Detection of Anticardiolipin Antibody in Systemic Lupus Erythematosus and Its Clinical Significance

Objective To determine the frequency and the clinical significance of anticardiolipin antibodies (ACA) in patients with systemic lupus erythematosus( SLE).Methods The serum ACA in 30 patients with SLE and 30 sera from healthy volunteers was detected by the enzyme linked immunosorbend assay (ELISA).Results In normal group the binding index(BI) oflgG, IgM and IgA type of ACA was 1.48 ?

A rationally designed CD19 monoclonal antibody-triptolide conjugate for the treatment of systemic lupus erythematosus

Tripterygium wilfordii Hook F(TWHF)is a traditional Chinese medicine widely used in the treatment of systemic lupus erythematosus(SLE),with triptolide(TP)as its main active ingredient.However,its side effects also induced by TP,especially hepatotoxicity and reproductive toxicity,largely limit its application in a subset of patients.Monoclonal antibodies(mAbs)developed for the treatment of SLE that deplete B cells by targeting B cell-expressing antigens,such as CD19,have failed in clinical trials,partly due to their poor efficacy in consuming B cells.Here,we report the development of a rationally designed antibody‒drug conjugate(ADC),CD19 mAb-TP conjugate,to alleviate the side effects of TWHF and simultaneously improve the therapeutic efficacy of CD19 mAb.The CD19 mAb-TP conjugate,which was named ADC-TP,selectively depleted B cell subsets both in vitro and in vivo and effectively alleviated disease symptoms in mouse lupus models with enhanced therapeutic efficacy than CD19 mAb and fewer side effects than TP.Our present study proposes a CD19 mAb‒TP conjugate strategy to mitigate the toxicity of TWHF while also enhancing the therapeutical efficacy of CD19 mAbs for the treatment of SLE,providing a feasible method for improving the current agents used for treating SLE.

Bilateral Choroidal Occlusion in Antiphospholipid Syndrome Associated with Systemic Lupus Erythematosus

This article reports a rare case of bilateral choroidal occlusion that occurred in a 24-year-old woman with antiphospholipid syndrome (APS) associated with systemic lupus erythematosus (SLE). This young lady concurred with aorta ventralis thrombosis and bilateral iliac artery occlusion when presented, and experienced a rapid deterioration of vision. She also has a history of recurrent miscarriage. Corticosteroid,immunosuppression and anticoagulation therapy were administered. Patients with APS associated with SLE are at risk for thrombotic phenomena, which may affect the ocular vessels of all sizes, including choroidal vessel.Our case alerts ophthalmologists and rheumatologists that bilateral choroidal occlusion may indeed be developed in patients with APS associated with SLE, and is a potential cause of visual morbidity.

Autoantibodies in Systemic Lupus Erythematosus, on Black African Subject, in Abidjan

Aim: To determine the clinical and immunological characteristics of patients with systemic erythematosus lupus in Abidjan. Patients and Method: We studied 117 patients’ files with systemic lupus erythematosus aged 12 to 73 years old, who fulfilled the American College of Rheumatology (ACR)’s criteria. Antinuclear autoantibodies (ANA) were searched by indirect immunofluorescence. Anti-DNA native autoantibodies, extractable nuclear anti-antigens autoantibodies (anti-Sm, anti-SSA, anti-SSB and anti-RNP) and anti-phospholipids autoantibodies have been searched by ELISA technic. Results: The most frequent clinical manifestations were: articular damages (86.32%), cutaneous and mucosal lesions (71.79%) and fever (76.67%). Kidney damages have been noticed in 40.17%. Neurologic manifestations have been observed in 36.75%. Pericarditis and pleurisies have been noticed in 22.22% and 11.97% of cases, and anaemia in 86.32% of cases. ANA have been detected in 94.12% of cases, anti-DNA native’s autoantibodies in 73.53% and anti-Sm autoantibodies in 75% of cases. Anti-SSA and anti-SSB autoantibodies were respectively in 75% and 56.25% of cases. Anti-RNP autoantibodies were in all the patients, and anti-phospholipids autoantibodies were in 37.50% of cases. Conclusion: Systemic lupus erythematosus of Ivorian black subject is characterised by high prevalence of autoantibodies, mostly Anti-RNP.

