目的 研究C-C亚族趋化因子单核细胞趋化蛋白-4（MCP-4/CCL13）在系统性红斑狼疮（SLE）患者外周血的表达水平，并分析MCP-4的水平与狼疮肾炎的关系，以探讨MCP-4在SLE发病机制中可能起的作用。 方法 选取2007年9月－2010年8月在四川大学华西医院和宜宾市第一人民医院诊断明确的SLE及类风湿关节炎（RA）患者各40例。另收入正常健康对照组（20例），应用酶联免疫吸附试验定量方法测定SLE组、RA患者和正常健康对照者血清中MCP-4的水平，SLE患者根据有无肾脏受累分为非狼疮肾炎组和狼疮肾炎组，其中非狼疮肾炎组20例，狼疮肾炎组20例，并分析SLE组血清MCP-4水平是否与抗核抗体、补体C3、C4等指标及SLE疾病活动指数SLEDAI评分相关性，血清MCP-4水平采用方差分析、LSD-t检验和Spearman相关进行统计分析。 结果 血清MCP-4水平SLE组为（216.32 ± 12.65）pg/mL，RA组为（203.79 ± 18.64）pg/mL，正常健康对照组为（125.13 ± 11.08）pg/mL。SLE组、RA组血清MCP-4水平与正常健康对照组相比均有统计学意义（P＜0.05），SLE组与RA组比较血清MCP-4水平无统计学意义（P＞0.05）；SLE患者中狼疮肾炎组与非狼疮肾炎组比较血清MCP-4水平无统计学意义（P＞0.05）。SLE组血清MCP-4水平与抗核抗体、补体C3、C4等指标及SLEDAI评分无相关性。 结论 MCP-4在SLE组患者血清中表达增高，MCP-4可能参与了SLE的发病过程，可能成为SLE新的血清学有用指标并作为治疗的靶点。
目的 回顾性研究老年系统性红斑狼疮（SLE）患者合并感染的危险因素。 方法 选取1995年1月－2009年12月间在四川大学华西医院确诊为SLE，起病年龄为50周岁以上的158例患者，收集性别、临床表现、疾病活动度、实验室检查指标、合并症以及并发症等进行单因素分析或多因素非条件logistic回归分析。 结果 所纳入的158例患者中，合并感染53例（占33.5%），采用单因素分析显示疾病活动性（P=0.001）、低蛋白血症（P=0.030）、糖尿病（P=0.003）、肺间质病变（P=0.000）与老年SLE患者感染发生有关。经logistic回归分析显示，疾病活动性（OR=7.533，P=0.000）、肺间质病变（OR=19.762，P=0.000）、糖尿病（OR=6.862，P=0.025）是老年SLE患者感染发生的危险因素。 结论 积极控制老年SLE的疾病活动度，减少危险因素的发生是控制老年SLE患者并发感染的有效手段。
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 contrastenhanced 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. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.
Objective To observe the clinical features of systemic lupus erythematosus (SLE) with retinopathy.Methods Ninety-seven SLE patients were enrolled in this comparative clinical study. The patients were divided into retinopathy group (positive group, 32 eyes of 23 patients) and non-retinopathy group (negative group, 148 eyes of 74 patients). The age, course of disease, clinical features, laboratory results in these two groups were comparatively analyzed.Results The positive rate of retinopathy in all SLE patients was 23.7%. Seventeen patients (22 eyes, 73.9%) of positive group had retinal cotton-wool spot, retinal hemorrhage, tortuous retinal vein, retinal arterial spasm, microaneurysm and hard exudates. The other six patients (10 eyes, 26.1%) in this group showed retinal main vessel occlusion. The incidence rate of rash, cutaneous vasculitis, elevated erythrocyte sedimentation rate (ESR), decreased complement C3 and positive anti double stranded-DNA (anti-ds-DNA) antibody in the positive group were higher than those in the negative group (chi;2=9.206, 6.987, 7.824, 8.581, 6.599;P＜0.05). There was no significant difference between these two groups in age, course of disease, mucosal ulcers, arthritis, fever, headache, neutropenia, thrombocytopenia, proteinuria, elevated blood urea nitrogen, increased creatinine, positive antinuclear (ANA) and anti-Sm antibodies (t=0.321, 0.063;chi;2=0.135, 0.046, 0.176, 0.002, 0.036, 0.113, 0.053,0.032,0.012,0.000,0.004;P＞0.05). Conclusions Tortuous retinal veins, retinal cotton-wool spots and retinal main vessels occlusion are the three major fundus features of SLE patient with retinopathy. Rash, cutaneous vasculitis, increased ESR, decreased complement C3 and positive anti-ds-DNA antibody are the five major systemic clinical features of SLE patient with retinopathy.
Objective To investigate the relationship of clinical indexes between retinopathy in systemic-lupus-erythematosus （SLE）nephritis and SLE，and to discuss its clinical significance. Method The clinical data of 43 cases of SLE nephritis with ocular fundus diseases were retrospectively analyzed.The relationships between retinopathy and kidney defect，general lesions，SLEDAI grade，antinuclear antibody （ANA），anti-double stranded DNA，complement 3 and antiphospholipid antibodies were analyzed with Logistic regression respectively. Results In 86 eyes of the43paitents，there were retinal cotton wool spots in51eyes（59.3%），edema of optic disk in 43 eyes（50.5%），retinal haemorrhage in 12 eyes（14.0%），retinal artery occlusion in 5 eyes（5.8%），central retinal vein occlusion in 2 eyes（2.3%），retinal detachment in 3 eyes（3.5%），optic atrophy in 2 eyes（2.3%），and neovascularization in 2 eyes（2.3%）.Logistic regression analysis revealed that SLEDAI grade had linear dependent relation with cotton wool spots and optic disk edema（chi;2=42.154，6.498;P＜0.001），and didnrsquo;t have any correlation with proteinuria，hematuria and kidney function.Linear relation between retinal vascular occlusion and antiphospholipid antibodies was found（chi;2=24.475，P＜0.001）.Retinal haemorrhages，retinal detachment，optic atrophy and neovascularization did not correlate with clinical features. Conclusion SLEDAI grade had linear dependent relation with cotton wool spots and optic disk edema in patients with SLE nephritis，and Linear relation between retinal vascular occlusion and antiphospholipid antibodies is ascertained. Ocular fundus diseases are clinically important for evaluating the therapeutic responses and prognosis in lupus nephritis. (Chin J Ocul Fundus Dis, 2006, 22: 239-241)