ObjectiveTo evaluate the association of serum uric acid (SUA) with established lupus nephritis (LN) and to explore its prospective association with incident LN in systemic lupus erythematosus (SLE) patients presenting with preserved renal function.MethodsWe enrolled 97 SLE patients with preserved renal function (creatinine clearance ≥ 90 mL/min), including 58 with baseline LN and 39 without LN (NLN). Baseline associations were evaluated using multivariable logistic regression, with a sensitivity model further adjusting for baseline glucocorticoid dose, mycophenolate mofetil use, and cyclophosphamide use. Model discrimination was compared by Area Under the Curve (AUC) and DeLong testing. The baseline NLN cohort was followed for 3 years, and incident LN was analyzed using a Cox model adjusted for baseline Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).ResultsBaseline SUA was higher in LN than in NLN patients (489.2 ± 80.8 vs. 339.8 ± 104.2 µmol/L, p < 0.001). Higher SUA remained associated with baseline LN in the main model (adjusted OR 4.20 per 1-SD increase, 95% CI 2.00–8.83, p < 0.001) and after additional adjustment for baseline treatment exposures (adjusted OR 6.32, 95% CI 1.21–32.96, p = 0.029). Adding SUA to the base clinical model increased discrimination within this dataset (AUC 0.863 to 0.929; DeLong test p = 0.001). During 3 years of follow-up, 11 NLN patients (28.2%) developed incident LN; in exploratory Cox analysis adjusted for baseline SLEDAI, higher baseline SUA was associated with a possible increased hazard of subsequent LN (adjusted HR 1.83, 95% CI 1.09–3.07, p = 0.022).ConclusionIn this dataset, SUA was associated with LN risk stratification in SLE patients with preserved renal function, but this signal may also reflect broader disease activity, systemic inflammation, and treatment-related factors. The renal specificity of SUA remains uncertain.

Telitacicept, an innovative drug used for the treatment of systemic lupus erythematosus (SLE), can effectively control disease progression and achieve favorable outcomes. While case reports have mentioned the use of Telitacicept in lupus nephritis (LN) treatment, its safety and efficacy in treating patients with LN have not been explored. Therefore, in this study, we aimed to evaluate the safety and efficacy of Telitacicept in managing patients with LN. In a single-center, real-world retrospective study, 30 LN patients with poor response or adverse reactions to conventional glucocorticoids at our Hospital were enrolled to receive Telitacicept. Patients were administered 160 mg of Telitacicept subcutaneously once a week for at least 24 weeks in addition to standard treatment. We assessed the SLE responder index-4 (SRI-4) at the beginning and the end of the treatment period, measured laboratory test indicators at 3, 6, and 9 months, and observed the occurrence of adverse events in these patients. The SRI-4 response rate was 86.67

Objective To assess the association of serum magnesium with infection in new-onset systemic lupus erythematosus (SLE) patients. Methods We conducted a single-center retrospective cohort study of new-onset SLE patients from 2012 to 2021. The hospitalized SLE patients were divided into infection and noninfection groups. Logistic regression analysis was conducted to examine the association of hypomagnesemia with infection. Results A total of 476 new-onset SLE patients were included, with 299 cases in the infection group and 177 cases in the noninfection group. The patients were mostly females (81.7%). The average age at diagnosis was 43.7 years. The median duration was 1.0 month. The prevalence of hypomagnesemia (<0.70), normomagnesemia (0.70-1.10), and hypermagnesemia (>1.10) in new-onset SLE patients was 14.3%, 83.4%, and 2.3%, respectively. The prevalence of hypomagnesemia was 18.4% in the infection group and 7.3% in the noninfection group (p = .001). The baseline value of serum magnesium was 0.819 mmol/L, with values of 0.799 mmol/L in the infection group and 0.854 mmol/L in the noninfection group (p = .000). The following clinical variables were significantly different between the two groups (p < .05): age, duration, hospitalization stay, fever, serositis, and SLE Disease Activity Index 2000 (SLEDAI 2K). The laboratory parameters, including hemoglobin, white blood cell count, albumin level, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin, and complement C3 were also significantly different between the two groups (p < .05). The mortality was 4.4% (21/476), with 20 cases occurring in the infection group. Logistic regression analysis showed that hypomagnesemia was associated with an increased risk of infection (p = .001) and poor prognosis (p = .015). Conclusion Hypermagnesemia was rare in new-onset SLE patients. Hypomagnesemia was common and was associated with an increased risk of infection in new-onset SLE patients.