Prevalence of Anti-Cardiolipin and Anti-β2 Glycoprotein Antibodies in Indian Systemic Lupus Erythematosus Patients

Anti-phospholipid antibodies (APA) like anti-cardiolipin antibodies (ACA) and anti-β2glycoprotien (anti-β2GP) are important cause of venous and arterial thrombosis and other occlusive vascular diseases. The prevalence of these antibodies in SLE patients at the time of diagnosis is not known in Indian SLE patients. This study was conducted to evaluate the prevalence of ACA and anti-β2GP autoantibodies in SLE patients and to correlate them with disease activity and immune parameters such as C3, C4 and CRP levels. where 85 SLE patients referred from Rheumatology Department, KEM hospital, Mumbai were studied. SLE disease activity was evaluated by SLE Disease Activity Index (SLEDAI) score at the time of evaluation. All patients studied were in an active stage of disease of which 37.6% patients had renal disorders, which were categorized as Lupus Nephritis (LN) and 62.3% patients did not show any renal manifestations (non-LN). ACA and anti-β2GP autoantibodies, to IgG and IgM subclasses were tested by ELISA. C3, C4 and CRP levels were detected by nephelometer. It was observed that 12.9% patients were IgG-ACA and IgM-ACA positive and ACA positivity was noted more among LN group Anti-β2GP autoantibody positivity was 27.1% for IgG and 31.8% for IgM., IgG-anti-β2GP antibodies were slightly higher in non-LN patients, whereas a higher incidence of IgM-anti-β2GP antibodies were detected in LN patients. Hence detection both ACA and anti-β2GP antibodies along with associated immune parameters were helpful to evaluate their possible association with disease severity in SLE patients. A long term follow up of patients having ACA and anti-β2GP antibodies without thrombotic event is also needed to detect their possible thrombotic event in future along with their clinical presentation.

Anti-M₃Muscarinic Acetylcholine Receptor Antibodies in Systemic Lupus Erythematosus

Background: Evidences have shown that anti-M3 muscarinic acetylcholine receptor IgG (anti-M3 mAChR IgG) are clinically useful autoantibody that exert a cholinergic pharmacologic effect binding and interacting with M3 mAChR at the level of exocrine gland (salivary and ocular). Aims: The aim of this study was to determine the associations between serum level of anti-M3 mAChR IgG in patients with systemic lupus erythematosus (SLE) and other autoantibodies, serum prostaglandin E2 (PGE2), and clinical manifestations. Methods: Serum autoantibodies against M3 mAChR synthetic peptide were measured by enzyme-linked immuno absorbent assay (ELISA) using, as an antigen, a 25-mer peptide K-R-T-V-P-D-N-Q-C-F-I-Q-F-L-S-N-P-A-V-T-F-G-T-A-I corresponding to the amino acid sequence of the second extracellular loop of the human M3 mAChR. Serum levels of antinuclear antibodies (ANA), anti-Smith (Sm) antibodies, anti-phospholipid (APL) antibodies, and PGE2 were determined by ELISA in patients with SLE. Results: We found significantly enhanced titers of anti-M3 mAChR IgG in sera from SLE patients compared with healthy individuals (control). In addition, serum levels of PGE2 were significantly higher in SLE patients than in control patients and were significantly higher in active than in non-active SLE. No correlation was found with other autoantibodies present in SLE. By contrast, a positive correlation was found between anti-M3 mAChR IgG and PGE2 serum levels in SLE. Conclusions: As anti-M3 mAChR antibodies present in the sera of SLE patients may be another factor in the pathogenesis of this disease, and the increment of PGE2 in the sera of SLE has a modulatory action on the inflammatory process, suggesting that the presence of these autoantibodies against M3 mAChR may contribute to sustained immune deregulation and the strong inflammatory component observed in SLE.

