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.
Objective To explore the relevances of serum prolactin level to clinical symptoms and disease activities of systemic lupus erythematosis (SLE). Methods From December 2008 to December 2014, 63 female patients who met the American Rheumatism Society diagnostic criteria of SLE in the First People’s Hospital of Chengdu were collected as the SLE group, and other 20 healthy females were collected as the control group. The serum prolactin level was determined by immunofluorescence, and the disease activity of SLE was assessed by SLE Disease Activity Index (SLEDAI). The relevances of serum prolactin level to clinical symptoms and disease activity of SLE patients were analyzed. Results The mean serum prolactin level was (22.35±14.86) ng/mL in the SLE group and (15.30±8.54) ng/mL in the control group, respectively; the difference was statistically significant (P<0.05). In the 63 SLE patients, 15 (23.8%) had higher serum prolactin level compared with the normal ones. According to the SLEDAI score, the SLE patients were divided into stable group (25 patients), mild activity group (21 patients), moderate activity group (10 patients), and severe activity group (7 patients); and their serum prolactin levels were (20.43±11.23), (22.50±13.54), (27.97±21.20), and (33.91±18.18) ng/mL, respectively; the differences were not statistically significant (P>0.05). There were statistically significant differences (P<0.05) between the SLE patients with hyperprolactinemia and the ones with normal serum prolactin level in a number of clinical symptoms such as serositis, kidney damage,hematological system damage, and hypocomplementemia, but the serum prolactin level was not significantly correlated with the SLEDAI (rs=0.217, P=0.088). Conclusions Less hyperprolactinemia is found in SLE patients. Serum prolactin level is correlated with multiple clinical symptoms and laboratory indexes but not related to disease activity in SLE patients.
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.
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.
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 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 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.
Objective To describe the disease characteristics of osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE) who experiencing prolonged glucocorticoid (GC) exposure. Methods Between January 2016 and June 2019, 449 SLE patients meeting the criteria were recruited from multiple centers. Hip MRI examinations were performed during screening and regular follow-up to determine the occurrence of ONFH. The cohort was divided into ONFH and non-ONFH groups, and the differences in demographic baseline characteristics, general clinical characteristics, GC medication information, combined medication, and hip clinical features were compared and comprehensively described. ResultsThe age at SLE diagnosis was 29.8 (23.2, 40.9) years, with 93.1% (418 cases) being female. The duration of GC exposure was 5.3 (2.0, 10.5) years, and the cumulative incidence of SLE-ONFH was 9.1%. Significant differences (P<0.05) between ONFH and non-ONFH groups were observed in the following clinical characteristics: ① Demographic baseline characteristics: ONFH group had a higher proportion of patients with body mass index (BMI)<20 kg/m2 compared to non-ONFH group. ② General clinical characteristics: ONFH group showed a higher proportion of patients with cutaneous and renal manifestations, positive antiphospholipid antibodies (aPLs) and anticardiolipin antibodies, severe SLE patients [baseline SLE Disease Activity Index 2000 (SLEDAI-2K) score ≥15], and secondary hypertension. Fasting blood glucose in ONFH group was also higher. ③ GC medication information: ONFH group had higher initial intravenous GC exposure rates, duration, cumulative doses, higher cumulative GC doses in the first month and the first 3 months, higher average daily doses in the first 3 months, and higher proportions of average daily doses ≥15.0 mg/d and ≥30.0 mg/d, as well as higher full-course average daily doses and proportion of full-course daily doses ≥30.0 mg/d compared to non-ONFH group. ④ Combined medications: ONFH group had a significantly higher rate of antiplatelet drug use than non-ONFH group. ⑤ Hip clinical features: ONFH group had a higher proportion of hip discomfort or pain and a higher incidence of hip joint effusion before MRI screening than non-ONFH group. Conclusion The incidence of ONFH after GC exposure in China’s SLE population remains high (9.1%), with short-term (first 3 months), medium-to-high dose (average daily dose ≥15 mg/d) GC being closely associated with ONFH. Severe SLE, low BMI, certain clinical phenotypes, positive aPLs, and secondary hypertension may also be related to ONFH.
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.