目的:探讨结缔组织病相关间质性肺病(CTD-ILD)患者发生疾病进展的临床特点及危险因素分析.方法:收集2020年1-12月首次就诊于福建医科大学附属漳州市医院风湿免疫科并明确诊断CTD-ILD的患者91例,根据随访6个月期间是否出现疾病进展分为进展组(27例)和非进展组(64例),分析两组一般资料、临床指标并构建二分类Logistic回归模型分析CTD-ILD患者发生疾病进展的危险因素.结果:单因素分析提示,两组基线时有无吸烟史、血清铁蛋白、用力肺活量占预计值百分比(FVC％pred)、一氧化碳弥散量占预计值百分比(DLCO％pred)、CT受累范围方面差异均有统计学意义(P<0.05),进一步行Logistic回归模型发现,血清铁蛋白水平升高(OR=1.002,95％CI:1.000,1.003,P=0.004)是CTD-ILD患者发生疾病进展的独立危险因素,血清铁蛋白最佳临界值为303.25 ng/ml,敏感度与特异度分别为81.5％、54.7％,曲线下面积为0.747.结论:血清铁蛋白水平可能作为CTD-ILD患者发生疾病进展的独立预测指标.

目的 探讨系统性红斑狼疮(SLE)合并恶性淋巴瘤(ML)血清可溶性白细胞介素2受体(sIL-2R)、高迁移率族蛋白B1(HMGB1)、25-羟维生素D3[25(OH)D3]水平变化的意义及其与SLE疾病活动指数(SLE-DAI)积分的相关性.方法 回顾性选取2015年1月至2015年12月福建医科大学附属漳州市医院30例SLE合并ML患者作为观察组,另选取同期30例未合并ML的SLE患者作为对照组,比较两组临床资料基线数据及血清sIL-2R、HMGB1、25(OH)D3水平,分析SLE合并ML的影响因素,评价SLEDAI积分、sIL-2R、HMGB1、25(OH)D3对SLE合并ML的诊断价值,并进行个体值预测验证,分析血清sIL-2R、HMGB1、25(OH)D3水平与SLEDAI积分相关性.结果 观察组SLEDAI积分及血清sIL-2R、HMGB1水平明显高于对照组(P<0.05),25(OH)D3水平则低于对照组(P<0.05).Logistic回归模型分析结果 显示,SLEDAI积分、sIL-2R、HMGB1是SLE合并ML的独立危险因素,25(OH)D3是SLE合并ML的独立保护因素(P<0.05).受试者工作特征曲线分析结果 显示,SLEDAI积分、sIL-2R、HMGB1、25(OH)D3单独诊断SLE合并ML的曲线下面积(AUC)分别为0.728、0.779、0.741、0.711,而4项指标联合诊断的AUC为0.868,较各指标单独诊断价值明显提高.随机抽取1例患者,其各自变量取值为SLEDAI积分=1;sIL-2R=0;HMGB1=1;25(OH)D3=0,代入概率预测方程得到概率值P=0.265,大于最佳临界值,故在预测准确率为85.41％的条件下该患者会发生ML,且符合临床实际.Pearson相关分析结果 显示,SLE合并ML患者血清sIL-2R、HMGB1水平与SLEDAI积分呈正相关(r=0.740、0.760,P<0.05),25(OH)D3水平与SLEDAI积分呈负相关(r=-0.745,P<0.05).结论 SLE合并ML患者血清sIL-2R、HMGB1水平明显升高,25(OH)D3水平明显下降,且均与SLEDAI积分有关.检测血清sIL-2R、HMGB1、25(OH)D3水平,有助于早期预警、诊断SLE合并ML,并为临床诊疗提供依据.