Systemic lupus erythematosus combined with primary hyperfibrinolysis and protein C and protein S deficiency:A case report

BACKGROUND Systemic lupus erythematosus(SLE)is an autoimmune disease characterized by systemic involvement and multiple autoantibodies in the serum.Patients with protein C(PC)and protein S(PS)deficiency are prone to thrombosis.In contrast,patients with primary hyperfibrino-lysis tend to bleed.CASE SUMMARY A 52-year-old female patient with bilateral pleural effusion was diagnosed with"tuberculous pleurisy"and treated with anti-tuberculosis drugs and prednisone.The coagulation-related laboratory results showed decreased fibrinogen,PC activity,PS activity,and antithrombinШactivity.The immune-related laboratory results showed positive antinuclear antibody,anti-Smith antibody,anticardiolipin antibody(ACL),anti-β2-glycoprotein I antibody(aβ2GPI)and direct Coomb’s test and decreased complement 3 and complement 4.Thoracoscopy was performed and bloody pleural fluid was drained.Pathology of the pleural biopsy showed lymphocytes,plasma cells,and a few eosinophils in adipose and fibrous connective tissue.Results of whole exome sequencing of blood showed no genetic mutations suggesting the presence of hereditary hematological diseases.The patient was finally diagnosed with SLE and primary hyperfibrinolysis,and was treated with prednisolone,hydroxychloroquine,and compound cyclophosphamide.CONCLUSION PC and PS deficiency in SLE might be related to ACL and aβ2GPI.SLE and primary hyperfibrinolysis can coexist in one patient,with both a risk of thrombosis and a risk of bleeding.

Histone H1/MBP hydrolysing antibodies - novel potential marker in diagnosis of disease severity in systematic lupus erythematosus patients

Recently we have shown the presence of catalytically active IgGs, capable to cleave histone H1 and bovine myelin basic protein (MBP), in blood serum of SLE patients. Here we present data that demonstrate the correlation between a) proteolytic activity towards histone H1 and MBP of IgG-antibodies from blood serum of SLE patients and b) disease severity level in these patients. IgGs were isolated from blood serum by chromatography on protein G-sepharose. Commercial preparations of bovine myelin basic proteins (MBP) and calf thymus histone H1 were used as substrates. Analysis of the proteolytic activity showed that 16 of 38 lgG-preparations (42,1%) obtained from blood serum of SLE patients were capable of cleaving both histone H1 and MBP with different efficiency. It was revealed that the presence in blood serum of lgGs possessing proteolytic activity towards both histone H1 and bMBP closely correlates with manifestation of the disease severity in SLE patients.

Pathogenesis of Neuropsychiatric Syndromes of Systemic Lupus Erythematosus

The pathogenesis of neuropsychiatric syndromes of systemic lupus erythematosus (NPSLE) is multifactorial and can involve various inflammatory cytokines, autoantibodies such as anti-neuronal antibodies, anti-ribosomal P antibodies, anti-NR2 glutamate receptor binding antibodies, anti-Sm antibodies, anti-U1-RNP antibodies and anti-phospholipid antibodies, and immune complexes (IC). Disruption of the blood-brain barrier (BBB) is integral to the neuropathology of SLE. Recently the possibility has been reported that aforementioned autoantibodies in the circulation may be strongly associated with disruption of the BBB. Each of these mechanisms might contribute to the pathogenesis of focal NPSLE (for example, cerebrovascular disease, movement disorders, myelopathy, seizures and cranial neuropathy) or diffuse NPSLE (for example, acute confusional state, psychosis and cognitive dysfunction) to varying degrees. In this review we focus on how the aforementioned autoantibodies, the BBB, IC and cytokines as well as chemokines are associated with the appearance of NPSLE.

An atypical presentation of Kikuchi-Fujimoto disease mimicking systemic lupus erythematosus: case report and literature review

Purpose: To report a case of atypical Kikuchi-Fujimoto disease (KFD) that illustrates several overlapping features with systemic lupus erythematosus (SLE). Methods: A case is reported followed by a review of the current literature. Case report: A 16-year-old boy with an unusual manifestation of Kikuchi-Fujimoto disease (KFD) is described. The patient presented with fever, weight loss and severe abdominal pain, due to extensive necrotizing retroperitoneal and mesenteric lymphadenopathy. During the course of his illness, he developed several symptoms suggestive of systemic lupus erythematosus (SLE): a pericardial effusion, cotton wool spots on the retina and antibodies against nuclear antigens (ANA), Smith (Sm) and ribonucleoprotein (RNP) antigens. However, no additional features of SLE were found. The patient subsequently fully recovered within two months, without initiation of immunosuppressive therapy. His autoantibodies became negative five months after initial presentation and he remains well at his 23 month follow up visit. Discussion: We hypothesize that the autoantibodies developed by our patient were secondary to self-antigen induced autoimmunity related to his extensive tissue necrosis. Despite initially having clinical features suggestive of SLE, our patient’s full and spontaneous recovery strongly supports the diagnosis of KFD. This illustrates the need for careful diagnosis, in order to avoid unnecessary and potentially toxic treatment with immunosuppressive agents.

