Аннотация Представлен случай редкого сочетания первичного синдрома Шегрена (ПСШ) и саркоидоза у пациентки 41 года с поражением легких, опорно-двигательной системы и «сухим» кератоконъюнктивитом, подтвержденных гистологически. Диагноз ПСШ поставлен на основании классификационных критериев ACR (2012), в рамках которых проведены серологические, гистологические исследования, тесты, оценивающие функции желез, а также инструментальные методы диагностики. Диагноз саркоидоза основывался на клинических, рентгенологических, гистологических данных.

In this article we evaluated the relationship of specific capillaroscopic changes with clinical and immunological subtypes and endothelial function in patients with systemic sclerosis. Characteristic changes in the capillaries were found in 98 % of subjects with systemic sclerosis. The association capillaroscopic patterns with the presence of pulmonary hypertension, lung damage and the level of N-terminal peptide natriuretic peptide in the blood was found.

Objective: to study some vascular wall stiffness parameters in patients with ankylosing spondylitis (AS) without clinically manifest cardio­ vascular diseases. Subjects and methods. One hundred and six patients with AS and 21 healthy volunteers without cardiovascular diseases who were matched for age, gender, and cardiovascular risk were examined at two centers. Cardiovascular risk and vascular wall stiffness (augmentation index and pulse wave propagation velocity (PWPV)) were assessed by oscillography.  Results. Vascular wall stiffness was comparable in the patients with AS (at both centers) and in the healthy individuals. PWPV was 7.45 (5.4–8.71) m/sec in the AS patients (n = 106) and 8.53 (6.28–9.5) m/sec in the healthy individuals (n = 21); the aortic augmentation in­ dex was 15.6 (7.9–31.1) and 21.1 (10.2–24) %, respectively; p > 0.05 for all. Correlation analysis revealed associations between aug­ mentation index, age, blood pressure, disease activity (BASDAI) and spine mobility (BASMI) scores.  Conclusion. The vascular wall stiffness did not differ between AS patients without cardiovascular diseases and cardiovascular risk­matched healthy individuals. Its parameters were related to age, blood pressure, and disease activity (BASDAI) and axial skeleton immobility (BASMI) indices.

The infections very often complicate the course of autoimmune rheumatic diseases. In diagnostic of septic complications in rheumatic patients the new biomarkers of infections can have a decisive importance. The procalciotonine test is one of them. The issue was to evaluate the diagnostic informativity of this test. The sample included 93 patients. The examination was applied to 65 patients with rheumatic diseases. Among them, 13 patients had bacterial infections. The group consisted of 33 patients with rheumatoid arthritis, 11 patients with systemic lupus erythematous, 6 patients with systemic angiitis, and 15 patients with other rheumatic diseases. The comparative group included 27 patients of cardio-therapeutic profile and 8 of these patients had bacterial infections. The procalcitonine test was applied with quantitative electrochemiluminescent technique. In patients with rheumatoid arthritis the mean levels of procalciotonine test consisted 0.10 +/- 0.13 ng/ml; with systemic lupus erythematous--0.08 +/- 0.06 ng/ml; with systemic angiitis--0.22 +/- 0.2 ng/ml; with other rheumatic diseases--0.12 +/- 0.15 ng/ml; of cardio-therapeutic profile without infections--0.08 +/- 0.06 ng/vl/ With threshold of procalcitonine test higher than 0.5/ml the sensitivity to diagnostic of infections consisted of 58%, specificity--94% in the group with rheumatic diseases. The procalciotonine test in case of no infection process with values higher than 0.5 ng/ml was detected in three patients. The evaluation of dependence of sensitivity and specificity for procalciotonine test and C-reactive protein the area under curve of procalcitonine test was larger in patients with rheumatic diseases (0.85 against 0.79) and in patients of cardio-therapeutic profile (0.92 against 0.90). The quantitative procalcitonine test is the best technique to detect septic complications in rheumatic patients.

Инфекции часто осложняют течение аутоиммунных ревматических заболеваний. В диагностике септических осложнений у ревматологических пациентов решающее значение могут иметь новые биомакеры инфекций, одним из которых является прокальцитониновый (ПКТ) тест. Для уточнения диагностической информативности ПКТ при ревматических заболеваниях (РЗ) нами были исследовано 93 пациента. Было обследовано 65 пациентов с РЗ, у 13 из которых были обнаружены бактериальные инфекции. В группу вошли 33 больных ревматоидным артритом (РА), 11 больных системной красной волчанкой (СКВ), 6 больных системными васкулитами (СВ), а также 15 больных с другими ревматическими заболеваниями (ДРЗ). Группу сравнения составили 27 больных кардиотерапевтического (КТ) профиля, у 8 из которых были диагностированы бактериальные инфекции. Для измерения ПКТ использовался количественный электрохемилюминесцентный метод. Средние уровни ПКТ у больных РА составили 0,10 ± 0,13 нг/мл, СКВ – 0,08 ± 0,06 нг/мл, СВ – 0,22 ± 0,2 иг/мл, ДРЗ – 0,12 ± 0,15 нг/мл, КТ без инфекций 0,08 ± 0,06 нг/мл. При пороговом значении ПКТ более 0,5 нг/мл в группе с РЗ чувствительность в диагностике инфекций составила 58%, специфичность – 94%. Вне инфекционного процесса ПКТ более 0,5 нг/мл был обнаружен у 3 пациентов: больного РА, больного СВ и больного болезнью Стилла. При оценке зависимости чувствительности и специфичности для ПКТ и С-реактивного белка площадь под кривой ПКТ была больше как у больных с РЗ (0,85 против 0,79), так и у больных с КР-заболеваниями (0,92 против 0,90). При этом СОЭ характеризовалась наименьшей площадью под кривой в прогнозировании септических состояний у пациентов с РЗ и КР-заболеваниями (0,71 и 0,71 соответственно). Таким образом, количественный ПКТ представляет собой наилучший метод для выявления септических осложнений у ревматологических пациентов.

