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 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.
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.
ObjectiveTo evaluate diagnostic performance of crithidia luciliae immunofluorescence test (CLIFT), enzyme linked immunosorbent assay (ELISA), linear immunoassay (LIA) and chemiluminescence immunoassay (CLIA) for detection of anti-dsDNA antibodies for systemic lupus erythematosus (SLE). MethodsA total of 178 sera[SLE (n=86), other systemic rheumatic diseases (n=62), and healthy individual (n=30)], from whom received treatment from July 2012 to June 2013, were tested by 4 different assay kits. ResultsThe diagnostic performances of four methods for detecting anti-dsDNA antibodies for SLE were ELISA, CLIA, CLIFT and LIA, from higher to lower; while ELISA had the highest sensitivity (67.4%), and CLIA had the highest specificity (95.6%). The three test methods (ELISA, LIA, CLIA) had almost perfect concordance with the comparison method (CLIFT, Kappa >0.8). With cut-off values set at 95% of specificity, there was no statistical difference of sensitivity between ELISA and CLIA (58.1%, 60.5%; P>0.05). ConclusionFour assays can be used for the clinical detection of anti-dsDNA antibodies, and the results have an almost perfect concordance. Different assays show various performances depending on the methods and cut-off values used.
ObjectiveTo analyze the clinical manifestations and laboratory test results of 357 cases of first-diagnosed systemic lupus erythematosus (SLE), and provide a reference for SLE diagnosis. MethodsA total of 357 SLE patients on their first diagnosis were collected from 2008 to 2012 in our hospital, and the clinical manifestations and laboratory findings of these patients were recorded and analyzed. ResultsAll the patients had different clinical manifestations and serious multi-system damages. In these patients, there were 59.1% (211 cases) involved with arthritis, followed by rash and kidney damage. The complement declined in 75.9% of the patients according to the results of immunological tests. In the ENA spectrum inspection, anti-SSA antibody had the highest positive rate (51.3%), followed by anti-u1RNP antibody (44.0%), anti-dsDNA antibody and anti-nucleosome antibody. The first onset of most clinical manifestations was rash (43.4%), followed by arthritis and lower extremity edema; a few patients had headache or numbness as the first symptom. ConclusionSLE patients have diverse clinical manifestations, serious multi-system damages and outstanding heterogeneity, which is inconsistent with foreign reports.
ObjectiveTo study the perioperative treatment of total hip arthroplasty (THA) for avascular necrosis of the femoral head (ANFH) in systemic lupus erythematosus (SLE) patients. MethodsThe clinical data of 27 patients with SLE and ANFH, who underwent 40 THAs between August 2009 and November 2012 were retrospectively analyzed. There were 5 male and 22 female patients, and the average age of the patients at surgery was 40 years ranging from 21 to 66 years. Fourteen cases had unilateral THA and 13 had bilateral THA. The combined disease included 2 cases of hypertension, 3 chronic bronchitis, 1 autoimmune liver disease and hypohepatia, 2 sicca syndrome, and 2 anemia. ResultsAll the patients were stable peri-operatively. No patient had adrenal crisis. Four complications were noted, including one case of fever reaction (maximum temperature:39.3℃), 1 incision fat liquefaction, 1 pulmonary infection, and 1 early dislocation due to improper exercise on the 12th day after the operation. The patients were followed up for 24 to 53 months, and there was no deep infection, prosthetic loosening, peri-prosthetic fracture or deep vein thrombosis after THA. ConclusionAlthough the incidence of postoperative complication is high in patients with SLE and ANFH undergoing THA, meticulous perioperative management can help these patients get through operation safely, including the use of glucocorticoid and antibiotics, treatment of osteoporosis, and prevention and treatment of complications.
ObjectiveTo analyze the correlation between anti-cell membrane DNA (mDNA) antibodies and other autoantibodies and estimate its diagnosing significance for systemic lupus erythematosus (SLE). MethodsFrom January to August 2015, the sera samples from 254 patients with various autoimmune diseases, including 106 SLE, 80 rheumatoid arthritis (RA), 32 mixed connective tissue disease (MCTD), 29 Sjogren's syndrome (SS), 7 polymyositis/dermatomyositis (PM/DM) and 20 healthy controls, were collected. The anti-mDNA antibody, anti-dsDNA antibody, antinuclear antibody (ANA) and anti-keratin antibody (AKA) were detected by indirect immunofluorescent assay; anti-cyclic citrylinated peptide antibody (CCP) antibody was detected by enzyme-linked immuno sorbent assay; rheumatoid factor (RF) was detected by rat scatter turbidimetry assay; and anti-Sm antibody was detected by Western blotting method. ResultsAnti-mDNA antibody was found in 77 of 106 SLE (72.6%), 4 of 80 RA (5.0%), 6 of 32 MCTD (18.7%), 4 of 29 SS (14.7%), 0 of 7 PM/DM (0.0%) and 0 of 20 healthy controls (0.0%), respectively. It's notable higher in SLE than that in the others (P < 0.001). The sensitivity, specificity and diagnosis efficiency of anti-mDNA antibody for SLE were 72.6%, 91.7% and 84.3%, respectively. Anti-mDNA antibody was significantly correlated with ANA, anti-dsDNA antibody and anti-Sm antibody (P < 0.001), while it had no significant correlation with anti-CCP antibody, AKA and RF (P > 0.05). ConclusionAnti-mDNA antibody is closely related with other SLE associated antibodies and with high sensitivity and specificity for SLE diagnosis.