Objectives:This study aimed to investigate the risk factors of lung progression in patients with connective tissue disease-associated interstitial lung disease (ILD). Patients and methods:A total of 91 ILD patients (28 males, 63 females; mean age: 54.9±11.3 years; range, 30 to 77 years) were included in the prospective follow-up study conducted throughout 2020. They were divided into progressors (n=27) and nonprogressors (n=64) according to whether the pulmonary disease progressed during a six-month follow-up period. The clinical data of the two groups were analyzed, and a logistic regression model was constructed to analyze the risk factors of the progression of ILD in all patients. Results:Univariate analysis revealed significant differences (p<0.05) between the two groups in smoking history, serum ferritin, FVC% (the percentage of forced vital capacity), DLCO% (the percentage of diffusion capacity for carbon monoxide), and computed tomography involvement range. Further application of a logistic regression model revealed that increased serum ferritin level was an independent risk factor for ILD progression (odds ratio=1.002, 95% confidence interval: 1.000-1.003, p=0.004). The optimal critical value of serum ferritin was 303.25 ng/mL, the sensitivity and specificity were 81.5% and 54.7%, respectively, and the area under the curve was 0.747. Conclusion:The level of serum ferritin may be an independent predictor for ILD progression.

目的 观察柳氮磺吡啶肠溶片联合羟氯喹片及甲氨蝶呤片治疗类风湿关节炎(RA)的临床疗效.方法 选取2019年4月—2021年4月漳州市龙海区第一医院收治的RA患者80例作为研究对象,采用随机数字表法分为对照组与研究组,每组40例.对照组予以甲氨蝶呤片与硫酸羟氯喹片治疗,研究组在对照组基础上予以柳氮磺吡啶肠溶片治疗.2组均持续治疗24周.比较2组治疗前后血清C反应蛋白(CRP)、类风湿因子(RF)、红细胞沉降率(ESR)、血脂指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、疾病活动度[RA病情活动度评价表(DAS28)评分、临床疾病活动指数(CDAI)评分、简化疾病活动指数(SDAI)评分]的变化情况,并观察2组不良反应.结果 治疗后,2组CRP、ESR、RF滴度低于治疗前,且研究组低于对照组(P<0.01).治疗后,2组TC、TG、LDL-C低于治疗前,HDL-C高于治疗前,且研究组TC、TG、LDL-C低于对照组,HDL-C高于对照组(P<0.01).治疗后,2组DAS28、CDAI、SDAI评分低于治疗前,且研究组DAS28、CDAI、SDAI评分低于对照组(P<0.01).研究组不良反应总发生率为12.50％,与对照组的7.50％比较,差异无统计学意义(χ2=1.389,P=0.239).结论 柳氮磺吡啶肠溶片联合羟氯喹片及甲氨蝶呤片治疗RA患者的临床疗效确切,可有效改善疾病活动度,降低血脂,减轻炎症反应,且安全性较高.

Objectives This study aims to assess the nailfold capillary changes in patients with systemic lupus erythematosus (SLE), particularly among those with Raynaud’s phenomenon (RP), and the correlation between nailfold capillary changes and autoantibodies and disease activity. Patients and methods A total of 85 patients (9 males, 76 females; median age 31 years; range, 15 to 58 years) with newly diagnosed SLE were selected between July 2016 and July 2018 from our hospital. Disease activity was scored by the SLE Disease Activity Index. Nailfold capillaroscopy (NFC) was performed in all patients. Results Normal pattern, non-specific pattern, and scleroderma pattern were found in 13 (15.3%), 64 (75.3%), and eight (9.4%) patients, respectively. There was no significant difference between anti-double stranded deoxyribonucleic acid, anti-Smith antibodies, and low complements (all p>0.05), while significant differences of NFC pattern were found between low disease activity and high disease activity (p=0.002). RP was present in 31.7% of SLE patients, and the NFC findings in SLE patients with and without RP were significantly different in dilatation (81.5% vs. 14.0%). Conclusion The results of our study showed that capillary changes were very common in patients with SLE, which seem to associate with disease activity and RP condition.