Systemic lupus erythematosus therapeutic strategy: From immunotherapy to gut microbiota modulation

Systemic lupus erythematosus(SLE)is characterized by a systemic dysfunction of both the innate and adaptive immune systems,leading to an attack on healthy tissues of the body.During the development of SLE,pathogenic features,such as the formation of autoantibodies against self-nuclear antigens,cause tissue damage including necrosis and fibrosis,with increased expression levels of the typeⅠinterferon-regulated genes.Standard treatments for lupus with immunosuppressants and glucocorticoids are not effective enough but cause side effects.As an alternative,more effective immunotherapies have been developed,including monoclonal and bispecific antibodies that target B cells,T cells,co-stimulatory molecules,cytokines or their receptors,and signaling molecules.Encouraging results have been observed in clinical trials with some of these therapies.Furthermore,a chimeric antigen receptor T cell therapy has emerged as the most effective,safe,and promising treatment option for SLE,as demonstrated by successful pilot studies.Additionally,some emerging evidence suggests that gut microbiota dysbiosis may significantly contribute to the severity of SLE,and the normalization of the gut microbiota through methods such as fecal microbiota transplantation presents new opportunities for effective treatment of SLE.

PRESENCE OF ANTILAMIN ANTIBODIES IN SERA OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

In this study, we characterized specifically-stained sera from patients with systemic lupus erythematosus (SLE) which had been shown to display the homogeneous or peripheral region of nuclei by indirect immunofluorescence (IIF). By western blotting, we demonstrated that in some cases there was a correlation between the peripheral or homogenous. IIF staining of nuclei by sera from patients with SLE and the presence of autoantibodies to lamins. Here we first report the presence of 2. 2% anti-lamin autoantibodies in the sera among the 174 patients with SLE in China.

Clinical value of chemiluminescence method for detection of antinuclear antibody profiles

BACKGROUND Antinuclear antibodies(ANAs)are crucial in diagnosing autoimmune diseases,mainly systemic lupus erythematosus(SLE).This study aimed to compare the performance of chemiluminescence assay(CLIA)and line immunoassay(LIA)in detecting ANAs in patients with autoimmune diseases,evaluate their diagnostic accuracy for SLE,and develop a novel diagnostic model using CLIA-detected antibodies for SLE.Specimens from patients with autoimmune diseases and physical examination specimens were collected to parallel detect specific antibodies.Individual antibodies'diagnostic performance and a model combining multiple antibodies were assessed.The findings provide valuable insights into improving the diagnosis of SLE through innovative approaches.AIM To compare the performance of CLIA and LIA in detecting ANAs in patients with autoimmune diseases,assess their accuracy for SLE,and develop a novel diagnostic model using CLIA-detected antibodies for SLE.METHODS Specimens have been obtained from 270 patients with clinically diagnosed autoimmune disorders,as well as 130 physical examination specimens.After that,parallel detection of anti-double-stranded DNA(dsDNA)antibody,anti-histone(Histone)antibody,anti-nucleosome(Nuc)antibody,anti-Smith(Sm)antibody,anti-ribosomal P protein(Rib-P)antibody,anti-sicca syndrome A(Ro60)antibody,anti-sicca syndrome A(Ro52)antibody,anti-sicca syndrome(SSB)antibody,anticentromere protein B(Cenp-B)antibody,anti-DNA topoisomerase 1(Scl-70)antibody,anti-histidyl tRNA synthetase(Jo-1)antibody,and anti-mitochondrial M2(AMA-M2)antibody was performed using CLIA and LIA.The detection rates,compliance rates,and diagnostic performance for SLE were compared between the two methodologies,followed by developing a novel diagnostic model for SLE.RESULTS CLIA and LIA exhibited essentially comparable detection rates for anti-dsDNA antibody,anti-Histone antibody,anti-Nuc antibody,anti-Sm antibody,anti-Rib-P antibody,anti-Ro60 antibody,anti-Ro52 antibody,anti-SSB antibody,anti-Cenp-B antibody,anti-DNAScl-70 antibody,anti-Jo-1 antibody and anti-AMA-M2 antibody(P>0.05).The two methods displayed identical results for the detection of anti-dsDNA antibody,anti-Histone antibody,anti-Nuc antibody,anti-Sm antibody,anti-Ro60 antibody,anti-Ro52 antibody,anti-SSB antibody,anti-Cenp-B antibody,anti-Scl-70 antibody,and anti-AMA-M2 antibody(Kappa>0.7,P<0.05),but showed a moderate agreement for the detection of anti-Rib-P antibody and anti-Jo-1 antibody(Kappa=0.671 and 0.665;P<0.05).In addition,the diagnostic performance of these antibodies detected by both methods was similar for SLE.The diagnostic model's area under the curve values,sensitivity,and specificity,including an anti-dsDNA antibody and an anti-Ro60 antibody detected by CLIA,were 0.997,0.962,and 0.978,respectively.These values were higher than the diagnostic performance of individual antibodies.CONCLUSION CLIA and LIA demonstrated excellent overall consistency in detecting ANA profiles.A diagnostic model based on CLIA-detected antibodies can successfully contribute to developing a novel technique for detecting SLE.

