosus (SLE) by analyzing the randomized controlled trials (RCT). Methods　The electronic databases such as PubMed (1966 to Aug. 2010), EMbase (1974 to Aug. 2010), The Cochrane Library (Issue 2, 2010), CNKI (1994 to Aug. 2010), VIP (1989 to Aug. 2010), CBM (1978 to Aug. 2010) and Chinese Medical Association Digital Periodicals (1998 to Aug. 2010) were searched to collect RCTs of intravenous immunoglobulin for the patients with SLE. The methodology quality of the included studies was evaluated in accordance with RCTs quality evaluation standard of the Cochrane Handbook 4.2.6, and meta-analyses were performed by using RevMan 5.0 software. Results　Four RCTs involving 154 participants were included. The results of meta-analyses showed that compared with cyclophosphamide pulse therapy, the combining intravenous immunoglobulin markedly reduced the SLE disease activity index (MD= –3.09, 95%CI –4.21 to –1.97), the incidence of infection (OR=0.24, 95%CI 0.11 to 0.54), the proteinuria (MD= –1.09, 95%CI –2.11 to –0.06), and the relapse of SLE (OR=0.07, 95%CI 0.01 to 0.37). But there was no significant difference in elevating of complement between two groups. Conclusion　According to the results of meta-analyses, compared with cyclophosphamide pulse therapy, cyclophosphamide combining intravenous immunoglobulin may be more efficient in improving clinical symptoms, decreasing incidence rate of infectious diseases, and reducing relapse for SLE patients.

Correlation between TNF-α Promoter–308A/G Polymorphism and Systemic Lupus Erythematosus in Chinese Populations: A Meta-analysis

Objective　To summarize results of the correlation of tumor necrosis factor-α (TNF-α) promoter –308A/G polymorphism with systemic lupus erythematosus (SLE) susceptibility in Chinese populations. Methods　We collected all the publications about the correlation between TNF-α promoter –308A/G polymorphism and SLE in Chinese populations by searching PubMed, EBSCO, CBM, CNKI and Wanfang Data before the date of March 20, 2010. Meta-analysis was performed for checking the difference between two groups about genotypes such as AA versus GG, GA versus GG, AA versus GG+GA, GA+AA versus GG, and A allele versus G allele. Results　A total of 8 studies involving 731 SLE patients and 901 healthy people were included. The meta-analysis of total populations showed that, there was no significant correlation between A allele and increased SLE risk (OR=1.42, 95%CI 0.97 to 2.09, P=0.07); the meta-analyses of populations in different regions showed there was no significant correlation of A allele and increased SLE risk in Chinese Taiwan populations (OR=1.04, 95%CI 0.77 to 1.40, P=0.82). Moreover, there was no significant difference between SLE group and control group in the genotypes of AA versus GG, GA versus GG, AA versus GG+GA, and GA+AA versus GG.Conclusion　This meta-analysis dosen’t demonstrate the correlation between TNF-α promoter–308A/G polymorphism and SLE in Chinese populations.

Diagnostic Value of Anti-nucleosome Antibody in SLE Patients: A Systematic Review

Objective　To evaluate the diagnostic value of anti-nucleosome antibody (AnuA) in patients with systemic lupus erythematosus (SLE). Methods　We searched MEDLINE, EMbase and The Cochrane Library to identify studies on the diagnostic value of AnuA in patients with SLE. The searching time was from 1990 to 2005. The quality of included studies was evaluated and the data were extracted. The Cochrane Collaboration’s RevMan software was used to analyze heterogeneity, and MetaDisc was used to perform meta-analyses and draw summary receiver operator characteristic curve (SROC). Results　Twenty-five studies involving 7 289 patients (2 459 SLE and 5 030 non-SLE patients were diagnosed by gold standard) were included, most of which were poor in quality. The heterogeneity among studies was high (Plt;0.000 01, I2=87.2%). The pooled sensitivity was 64.9%, 95% CI 63.0 to 66.85, and the pooled specificity was 92.6%, 95% CI 91.8% to 93.3%. Area under the SROC was 0.918, SE0.0212. These data suggested that AnuA had a relatively high false negative rate (35.1%) and a relatively low false positive rate (7.4%). Conclusions　AnuA has some value in diagnosing SLE and could possibly be used as one of the diagnostic tests for SLE.