原发性干燥综合征(pSS)是一种以淋巴细胞浸润外分泌腺为特征的系统性自身免疫性疾病,多起病隐匿,可累及肾脏导致肾小管性酸中毒、累及血液系统导致全血细胞减少、累及呼吸系统导致肺间质病变、累及神经系统导致周围神经病变和视神经脊髓炎等[1].pSS合并神经系统损害最早由Alexander等[2]于1982年报道,pSS合并脊髓炎既往报道较多,而合并缺血性脑卒中目前仅有个案报道.我们通过收集2007年1月1日～2017年12月31日于福建医科大学附属漳州市医院诊治的328例pSS患者,其中合并脑梗死24例,旨在探讨其临床特点以提高对其认识.

BACKGROUND:MicroRNA-34a (miR-34a), as a tumor-suppressive miRNA, has been found to induce cell apoptosis in acute myeloid leukemia (AML). However, the diagnostic and prognostic significance of miR-34a in AML remains largely unknown. OBJECTIVE:We aimed to explore its associations with clinical characteristics and prognosis of AML patients. METHODS:This study detected serum miR-34a level in 117 diagnosed AML patients and 60 control subjects by using qRT-PCR, and results were compared to clinical features and patient outcome. Since cytogenetically-normal AML (CN-AML) has a good uniformity of cytogenetics and provides a perfect platform for detection of AML biomarkers, we further analyzed miR-34a expression in 56 CN-AML subjects. RESULTS:We found that miR-34a was significantly downregulated in AML and CN-AML patients. MiR-34a underexpression was commonly observed in AML patients with intermediate/poor risk cytogenetic, and M5 subtype. ROC analysis demonstrated that serum miR-34a could well identify AML/CN-AML patients from healthy individuals. More importantly, miR-34a expression was found negatively correlated with aggressive clinical variable, and served as an independent prognostic indicator. In addition, AML/CN-AML patients with low miR-34a expression displayed shorter overall and recurrence free survival. CONCLUSIONS:Altogether, miR-34a might have an application as a diagnostic and prognostic indicator for AML patients.

目的:分析探讨系统性红斑狼疮(SLE)合并恶性淋巴瘤(ML)的临床特点.方法:选择2012年1月-2016年12月笔者所在医院诊断系统性红斑狼疮并先后合并淋巴瘤的8例病例进行临床资料分析,从临床表现、实验室检查、淋巴瘤病理分型、治疗及预后方面入手,探讨疾病相关性.结果:8例中,淋巴瘤病理类型均为非霍奇金淋巴瘤,并以B细胞淋巴瘤居多(5/8),淋巴结受累6例,结外受累2例.SLE合并ML患者多有发热、盗汗、消瘦等淋巴瘤B组症状(7/8),SLEDAI积分均为中度及以上(≥10分),实验室结果发现8例均有血浆β2-微球蛋白、乳酸脱氢酶升高、补体低下.6例化疗后获得完全缓解,淋巴瘤缓解同时SLE活动度下降.结论:系统性红斑狼疮合并淋巴瘤患病率较高,当SLE患者疾病控制不良(SLEDAI为中度及以上),伴有不明原因发热、淋巴结肿大、LDH及β2-MG升高时,应注意排除合并淋巴瘤可能.B细胞异常可为两者的共同发病基础,利妥昔单抗通过B细胞清除,在SLE合并ML患者中具有显著疗效.

Objective To explore the value of contrast-enhanced ultrasound in the diagnosis of gastric involvement in SLE patients.Methods 30 SLE patients with gastric involvement were examed by contrast-enhanced ultrasound and the relationships between the stomach wall thickness and the upper gastrointestinal symptoms,lupus activity were analysed.Results The manifestation of gastric involvement in SLE patients was the thickening of stomach wall and mainly involved the second or and fourth layer.Stomach wall thickness and SLE activity have significant cor relation (r =0.917,P＜0.01).The more thicker the stomach wall was,the more obvious upper gastrointestinal symptoms were (r=0.809,P＜0.01).And SLE activity was positively correlated with upper gastrointestinal symptoms (r=0.841,P＜0.01).Conclusions The contrast-enhanced ultrasound has high value in the diagnosis of gastric involvement in SLE patients.