The clinical signifcance of serodiagnostic assay of rheumatoid arthritis increased nowadays. This is a reason to include the citrullinated antigens' antibodies into the new criteria of diagnostics ACR/EULAR 2010. The approbation of national test system detecting the cyclic citrullinated peptide antibodies was implemented. The analysis was applied to 211 blood serum samples taken of 50 blood donors, 60 patients with rheumatoid arthritis, 66 patients with other rheumatoid diseases. In addition, 35 samples were concurrently analyzed with the comparative test system (CCP2 Euroimmun, Germany). The referential meanings of standard limits were established on the basis of results of study of samples taken from healthy blood donors. When the standard limit was less than 10 arbitrary units the sensitivity made up 75% and the specificity--87.9%. In the case of higher values of citrullinated antigens' antibodies which are more than 15 arbitrary units, the sensitivity made up 68% and the specificity--93.1%. The results of comparing with the comparative test system characterized by high convergence made up 94% (33 out of 35), but the comparative test system detected citrullinated antigens' antibodies in 2 samples. The positive qualitative results of both methods analysis of autoantibodies weakly correlated with one another (r = 0.14). The results testify that the parameters of national test system correspond to the publication data concerning the second generation methods of cyclic citrullinated peptide antibodies detection though yield to the best foreign analogues.

The connective tissue systemic diseases originate from pathologic process following with antinuclear antibodies emergence. To detect these antibodies a significant number of diagnostic tests and techniques has been applied. Besides that, there is no conventional algorithm of antinuclear antibodies diagnostic. To detect antinuclear antibodies a two-fold diagnostic algorithm was applied In the capacity of screening techniques the indirect immunofluorescence technique was applied to the cells of line Hep-2 (antinuclear factor) and detection of antibodies to extractable nuclear antigen. The second stage of diagnostic included the detection of content of more specific antinuclear antibodies using the Lineblott method and the double-helical DNA antibodies. The blood serum from 981 patients with suspected connective tissue systemic diseases, 115 patients with systemic lupus erythematous and 57 healthy individuals was analyzed. The levels of antinuclear factor, nuclear antigen antibodies and double-helical DNA antibodies were detected. The antinuclear factor was detected in 84% and 86% of cases, double-helical DNA antibodies in 55% and 39% of cases depending of reagents using in detecting these characteristics. Among healthy individuals, antinuclear factor was detected in 5% (1/20) of blood serum samples in titers less than 1:160. In the group of patients with suspected connective tissue systemic diseases, antinuclear factor was detected in 48% (474/981) of cases and extractable nuclear antigen in 20% (326/981) of cases. The Lineblott test was positive in 33% (326/981) of patients with suspected connective tissue systemic diseases. Among antinuclear factor positive patients nuclear antigen antibodies were detected in 36% (171/474) and the Lineblott test was positive in 63% (298/474) of cases. Among antinuclear factor negative patients but positive under anti-nuclear antigen identification, the Lineblott test was positive in 6% (28/507) of cases. The two-fold algorithm of nuclear antigen testing is an effective technique to be applied in the clinical diagnostic laboratory. The results of effectiveness of this algorithm demonstrated that this method can ensure 33% of cost savings of testing individuals with higher incidence of diseases.

We studied the possibility of IL-2 application in the complex treatment of the asthmatic patients. 18 patients, who received the Roncoleukin therapy («Biotech», St. Petersburg, Russia), and 16 patients of the control group with traditional anti-inflammatory and bronchodilative therapy were examined. The mild or moderate form of primary allergic bronchial asthma in the abating exacerbation or remission phase was diagnosed in all the cases. We fulfilled the bronchoscopy, immunoglobulin profile monitoring with calculation of permeability coefficients blood/lavage and relative coefficients of the secretion for immunoglobulins. We also evaluated spontaneous and induced by lypopolysaccharides TNF-α production by blood mononuclears. Our results showed good clinical acceptability of Roncoleukin in all examined patients, lack of allergic responses to the Roncoleukin administration, and considerable effectiveness of its application. We observed both clinical and lung function indexes (OFV1) improvement after Roncoleukin treatment in patients with bronchial asthma. Thus, we showed the possibility and advisability of the Roncoleukin insert in complex therapy of the asthmatic patients. (Med. Immunol., 2000. Vol. 2, N 3, pp 311-320)