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系统性红斑狼疮患者行二尖瓣成形术一例

系统性红斑狼疮伴肾炎、膀胱炎和肠炎一例

系统性红斑狼疮并发急性粒细胞白血病一例

The Systematic Lupus Erythematosus Liver Harms 30 Examples Clinically To Analyze

摘要:目的:探讨系统性红斑狼疮（SLE）肝损害的临床特点、肝损害发生率与SLE的病情严重程度的关系。方法:对98例SLE的临床资料进行分析,收集所有研究对象的临床资料,对肝损害组(30例)的症状与体征、病情程度、肝功能指标、影像学检查结果进行数据分析,并将其部分生化及免疫学指标与无肝损害组(68对照组)进行比较。结果:SLE患者中SLE肝损害的发生率为30.61%。肝损害组中,病情重度16例(53.33%),17例患者(56.67%)无明显自觉症状,以ALT、AST轻中度升高为主。7例患者肝脏B超异常。肝损害组患者的白细胞值明显低与无肝损害组(Plt;0.05)。而2组的血红蛋白、血小板、CRP、ESR、抗核抗体、抗dsDNA抗体、IgG、补体3等比较差异均无统计学意义(P均gt;0.05)。11例患者接受肾上腺皮质激素(激素)、免疫抑制剂(环磷酰胺、甲氨蝶呤)等药物治疗,9例在出院时复查肝功能正常或好转,另2例肝功能无明显改善;19例患者在接受激素、免疫抑制剂治疗的同时,给予护肝治疗,15例出院复查肝功能正常或好转,另4例无明显改善。而对照组68例中病情重度8例(11.76%)。结论:肝脏是SLE常见累及的靶器官之一,SLE肝损害的临床表现缺乏特异性,以轻至中度肝细胞损害多见,肝损害发生率与SLE病情严重程度成正相关、与SLE的近期预后无关、与长期预后有待进一步研究。Abstract: Objective: To discuss the relationship between the clinical characteristic, The incidence of liver damage and the severity of SLE. Methods: Carries on the mathematical analysis to 98 example SLE clinical material, the collection all object of study clinical material, to liver harm group (30 examples) the symptom and the symptom，Severity the liver function target， the phantom study inspection result carries on the mathematical analysis, and (68 control groups) carries on its part of biochemistry and the immunology target with the nonliver harm group the comparison.Results: In the SLE patient the SLE liver harms the formation rate is 30.61%.In liver harm group, severe illness in 16 cases (53.33%), 17 example patient (56.67%) not obvious subjective symptom, by ALT, AST light moderate ascension primarily.7 example patient liver B ultra exceptionally.The liver harm group patient’s white blood cell value is lower than the nonliver harm group obviously (Plt;0.05), but 2 groups of hemoglobins, the blood platelet, CRP, ESR, the antinuclear immune body, the antidsDNA immune body, IgG, the complement 3 and so on the comparison differences do not have statistics significance (Pgt;0.05). 11 example patients accept the adrenal cortex hormone (hormone), the immunity inhibitor (endoxan, armor ammonia pterin) and so on the medicine treatments, 9 examples when out of hospital reexamines the liver function normal or the change for the better, another 2 example liver function improves not obviously; 19 example patients while accept the hormone, immunity inhibitor treatment, gives protects the liver treatment, 15 example out of hospital reexamination liver function normal or change for the better, another 4 examples improve not obviously. While the control group, 68 cases of severe illness in 8 cases (11.76%).Conclusion: The liver is one of target organs which SLE implicates common, the SLE liver harm. the clinical manifestation lacks the specificity, by sees lightly to the moderate liver cell harm,The incidence of liver damage and SLE severity is positively correlated with shortterm prognosis of SLE has nothing to do with the longterm prognosis remains to be further studied.

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.

Magnetic Resonance Imaging Features of Systemic Lupus Erythematosus Encephalopathy

【摘要】 目的 探讨系统性红斑狼疮脑病（SLEE）的磁共振成像（MRI）特征和诊断价值。 方法 回顾性分析2007年1月-2009年7月间18例SLEE的临床表现及MRI特征。 结果 18例患者MRI检查的颅脑阳性率为88.88%（16/18），脑部MRI表现为:①15例为多发病灶，局灶者1例。②双侧大脑半球、基底节区及小脑半球脑实质内长T1、长或稍长T信号，DWI及EPI成像上呈高或稍高信号，灰白质均可受累，分布无规律性。③增强MRI扫描9例，其中5例呈斑片状强化，4例无明显强化。④脑梗死12例，脑出血4例。合并脑水肿9例，脑萎缩7例。 结论 SLEE的MRI表现多样，结合临床资料，MRI可以作出诊断。【Abstract】 Objective To investigate the magnetic resonance imaging (MRI) features of systemic lupus erythematosus encephalopathy (SLEE) and its diagnostic value. Methods The clinical data and MRI images of 18 patients with SLEE admitted from January 2007 to July 2009 in our hospital were analyzed retrospectively. Results Positive findings were found in 16 patients (88.88%). MRI findings of SLEE were the following: ①A Total of 15 patients were with diffuse lesions, one patient was with focal lesions. ②Cerebral hemisphere involvement and bilateral caudate long T1 and long or slightly long T2 signal were intensive in the brain parenchyma, and appeared as hyper-intensity or slightly hyper-intensity on DWI and EPI. Grey and white matters were involved often and irregularly distributed. ③The results of 9 patients by enhanced MRI showed that 5 patients were with patchy enhancement and 4 were without enhancement. ④Of the 16 positive patients, 12 were with cerebral infarction and 4 with cerebral hemorrhage, while 9 patients were complicated with cerebral edema, and 7 patients were with cerebral atrophy. Conclusion MRI manifestations of SLEE are various. Combined with clinical data, MRI can diagnose SLEE exactly.

Causal effect of educational attainment on systemic lupus erythematosus: Mendelian randomization study

Objective To analyze the causal relationship between educational attainment and the risk of systemic lupus erythematosus (SLE). Methods Based on the data from publicly available genome-wide association studies, we employed single nucleotide polymorphisms (SNPs) strongly associated with educational attainment as instrumental variables. Two-sample Mendelian randomization analysis was used to investigate the causal relationship between educational attainment and SLE. The primary analysis method used was the inverse variance weighted with multiplicative random effects. Validation methods included inverse variance weighted with fixed effects and MR-Egger methods. Additionally, sensitivity analysis was conducted using the leave-one-out approach. Results Finally, 433 SNPs were included. The inverse variance weighted with multiplicative random effects analysis indicated no causal effect of educational attainment on the risk of SLE [odds ratio =1.111, 95% confidence interval (0.813, 1.518), P=0.509]. Similarly, the other two methods did not find any evidence of a causal relationship (P>0.05); however, significant heterogeneity was observed. The MR-Egger regression analysis provided no evidence of horizontal pleiotropy among the included instrumental variables (P>0.05). The leave-one-out approach did not identify any individual SNP that had a significant impact on the overall effect estimate. ConclusionIn conclusion, this study does not support a causal effect of educational attainment on the risk of SLE.

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肠穿孔的临床分析

目的探讨系统性红斑狼疮（SLE）引发肠穿孔的临床特点。 方法对2011年1月－2013年1月外科重症监护室收治的3例SLE引发肠穿孔病例，结合相关文献分析该类疾病的临床表现和治疗方法。 结果患者经积极治疗，病情逐渐稳定，均康复出院。 结论SLE合并肠穿孔临床上较少见，迷惑性强，容易误诊误治，未及时发现穿孔可引起严重后果。

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。