Detection and Significance of TypeⅠIFN Receptor on the Treg Cells from Patients with Systemic Lupus Erythematosus

目的　检测系统性红斑狼疮（SLE）患者CD4+CD25+调节性T细胞（Treg）上Ⅰ型干扰素受体（IFNAR）的分布格局，了解Ⅰ型干扰素对SLE患者CD4+CD25+Treg产生直接影响的作用靶点。 方法　选取2010年9月－2011年10月间20例初次确诊的SLE患者（SLE组）和20例健康女性（对照组），分离SLE患者和对照组的外周血单个核细胞，采用流式细胞术测定CD4+CD25+Treg上IFNAR的表达。 结果　① IFNAR1、IFNAR2在Treg和CD4+CD25? T细胞表面均有表达；两组Treg表面IFNAR1和IFNAR2的表达水平均高于CD4+CD25? T细胞。② 与对照组相比，SLE组Treg表面IFNAR1表达的平均荧光强度明显增高（P=0.001）。③ SLE组Treg表面IFNAR1表达平均荧光强度与疾病活动指数评分呈正相关（rs=0.505，P=0.023）。 结论　SLE患者CD4+CD25+Treg表面相对高表达IFNAR1且与疾病活动性相关，提示Ⅰ型干扰素以Treg上IFNAR为靶点在SLE发病机制中可能发挥重要作用，为SLE等自身免疫性疾病治疗寻找新的干预手段提供了理论基础。

系统性红斑狼疮继发纯红细胞再生障碍一例

【摘要】　目的　提高对系统性红斑狼疮继发纯红细胞再生障碍（pure red cell aplasia，PRCA）的诊断和治疗认识。　方法　报道系统性红斑狼疮继发PRCA病例1例，观察患者对甲泼尼龙联合环孢素治疗的疗效。　结果　使用甲泼尼龙联合环孢素治疗后，系统性红斑狼疮继发PRCA患者血红蛋白恢复良好。　结论　大多数系统性红斑狼疮继发PRCA患者对糖皮质激素和免疫抑制剂联合治疗反应良好。

Systemic Lupus Erythematosus Patients with Acute Abdomen: A Report of 20 Cases and Literature Review

【摘要】 目的 提高对系统性红斑狼疮(SLE)并发急腹症(AA)临床复杂性的认识,总结诊治经验。方法 对2008年以来收治20例系统性红斑狼疮并发急腹症的患者进行回顾性分析,并复习近9年相关文献。结果 系统性红斑狼疮住院患者中并发急腹症发生率2.56％；急腹症多数(80%)与系统性红斑狼疮病情活动相关,也可能由独立于系统性红斑狼疮的其他疾病引起(20%),病情复杂,容易误诊。腹部CT尤其是增强CT检查对确定系统性红斑狼疮相关急腹症病因有重要作用。结论 系统性红斑狼疮活动是系统性红斑狼疮并发急腹症最主要的原因,SLEDAI评分在系统性红斑狼疮并发急腹症鉴别诊断中有一定作用。及时诊断、正确治疗后,系统性红斑狼疮活动相关急腹症患者的预后较好。

系统性红斑狼疮伴发急腹症的护理

目的 总结系统性红斑狼疮（systemic lupus erythematosus, SLE）伴发急腹症(acute abdomen, AA)的临床特点与护理体会。 方法 对2004年1月-2009年1月收治的25例SLE伴发AA的临床资料与护理进行回顾性分析。 结果 AA是狼疮活跃的表现,加强其护理的同时不能忽略SLE的护理，重视健康教育。 结论 AA与SLE合并时病情危重，治疗护理有一定的特殊性，应引起护理人员关注。