Objective To identify the best therapy regimen for a patient with rare hypoglycemia due to insulin autoantibody (IAA). Methods We searched The Cochrane Library (Issue 3, 2008), PubMed (1966-July 2009), EMbase (1974-July 2009) and CBM (1978-July 2009) to identify relevant evidence. The quality of the retrieved studies was critically assessed. Results A total of 291 records were retrieved. No clinical guidelines, systematic reviews or clinical randomized studies were identified. Thirty treatment-related studies involving 6 interventions showed that insulin combined with Prednisone was relatively more effective and safer than conventional therapies. Conclusion The steroid treatment might be useful for the improvement of glycamic control in patients with high IAA levels and severe hypoglycemia and hyperglycemia due to insulin antibodies raised against subcutaneously-injected human insulin.
【摘要】 目的 探讨慢性丙型肝炎患者干扰素治疗前后血清自身抗体的合并状况。 方法 回顾性分析2005年2月-2008年2月66例慢性丙型肝炎患者应用干扰素治疗前后的检测结果，观察治疗前后自身抗体合并状况及与干扰素疗效的关系。 结果 ①66例慢性丙型肝炎患者中39例自身抗体阳性，阳性率59.1%（39/66），主要为ANA；②自身抗体的产生与年龄相关，而与性别、HCVRNA定量无关；③自身抗体阳性组干扰素应答率66.7% （26/39）明显高于阴性组40.7%（11/27），二者比较差异有统计学意义；④干扰素治疗后，自身抗体阴性组自身抗体检出率为44.4%（12/27），但滴度均lt;1∶320；治疗前抗甲状腺球蛋白抗体阳性患者会出现较高的甲状腺功能异常率。 结论 慢性丙型肝炎合并血清自身抗体阳性的患者干扰素应答率高于阴性组，但应注意抗甲状腺球蛋白抗体，以预测不良反应。【Abstract】 Objective To explore the consolidation of serum autoantibodies in chronic hepatitis C patients treated with interferon. Methods The clinical data of 66 patients with chronic hepatitis C treated with interferon from February 2005 to February 2008 were retrospectively analyzed. The relationship between the consolidation of serum autoantibodies and the effect of interferon was observed. Results ①There were 39 patients with positive autoantibodies; the positive rate was 59.1% (39/66) and ANA was the main antibody. ②The appearance of autoantibodies correlated with the patients′ ages but not with the sexes and CVRNA quantification. ③The interferon response rate in autoantibodies positive group was 66.7% (26/39) which was much higher than that in the negative group; the difference between the two groups was significant. ④After the interferon treatment, the autoantibody detection rate in autoantibody negative group was 44.4%(12/27)and the titer was lower than 1:320; before the treatment, the anti-thyroglobulin antibody-positive patients had a higher rate of thyroid dysfunction. Conclusion The interferon response rate in chronic hepatitis C patients with positive serum autoantibodies is higher than that in the patients with negative serum autoantibodies. Anti-thyroglobulin antibodies should be noted to predict the adverse effects.
ObjectiveTo discuss the relationship between antinuclear antibody (ANA) fluorescence pattern detected by indirect immunity fluorescence (IIF) and antinuclear antibody profiles (including anti-dsDNA, RNP, Sm, SSa, SSb, Scl-70, Jo-1 and rib-P) in human serum. MethodsA total of 7385 cases of ANA pattern and ANA profiles were retrospectively analyzed from January 2010 to December 2013. ANA was detected by IIF substrated as HEp-2 cells, anti-dsDNA by IIF substrated as crithidia, and the other 7 antibodies by enzyme immunoblot with purified antigen. ResultsGranular pattern mostly presented as anti-RNP, anti-Sm, anti-SSa and anti-SSb (P < 0.001); homogeneous pattern was anti-dsDNA and anti-SSa (P < 0.001); nucleolus, centromere, and mixed pattern was anti-SSa (P < 0.05); cytoplasm pattern was anti-rib-P and anti-SSa (P < 0.05). But few above antibodies could be detected in Golgi, dots, rim, actin, actotropomyosin, prolifevating cell nuclear antigen (PCNA) and vementin pattern. Homogeneous pattern was shown up to 77.91% in only anti-dsDNA positive serum; granular was 96.84%, 52.01%, and 82.35% respectively in only anti-RNP or anti-SSa or anti-Sm positive. Homogeneous and nucleolus mix pattern was up to 30.53% in only anti-Scl-70 positive. Cytoplasm pattern was 50.00% and 61.54% respectively in only anti-rib-P or anti-Jo-1 positive. But no fixed relationship was found between ANA pattern and anti-SSb. ConclusionsThere is a certain relationship between ANA and antinuclear antibody profiles. Granular, homogeneous and cytoplasm pattern often can be detected more than one autoantibodies. Eight kinds of specific autoantibodies often are negative when ANA patterns are centromere, Golgi, dots, rim, actin, tropomyosin, PCNA, and vimentin. Anti-dsDNA is mainly corresponding to homogeneous, anti-RNP, anti-SSa and anti-Sm to granular, anti-Scl-70 to homogeneous and nucleoli, anti-rib-P and anti-Jo-1 to cytoplasm. The study can give suggestions for further tests application and lab result checking.