血清anti-β2GPI、FSTL1、PD-1对系统性红斑狼疮免疫功能、疾病活动度的影响

目的探究血清抗β2糖蛋白I抗体(anti-β2GPI)、卵泡抑素样蛋白(FSTL1)、程序性死亡受体1(PD-1)对系统性红斑狼疮(SLE)患者免疫功能、疾病活动度的影响。方法选取我院2019年1月~2022年6月SLE患者113例作为观察组,另选取同期健康体检者105例作为对照组。比较两组、不同疾病活动度患者血清anti-β2GPI、FSTL1、PD-1水平,评价各血清指标与疾病活动度的关系,并根据观察组血清表达水平分为高表达者、低表达者,对比两者免疫功能(CD4+、CD8+、CD4+/CD8+),分析各血清指标与免疫功能相关性。结果观察组血清anti-β2GPI、FSTL1、PD-1高于对照组(P<0.05);血清anti-β2GPI、FSTL1、PD-1高表达患者CD4+、CD4+/CD8+低于低表达患者,CD8+高于低表达患者(P<0.05);血清anti-β2GPI、FSTL1、PD-1与CD4+、CD4+/CD8+呈负相关,与CD8+呈正相关(P<0.05);血清anti-β2GPI、FSTL1、PD-1水平随疾病活动度增加呈升高趋势,且重度活动患者>中度活动患者>轻度活动患者>病情稳定患者(P<0.05);血清anti-β2GPI、FSTL1、PD-1与疾病活动度显著相关(P<0.05)。结论血清anti-β2GPI、FSTL1、PD-1高表达可能参与SLE患者细胞免疫功能紊乱、疾病活动度加重的发生过程。

