A case of a patient positive for anti-cardiolipin antibodies with recurrent fetal wastage and cerebral infarction who was successfully treated with Sairei-to, low dose aspirin, and heparin

We report a successful case of a pregnant female positive for anti-cardiolipin antibodies who experienced two abnormal pregnancies with postpartum cerebral hemispheric infarctions. A 38-year-old female diagnosed as being positive for anti-cardiolipin antibodies was referred to our hospital due to her strong desire to have a baby. The administration of Japanese herbal medicine, Sairei-to, as immunosuppressive therapy, and low dose aspirin, as anti-coagulation therapy, were initiated prior to the patient’s pregnancy. Five months after beginning the treatment, the patient conceived spontaneously. At 34 weeks of gestation, emergency cesarean section was performed due to increasing genital bleeding resulting from coincidental placenta previa and the patient delivered an appropriate-for-date female infant (1970 g). Treatment with Japanese herbal medicine (Sairei-to) and low-dose aspirin is considered to be an effective treatment option for patients positive for anti-phospholipid antibodies with past histories of abnormal pregnancies.

Clinical Observation on Effect of Combination of Zhuanyindan (转阴丹) and Hormone in Treating MaleInfertility with Positive Antisperm Antibody

Objective:To explore the therapeutic effect of combination of Zhuanyindan (ZYD, 转阴丹, a self-made Chinese herbal preparation) and hormone in treating male infertility with positive antisperm antibody and its influence on nitric oxide (NO) level. Methods:Eighty-two patients were randomly divided (according to the digital list) into the WM group (n = 20, treated with prednisone), the TCM group (n=28, treated with ZYD) and the ICWM group (n=34, treated with prednisone plus ZYD). The clinical effect, negative converting rate of antisperm antibody, changes of NO level in semen and various parameters of sperm motion before and after treatment were observed. Results: The total effective rate in the ICWM group was 88.2%, that in theTCM group 75. 0% and in the WM group 65. 0%. Significant difference was seen in the ICWM and TCM group before and after treatment in NO level, sperm motion parameters, including linear motion speed, linearity, propulsion, whip frequency, sperm vitality and mean moving angle, and quality of semen ( P < 0. 05 or P < 0. 01). In the WM group, significant difference in comparison before and after treatment was seen in NO level, propulsion, whip frequency, mean moving angle and quality of semen, including vitality and survival rate (P<0. 01). Conclusion: Combination of Chinese herbs and hormone could lower the NO level in semen and improve the quality of sperm.Original article on CJITWM (Chin) 2004 ;23 (3): 223

Antibody-Coupled Drugs in HER2-Positive Gastric Cancer

Antibody drug conjugates (ADCs) are a new class of drugs that combine chemosynthetic drugs with antibody drugs through a linker. Antibody drug conjugates combine the targeting characteristics of traditional antibody drugs with the cytotoxic characteristics of small molecule drugs, while reducing the side effects of both drugs, making them a kind of “biological missile” and representing a relatively new and evolving class of anti-cancer drugs. Antibody-coupled drugs are currently used in many solid tumors, and this article reviews the clinical application of antibody-coupled drugs in HER2-positive gastric cancer.

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.

Prevalence, significance and predictive value of antiphospholipid antibodies in Crohn's disease

AIM: To assess the prevalence and stability of different antiphospholipid antibodies(APLAs) and their association with disease phenotype and progression in inflammatory bowel diseases(IBD) patients.METHODS: About 458 consecutive patients [Crohn's disease(CD): 271 and ulcerative colitis(UC): 187] were enrolled into a follow-up cohort study in a tertiary IBD referral center in Hungary. Detailed clinical phenotypes were determined at enrollment by reviewing the patients' medical charts. Disease activity, medical treatment and data about evolvement of complications or surgical interventions were determined prospectively during the follow-up. Disease course(development f complicated disease phenotype and need for surgery),occurrence of thrombotic events, actual state of diseaseactivity according to clinical, laboratory and endoscopic scores and accurate treatment regime were recorded during the follow-up,(median, 57.4 and 61.6 mo for CD and UC). Sera of IBD patients and 103 healthy controls(HC) were tested on individual anti-β2-Glycoprotein-I(anti-β2-GPI IgA/M/G), anti-cardiolipin(ACA IgA/M/G)and anti-phosphatidylserine/prothrombin(anti-PS/PT IgA/M/G) antibodies and also anti-Saccharomyces cerevisiae antibodies(ASCA IgA/G) by enzyme-linked immunosorbent assay(ELISA). In a subgroup of CD(n = 198) and UC patients(n = 103), obtaining consecutive samples over various arbitrary timepoints during the disease course, we evaluated the intraindividual stability of the APLA status. Additionally,we provide an overview of studies, performed so far, in which significance of APLAs in IBD were assessed.RESULTS: Patients with CD had significantly higher prevalence of both ACA(23.4%) and anti-PS/PT(20.4%) antibodies than UC(4.8%, p < 0.0001 and10.2%, p = 0.004) and HC(2.9%, p < 0.0001 and15.5%, p = NS). No difference was found for the prevalence of anti-β2-GPI between different groups(7.2%-9.7%). In CD, no association was found between APLA and ASCA status of the patients.Occurrence of anti-β2-GPI, ACA and anti-PS/PT was not different between the group of patients with active vs inactive disease state according to appropriate clinical, laboratory and endoscopic scores in CD as well as in UC patients. All subtypes of anti-β2-GPI and ACA IgM status were found to be very stable over time, in contrast ACA IgG and even more ACA IgA status showed significant intraindividual changes.Changes in antibody status were more remarkable in CD than UC(ACA IgA: 49.9% vs 23.3% and ACA IgG:21.2% vs 5.8%). Interestingly, 59.1% and 30.1% of CD patients who received anti-TNF therapy showed significant negative to positive changes in ACA IgA and IgG antibody status respectively. APLA status was not associated with the clinical phenotype at diagnosis or during follow-up, medical therapy, or thrombotic events and it was not associated with the probability of developing complicated disease phenotype or surgery in a Kaplan-Meier analysis.CONCLUSION: The present study demonstrated enhanced formation of APLAs in CD patients. However,presence of different APLAs were not associated with the clinical phenotype or disease course.