ObjectiveTo evaluate the effect of autoantibody on the efficacy and safety of pegylated interferonα-2a (Peg-IFNα-2a) and ribavirin on chronic hepatitis C (HCV). MethodsWe enrolled 106 chronic HCV infected patients, who were divided into autoantibody-positive group and negative group based on the baseline autoantibody detection. The patients were treated for 48 weeks. The anti-viral response and adverse effects were observed. Data analyses were reported using the SPSS 20.0 statistical package. ResultsThe prevalence of any autoantibody in chronic hepatitis C patients amounted to 31.1%, and serum anti-nuclear antibody was positive in 24 patients. Difference in age, sex, serum alanine transaminase level, aspartate transaminase level, total bilirubin level, thyroid function and HCV RNA level between autoantibody-positive group and negative group was not significant (P > 0.05). The level of hemoglobin in autoantibody-positive group was significantly lower than the negative group (P=0.018). Of the 106 patients, 82 patients achieved sustained virological response (SVR), 56 achieved rapid virological response (RVR), 98 achieved ealy virological response (EVR) and 8 were non-responders. There were no significant differences between RVR, EVR and SVR in autoantibody-positive group and negative group (P > 0.05). The most common adverse effects in this study were fatigue, weight loss, hair loss and fever, and no significant differences in adverse effects were observed between the two groups (P > 0.05). ConclusionAutoantibody positivity may not affect the treatment response and is safe in chronic HCV infected patients with combination therapy of pegylated interferonα-2a plus ribavirin.
ObjectiveTo describe the clinical,radiographic,and laboratory features of autoimmune pulmonary alveolar proteinosis (PAP) from a single center. MethodsConsecutive autoimmune PAP cases diagnosed in the Nanjing Drum Tower Hospital between January 2006 and December 2012 were recruited in the study. The clinical,radiographic and laboratory data of the PAP patients were analyzed to explore the clinical significance of serum GM-CSF autoantibody (GMAb) and serum cytokeratin (CYFRA21-1). ResultsThe median serum GMAb level of the 26 cases was 28.64 μg/mL (interquartile range,19.2-75.4 μg/mL),which were diagnosed as autoimmune PAP based on the serum GMAb levels of these patients all above the cut-off value of 2.39 μg/mL while the serum GMAb levels of 30 normal controls were 0.10(0.05-0.15)μg/mL and all below the cut-off value. 34.6% of all recruited 26 autoimmune PAP patients had identified occupational inhalational exposure. There was no significant correlation in the serum GMAb in autoimmune PAP patients with disease severity scores (DSS),lung function parameters,chest high resolution computed tomography (HRCT) scores,or PaO2 (P>0.05). There was significant correlation of DSS of autoimmune PAP patients with PaO2,FVC%pred,TLCO%pred,opacity extent score of chest HRCT,and opacity severity score of chest HRCT (P<0.05). The median serum level of CYFRA21-1 of the autoimmune PAP patients was 9.9(4.3-19.5)ng/mL,which was significant higher than that of the normal control group (P<0.05). However there was no significant correlation in the serum CYFRA21-1 in the autoimmune PAP patients with DSS,lung function parameters,and chest HRCT scores. 92.3% of the chest HRCT of 26 autoimmune PAP patients had crazy paving sign,while 100% of them had geographic sparing sign. ConclusionSerum GMAb and CYFRA21-1 may be important biomarkers for diagnosis of autoimmune PAP. The PAP with occupational inhalational exposure constitutes a high proportion of autoimmune PAP patients.