联合检测ANuA、Anti-ds-DNA、anti-P和Anti-sm在SLE伴肾损害患者中的诊断价值

目的 探究抗核小体(ANuA)、抗双链DNA(Anti-ds-DNA)、抗核糖体P蛋白(anti-P)和抗Sm抗体(Anti-sm)联合检测在系统性红斑狼疮(SLE)伴肾损害患者中的诊断价值。方法 选取2019年1月至2022年4月黄山市人民医院收治的SLE患者163例为研究对象,根据患者是否合并肾损害分为SLE组(n=55)与SLE伴肾损害组(n=108)。收集两组患者血清进行ANuA、Anti-ds-DNA、anti-P和Anti-sm检测,比较两组上述抗体单一及联合检测的阳性率,并绘制ROC曲线分析上述抗体指标对SLE伴肾损害的诊断价值。结果 SLE组Anti-ds-DNA、Anti-sm抗体单一及联合检测阳性率均高于SLE伴肾损害组,差异均具有统计学意义(χ^(2)=18.360、10.513、8.010,P<0.05);SLE组ANuA、anti-P检测阳性率均低于SLE伴肾损害组,差异均具有统计学意义(χ^(2)=7.094、4.281,P<0.05)。多因素Logistic回归分析显示,ANuA(β=2.284,OR=9.816)、Anti-ds-DNA(β=0.749,OR=2.115)、anti-P(β=1.386,OR=3.999)和Anti-sm(β=0.475,OR=1.608)是SLE伴肾损害的独立影响因素(P<0.05)。ROC曲线显示,ANuA、Anti-ds-DNA、anti-P和Anti-sm四者联合检测时,预测SLE伴肾损害的AUC为0.911,敏感性、特异性分别为89.0%、92.6%,优于单一检测(P<0.05)。结论 ANuA、Anti-ds-DNA、anti-P和Anti-sm都与SLE伴肾损害有关,联合检测ANuA、Anti-ds-DNA、anti-P和Anti-sm对于提高SLE伴肾损害的诊断准确性具有重要价值。

Meta-analysis of anti-ribosomal P antibodies in lupus psychosis

AIM： To perform a meta-analysis of the prevalence of anti-ribosomal P （aRP） antibodies in lupus psychosis, and the odds of psychosis in aRP-positive subjects.METHODS： We identifed articles by searching PubMed, PsychInfo, and ISI, and the reference lists of identifed studies.RESULTS： Twenty-four studies met the inclusion criteria. Positive aRP antibodies were found in 51% （91 of 179 total cases） of cases of lupus psychosis. There was an almost 3.5-fold increased odds of psychosis in aRP-positive patients （OR = 3.46, 95%CI： 1.97-6.09, P 〈 0.001）. The population attributable risk percentage was 36% for aRP antibodies.CONCLUSION： aRP antibodies are common in lupus psychosis, although the potential mechanism（s） underlying this association remain unclear. Given the overlap between the clinical presentation and risk factors for lupus psychosis and schizophrenia, further investigation of aRP antibodies in schizophrenia is warranted.

抗dsDNA抗体阴性的系统性红斑狼疮患者抗Sm抗体、抗Rib⁃P抗体水平及临床意义

目的探讨抗Sm抗体、抗Rib-P抗体对抗双链DNA(dsDNA)抗体阴性的系统性红斑狼疮的诊断价值。方法选择2020年8月—2021年8月收治的抗dsDNA抗体阴性的系统性红斑狼疮68例作为研究组,同期72例非系统性红斑狼疮的自身免疫性疾病患者作为对照组,同期体检健康者78例作为健康组。采用化学发光法检测3组抗Sm抗体、抗Rib-P抗体,随后采用受试者工作特征(ROC)曲线分析抗Sm抗体、抗Rib-P抗体对抗dsDNA抗体阴性的系统性红斑狼疮的诊断价值,以及研究组抗Sm抗体、抗Rib-P抗体与临床表现、实验室指标的关系。结果研究组抗Sm抗体、抗Rib-P抗体阳性率均高于对照组、健康组(P<0.05)。ROC曲线分析结果显示,抗Sm抗体联合抗Rib-P抗体诊断抗dsDNA抗体阴性的系统性红斑狼疮的曲线下面积及敏感度均高于单一指标诊断。研究组抗Sm抗体、抗Rib-P抗体阳性者蛋白尿发生率及C3阳性率明显高于抗Sm抗体、抗Rib-P抗体阴性者(P<0.05)。结论抗Sm抗体、抗Rib-P抗体对抗dsDNA抗体阴性的系统性红斑狼疮具有一定的诊断价值,且二者联合诊断价值更佳,有望作为诊断抗dsDNA抗体阴性的系统性红斑狼疮的有效指标。

A successful birth of severe secondary recurrent miscarriage case after a decline of phosphatidylserine-dependent anti-prothrombin antibody by intravenous immunoglobulin administration