Objective To investigate the correlation between the change of peripheral blood T‐lymphocyte subsets CD4/CD8 with the disease progress in the patients with rheumatoid arthritis (RA) .Methods The peripheral blood T‐lymphocytes subsets CD4/CD8 in 94 patients with RA and 22 healthy controls were examined by flow cy‐tometry .94 cases of RA were divided into low value ,median value and high value groups by RA disease activity index (DAS28) scores .Results Compared with the healthy controls ,the expression rate of peripheral blood CD3+CD4+ T cells in the RA group was increased significantly (P<0 .05) ,in which CD3+CD4+ T cells were (41 .03 ± 9 .53)% in DAS28 low value group ,(42 .16 ± 7 .08)% in DAS28 median value group and (43 .72 ± 9 .63)% in DAS28 high value group .The expression rate of CD3+CD8+ T was significantly decreased (P<0 .05) ,in which CD3+CD8+ T cells were (21 .33 ± 6 .67)% in DAS28 low value group ,(21 .39 ± 7 .36)% in DAS28 median value group and (21 .28 ± 6 .60)%in DAS28 high value group .Conclusion CD4+ /CD8+ ratio is associated with RA progression ,indicating that the CD4+ /CD8+ imbalances plays an important role in the pathogenesis of RA .

This study was aimed to establish the matching method of hemolytic test in vitro, and to guide the transfusion treatment for puerpera with acute hemolytic disease. The donor's erythrocytes were sensibilized by all the antibodies in plasma of patient in vitro and were added with complement, after incubation for 6.5 hours at 38 °C, the hemolysis or no hemolysis were observed. It is safe to transfuse if the hemolysis did not occur. The results showed that when the matching difficulty happened to puerpera with acute hemolytic disease, the compatible donor could be screened by hemolytic test in vitro. There were no untoward effects after transfusion of 6 U leukocyte-depleted erythrocyte suspension. The all hemoglobin, total bilirubins, indirect bilirubin, reticulocyte, D-dimex and so on were rapidly improved in patient after transfusion , showing obvious clinical efficacy of treatment. It is concluded that when the matching results can not judge accurately compatible or incompatible through the routine method of cross matching, the agglutinated and no-hemolytic erythrocytes can be screened by hemolytic test in vitro and can be transfused with good efficacy; the hemoglobin level can be promoted rapidly, and no untoward effects occur.

Objective To observe the diagnosis of connective tissue diseases with interstitial lung disease.Methods The clinical manifestations of respiratory,pulmonary function tests,lung imaging characteristics,the presence or absence of pulmonary hypertension,pulmonary function in 124 patients with interstitial lung disease associated with connective tissue disease were retrospective analyzed.Results Cough,expectoration,shortness of breath,chest stuffiness and choking were common respiratory symptoms.The fall of activity tolerance and dyspnea were serious respiratory symptoms.64 patients had pulmonary function test and all of them showed a decreasing diffusing capacity.Among them,26 only showed diffusing capacity reduction,32 restrictive ventilation defect with diffusing capacity reduction,4 mixed ventilation defect with diffusing capacity reduction and 2 obstructive ventilation defect with diffusing capacity reduction.22 patients had pulmonary artery high pressure.In image,the features of interstitial lung diseases displayed as follows:nodus,steak,patchy sign,grid,ground-glass opacities and bullae of lung.The features of interstitial lung diseases displayed as grid and fibrosis in 15 of 32 restrictive ventilation defect with diffusing capacity reduction.Conclusions The respiratory symptoms of c onnective tissue diseases with interstitial lung disease are various.Pulmonary function of connective tissue diseases with interstitial lung disease primarily displays a restrictive ventilation defect with diffusing capacity reduction.Connective tissue diseases complicated with interstitial lung disease and of pulmonary arterial hypertension easily occur in mixed connective tissue disease (MCTD),overlap connective tissue disease,systemic lupus erythematosus (SLE) and systemic sclerosis(SSc).In image,the features of interstitial lung diseases is various.Among them,grid and fibrosis are related to pulmonary function of restrictive ventilation defect with diffusing capacity reduction.