Immune-mediated necrotizing myopathy (IMNM) is a type of autoimmune myopathy characterized by relatively severe proximal weakness with high serum muscle enzyme levels, myofiber necrosis with minimal inflammatory cell infiltrate on muscle biopsy, and infrequent extra-muscular involvement. The mechanism of necrotizing myopathy remains unclear. The new European Neuromuscular Centre criteria divides IMNM into three distinct subtypes according to different autoantibodies, which reminds us antibodies may be involved in the pathogenesis of IMNM and different subtypes may have different pathogenesis. This review summarizes the current understanding of the pathogenesis of IMNM.
Objective To explore the clinical characteristics of patients with connective tissue disease with positive anti-small ubiquitin-like modifier activating enzyme (SAE) antibodies. MethodsRetrospectively select the patients who completed the screening of myositis autoantibodies in West China Hospital of Sichuan University between January 1, 2015 and May 30, 2021. Meanwhile, patients with positive anti-SAE antibodies were screened out. According to the clinical data of anti-SAE antibodies positive patients, they were divided into the following groups: tumor group and non-tumor group, ILD group and non-ILD group, inflammatory myopathy group and non-inflammatory myopathy group. Clinical symptoms, signs, laboratory examinations, imaging examinations and other clinical data of the above patients were collected. Results A total of 1 594 patients were screened for myositis autoantibodies, of which 56 were positive for anti-SAE antibodies, with a positive rate of 3.5%. In 56 patients, 32.1% in skin involvement, 35.7% in muscle involvement, 12.5% in joint involvement, 5.4% in dysphagia, 5.4% in weight loss, 58.9% in patients with interstitial lung disease (ILD) and 12.5% in patients with tumor history. There was no significant difference in age, sex, skin involvement, muscle involvement, joint involvement and respiratory system involvement between the tumor group and the non-tumor group (P>0.05). Except for age, the frequency of muscle involvement, and positive rate of anti-Ro-52 antibody, there was no significant difference in other indicators between the ILD group and the non-ILD group (P>0.05). Except for the positive rate of ILD, the frequency of skin involvement, the frequency of muscle involvement, the level of creatine kinase and hydroxybutyrate dehydrogenase (P<0.05), there was no significant difference in other indexes between the non-inflammatory myopathy group and the inflammatory myopathy group (P>0.05). Conclusions The patients with positive anti-SAE antibodies mainly present skin and muscle symptoms, and are prone to ILD, malignant tumor and dysphagia. Patients with positive anti-SAE antibodies and ILD were older, had less muscle damage, and had a higher positive rate of anti-Ro-52 antibody. Anti-SAE antibodies appear not only in patients with inflammatory myopathy, but also in non-inflammatory myopathy, often associated with a higher frequency of ILD and less muscle involvement.
ObjectiveBy integrating biological assays with imaging evaluations, a clinical prediction model is developed based on a cohort of ten thousand individuals to enhance the accuracy of distinguishing between benign and malignant pulmonary nodules. MethodsA retrospective analysis was conducted on the clinical data of 1,017 patients with pulmonary nodules who underwent chest CT and testing for seven types of lung cancer-related serum autoantibodies (7-AABs) at the First Affiliated Hospital of Zhejiang University School of Medicine from January 2020 to April 2024, all of whom had definitive pathological diagnosis results. Statistical analysis was performed using R and MSTATA software, with the development of univariate and multivariate logistic regression models, as well as a nomogram model. The performance of the models was evaluated using ROC curves, calibration curves, and decision curve analysis (DCA). ResultsA total of 1,017 patients with pulmonary nodules were included in the study. The training set consisted of 712 patients, including 291 males and 421 females, with a mean age of (58.12±12.41) years. The validation set included 305 patients, comprising 129 males and 176 females, with a mean age of (57.99±12.56) years. Univariate ROC curve analysis indicated that the combination of CT and 7-AABs testing achieved the highest AUC value (0.794), surpassing the diagnostic efficacy of CT alone (AUC=0.667) or 7-AABs alone (AUC=0.514). Multivariate logistic regression analysis included age, imaging nodule diameter, nodule characteristics, and the combination of CT and 7-AABs testing as independent predictive factors to construct a nomogram prediction model. The AUC values for this model were 0.831 and 0.861 in the training and validation sets, respectively, demonstrating excellent performance in decision curve analysis (DCA). ConclusionThe combination of 7-AABs with CT significantly enhances the accuracy of distinguishing between benign and malignant pulmonary nodules. The developed predictive model provides strong support for clinical decision-making and contributes to achieving precise diagnosis and treatment of pulmonary nodules.