A 33 years old woman was referred to our hospital since her sixth pregnancy had been revealed. In fact, at 19 years of age she had diagnosed as having systemic lupus erythematosus without organ failure. In addition, she had a past history of uncontrollable severe pregnancy-induced hypertension occurred during the second pregnancy, resulting in extremely premature delivery and following postpartum HELLP syndrome. It was so severe that we employed administration of dexamethasone and plasma exchange to ameliorate a life-threatening situation. In the course of her recovery it was revealed that she had been complicated with antiphospholipid antibodies, and at the same time we observed that phosphatidylserine-dependent anti-prothrombin antibody IgG levels were declining as her condition was getting better. There-after, she became pregnant three times, but all pregnancies ended in miscarriage despite administration of prednisolone and anticoagulant therapy. Therefore, we realized that her recurrent miscarriages could not be prevented with generally acceptable therapies, so we tried intravenous immunoglobulin shortly after fetal heart beats were detected. In fact, her sixth pregnancy was going well, but we had to terminate it at the 35th week of gestation due to the onset of HELLP syndrome-like condition. However, she could achieve an almost intact pregnancy outcome without neonatal complications or persistently worsening postpartum HELLP syndrome-like condition. Considering the etiologic relation overlapping between systemic lupus erythematosus, antiphospholipid syndrome and recurrent miscarriage, intravenous immunoglobulin can be one of the treatment options for severe secondary recurrent miscarriage, although the evidence of the treatment is always certain. In addition, a decline of phosphatidylserine-dependent anti-prothrombin antibody IgG levels we observed in this case may represent its therapeutic immunomodulatory effects.

抗C1q抗体与儿童活动性系统性红斑狼疮和活动性狼疮性肾炎的相关性分析

目的研究抗C1q抗体与儿童活动性系统性红斑狼疮(systemic lupus erythematosus,SLE)和狼疮性肾炎(lupus nephritis,LN)的相关性,以及对活动性SLE和活动性LN的诊断价值。方法回顾性选择2016年1月-2019年3月中南大学湘雅二医院儿童医学中心住院的SLE患儿90例为SLE组,所有患儿均检测抗C1q抗体。收集同期住院的70例其他自身免疫性疾病(other autoimmune diseases,OAD)患儿为OAD组,比较两组抗C1q抗体水平差异,分析抗C1q抗体与SLE和LN各指标的相关性,评价抗C1q在SLE和LN中的诊断价值。结果SLE组患儿血清抗C1q抗体水平高于OAD组(P<0.05)。SLE疾病活动性指数与抗C1q抗体呈正相关(rs=0.371,P<0.001),与抗双链DNA抗体呈正相关(rs=0.370,P<0.001)。抗C1q抗体诊断活动性SLE的灵敏度和特异度分别为89.90%和53.90%,曲线下面积为0.720(P<0.05),临界值为5.45 U/mL。抗C1q抗体水平对诊断活动性LN的灵敏度和特异度分别为58.50%和85.00%,曲线下面积为0.675(P<0.05),临界值为22.05 U/mL。结论抗C1q抗体可作为评价儿童SLE疾病活动性或预测LN活动性的无创生物学指标之一。

老年系统性红斑狼疮患者抗核抗体谱检测阳性率观察

目的探讨ANAs检测在老年SLE患者中的阳性率及不同年龄段抗体分布特点与临床应用。方法用IFA检测217例老年SLE患者和211例非老年SLE患者ANA和抗ds-DNA抗体,免疫印迹法检测ANAs。对SLE患者不同年龄段ANAs阳性率进行统计分析,比较阳性率特点。结果ANA在老年组、非老年组SLE患者中阳性率分别为98.58%、99.54%;ANAs在老年组、非老年组SLE患者中阳性率分别为98.58%、92.17%,其中抗ds-DNA抗体、nRNP、抗Sm抗体、ANuA、r-RNP和PCNA的阳性率,老年组低于非老年组,差异有统计学意义(P<0.05);nRNP、AMA M2的阳性率,在老年组SLE患者不同年龄段间差异有统计学意义(P<0.05)。结论ANA检测在老年组、非老年组SLE患者中均有较高的阳性率,ANAs老年组阳性率低于非老年组;抗nRNP抗体和抗AMA M2抗体随年龄发生不同的改变可能是ANAs检测SLE老年组有别于非老年组的特点,总之ANAs检测对老年SLE诊断具有重要意义。