This study was aimed to investigate the effects of LY294002, a specific inhibitor of phosphatidylinositol 3-kinase, on growth and apoptosis of MCL Jeko-1 cell line and its mechanism. The proliferation inhibitory rate of Jeko-1 cells treated by different doses of LY294002 was assayed by MTT method; the level of apoptosis of Jeko-1 cells was detected by flow cytometry; the expression level of apoptosis-related protein Cyclin D1, Bcl-2, procaspase-3 and PI3K/Akt signaling pathway protein phosphorylated-Akt (p-Akt), phosphorylated-TOR (p-mTOR), phosphorylated-P70S6K (p-P70S6K) phosphorylated-Akt (p-Akt) in Jeko-1 cells were determined by Western blot. The results showed that the growth of Jeko-1 cell line was inhibited by LY294002. The apoptosis rates of Jeko-1 cells treated with 0, 5, 10 and 20 µmol/L of LY294002 for 24 hours were (3.25 ± 1.27)%, (11.34 ± 2.35)%, (22.81 ± 2.74)%, (43.61 ± 3.48)% respectively, the difference between them was statistically significant (P < 0.01). Phosphorylation levels of PI3K/Akt signaling pathway protein p-Akt, p-mTOR, p-P70S6K decreased, the expression of apoptosis-related protein cyclin D1, Bcl-2, procaspase-3 was down-regulated.It is concluded that the LY294002 can inhibit Jeko-1 cell proliferation, which may be realized through down-regulating the phosphorylation level of p-Akt, p-mTOR, p-P70S6K, inhibiting the P13k/Akt signaling pathway, and promoting the cell apoptosis.

目的 探讨抗环瓜氨酸多肽(CCP)抗体对类风湿性关节炎(RA)的诊断意义.方法 回顾性分析2000年5月至2008年5月150例风湿病患者完整的病历资料,其中RA患者110例,非RA患者40例.应用酶联免疫吸附试验检测抗CCP抗体,速率散射比浊法检测类风湿因子.计算抗CCP抗体的敏感度和特异度,并对2类患者检测结果进行对比分析.结果 RA患者和非RA患者抗CCP抗体表达阳性率分别为70.9%(78/110)和7.5%(3/40),差异具有统计学意义(x~2=33.41,P<0.01).类风湿因子对RA的敏感度为83.6%(92/110),特异度为65.0%(26/40).抗CCP抗体对RA的敏感度为70.9%(78/110),特异度为92.5%(37/40).抗CCP抗体与类风湿因子的敏感度差异无统计学意义(x~2=5.07,P>0.01),特异度差异有统计学意义(x~2=9.04 P<0.01).结论 抗CCP抗体对RA具有较好的敏感度和很高的特异度,对RA的诊断具有重要意义.

目的分析自身免疫性溶血(AIHA)患者合并恶性肿瘤的临床特点。方法对19例明确诊为AIHA合并恶性肿瘤患者的临床特征、发生肿瘤的时间、治疗情况以及预后进行回顾性分析。结果19例AIHA并发恶性肿瘤中,血液系统3例,淋巴系统8例,消化系统4例,肺癌2例,鼻咽癌1例,宫颈癌1例。4例AIHA发生于恶性肿瘤之前,2例同时发生,13例后续发生。结论AIHA大部分于肿瘤后续发生,及时有效治疗对AIHA疗效好。

系统性红斑狼疮(SLE)患者,特别是长期接受肾上腺皮质激素和/或免疫抑制剂治疗者,易患感染,感染部位以肺部、中枢神经系统、全身感染为主.中枢神经系统感染是SLE的严重并发症,易与狼疮性脑病相混淆,导致延误诊断和治疗.我院近年来诊治5例SLE并中枢神经系统感染,现报告如下.

限制毒物吸收,维持呼吸循环功能,应用阿托品及胆碱酯酶复能剂是有机磷中毒的常规治疗方法,其缺陷是无法清除已进入血液循环中的有机磷.我们应用血浆置换(PE)联合常规疗法抢救重度有机磷农药中毒,显著提高抢救成功率.现将结果报告如下.