ObjectiveTo systematically review the diagnostic value of anti-C1q antibodies for lupus nephritis (LN) in Chinese population. MethodsWe electronically searched databases including PubMed, EMbase, CNKI, The Cochrane Library, VIP and WanFang Data for diagnostic accuracy studies of anti-C1q antibodies for LN in Chinese population from inception to 1st March, 2015. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies by QUADAS tool. Then, meta-analysis was performed by Meta-DiSc 1.4 software and Stata 11.0 software. ResultsA total of 11 studies involving 1 084 systemic lupus erythematosus (SLE) patients were included. Among them, 474 patients were LN. The results of meta-analysis showed that:the pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio of anti-C1q in the diagnosis of LN were 0.67 (95%CI 0.63 to 0.71), 0.69 (95%CI 0.65 to 0.74), 5.09 (95%CI 3.29 to 7.85), 2.18 (95%CI 1.75 to 2.72), and 0.48 (95%CI 0.39 to 0.60), respectively. The area under the curve (AUC) of SROC was 0.749 6 and the Q index value was 0.693 1. The average missed diagnosis rate was 33.0% and the misdiagnosis rate was 31.0%. ConclusionCurrent evidence indicates that anti-C1q antibodies may have some value in the diagnosis of LN. Because of the high missed diagnosis rate and the misdiagnosis rate, it could not be used to diagnose LN alone, and it only could be used as an adjuvant diagnostic indicator for LN. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveSystemic lupus erythematosus (SLE) patients from a SLE family with homogeneity can provide experimental basis for individualized diagnosis and treatment by studying the characteristics of laboratory tests and symptoms. MethodsLaboratory tests were analyzed for three SLE patients in the family, and set up the screen model by three laboratory tests (anitnuclear antibody positive, rheumatoid factor positive and IgE positive, ANA+RF+IgE+). All SLE cases were screened from latest four years as SLE subtype patients (named "similar family SLE patients"), then the family laboratory tests and clinical characteristics were analyzed. ResultsA total of 55 patients (6.27%) were screened as similar family SLE patients from individual SLE patients according to model from 877 cases. The laboratory tests of similar family SLE patients including creatinine, WBC, CRP were significant lower than other SLE patients (P < 0.05), but significant higher for the IgG, positive rate of anti-SSA and anti-SSB (P < 0.05), and the alopecia and skin rashes were more common in similar family SLE patients than other SLE patients. ConclusionsThe ANA+RF+IgE+ SLE patients are of lower inflammatory state and kidney involvement; Clinical symptom is priority to alopecia and skin rashes.
ObjectiveTo investigate the clinical features,treatment and pathogenesis of shrinking lung syndrome (SLS). MethodsA patient of systemic lupus erythematosus(SLE)with SLS as initial manifestation was reported.Literatures about SLS were comprehensively reviewed for its clinical characteristics and pathogenesis. ResultsA 27-year-old man was admitted with chief complaint of intermittent dyspnea and chest pain in 2009.Chest X-ray showed small lung volume and elevated diaphragms.Chest CT revealed bilateral pleural thickness and multiple atelectasis,without significant sign of interstitial fibrosis.Lung function showed restrictive pattern.Routine blood test revealed declined white blood cell and platelet count.C3 and C4 were declined.The autoantibody test revealed positive ANA,dsDNA,AHA,and RNP antibody.A diagnosis of SLE with SLS was made.The patient received corticosteroids and immunosuppressive therapy and was followed up for 5 years.His symptoms had relieved,but there was no obvious improvement in chest radiology and lung function.A total of 118 SLS cases were recorded in literature review,among which 100 were females and 18 were males.The average age was 32.98±14.66 years.Common clinical features of SLS included dyspnea,chest pain,orthopnea,breathlessness,and decreased breath sound.Radiology revealed small lung volume,elevated diaphragm,and dysfunction of diaphragm.Lung function showed restrictive pattern.The primary treatment of the disease was corticosteroid and immunosuppressive agents.The use of theophylline,β-agonist and rituximab was also reported. ConclusionWe should be aware of SLS in patients with SLE or other autoimmune diseases when they present with unexplained dyspnea.