Case report of a healthy,elderly man with long-term high titers for anti-acetylcholine receptor antibody without myasthenia gravis

Anti-acetylcholine receptor antibodies （AAR） are considered pathognomonic and pathogenetic for myasthenia gravis （MG）. AAR detection confirms clinical diagnosis of MG. However, AAR is rarely detected in patients without MG. The underlying pathophysiological mechanisms in a normal subject without MG have not been adequately addressed in previous studies. The present study reports on a case study of a healthy, elderly man with high AAR titers for 14 years. Pathophysiological mechanisms could be due to AAR heterogeneity in specificity, affinity, and multiform, and to muscle variability in response to AAR.

Analysis of clinical features and prognosis of anti-glomerular basement membrane antibody positive patients with anti-neutrophil cytoplasmic antibodies

Objective To investigate the characteristics and outcome of glomerulonephritis in patients with both antineutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody.Methods The sera of 23 antiGBM glomerulonephritis patients were collected and were tested for ANCA respectively.Characteristics and outcome of patients with coexisting anti-GBM antibody

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。

乳腺癌受体阳转阴的发生机理与治疗进展

乳腺癌因其高度异质性,给乳腺癌精准治疗带来挑战。雌激素受体(estrogen receptor, ER)、孕激素受体(progesterone receptor, PR)和人表皮生长因子受体-2(human epidermal growth factor receptor-2, HER2)状态是乳腺癌精准诊疗的重要依据。对于复发或转移性乳腺癌患者,既往治疗主要基于原发病灶受体状态。但研究发现部分患者复发/转移灶受体表达与原发病灶不同,推测可能与肿瘤异质性和治疗后的克隆选择效应相关。相较于受体表达“阴转阳”,受体“阳转阴”的发生率更高,且受体表达的缺失可能导致对原有疗法耐药且预后不良。重新评估乳腺癌复发/转移灶受体状态对调整治疗策略和判断预后具有显著临床意义,但能否基于受体变化情况指导临床决策,在临床研究或实践层面仍存在较大争议。随着靶向药物、免疫疗法及抗体偶联药物(antibody-drug conjugates, ADC)等新型抗肿瘤药物的应用,如何优化受体“阳转阴”乳腺癌患者的治疗方案以提高疗效成为未解决的临床需求。该文旨在深入探讨乳腺癌受体“阳转阴”的机理、预后影响以及治疗现状,为这类患者的治疗提供理论支持和实践指导。

布鲁氏菌A19-△VirB12疫苗接种犊牛的免疫抗体变化

为了解不同剂量的布鲁氏菌A19-△VirB12疫苗采用不同接种方式免疫犊牛的抗体变化,使用不同剂量的布鲁氏菌A19-△VirB12疫苗采用点眼和皮下接种两种方式免疫3~6月龄母犊牛,用试管凝集试验(SAT)检测采集于犊牛免疫各时段的血清中抗体变化。结果表明,首次试验中在免疫24周除点眼10亿组和皮下接种50亿组外的其他免疫组均能检出SAT阳性结果。第二次试验中皮下免疫50亿组在免疫3周的SAT检测阳性率达到84.21%,在免疫25周之后的SAT检测均为阴性;两个点眼免疫组在免疫12周初次检出持续抗体阳性,至免疫52周抗体阳性率为4.54%~9.09%。可以得出,布鲁氏菌A19-△VirB12疫苗大剂量免疫犊牛后可能会干扰后期布病检疫结果的判定,A19-△VirB12疫苗50亿CFU/mL皮下免疫犊牛后具有免疫原性较好和抗体转阴时间较早的优势。点眼免疫组检出抗体时间晚,现缺乏针对前期该疫苗细胞免疫指标的检测方法,需要进一步研究。

丙型肝炎病毒抗体化学发光免疫分析法≥95%阳性预测值最佳吸光度/临界值建立方法学和重要性探讨

目的确定丙型肝炎病毒(hepatitis C virus,HCV)抗体阳性预测值≥95%的最佳吸光度/临界值(signal-to-cutoff,S/CO),确定首都医科大学附属北京地坛医院实验室医学决定水平,为探索不同系统丙型肝炎病毒抗体检测试剂95%阳性置信区间建立方法学。方法收集2021年7月至2022年2月门诊及住院患者进行化学发光免疫分析法(chemiluminescence analysis,CLIA)初筛检测同时进行HCV RNA检测的血浆样本共282例,其中抗体初筛有反应性(S/CO≥1)样本252例,阴性样本30例,进行重组免疫印记试验(recombinant immunoblot assay,RIBA)并查阅其HCV RNA检测结果,通过受试者工作特征(receiver operating characteristic,ROC)曲线得到预测本实验室阳性预测值≥95%时HCV感染的抗体S/CO值。结果初筛为阴性的30例样本双重确证试验结果均为阴性;排除16例HCV感染史不明确的样本,丙型肝炎病毒抗体S/CO≥1的236例样本经双重确证试验得到真阳性样本188例,阴性样本48例,经ROC曲线分析,本实验室阳性预测值≥95%时,本实验室抗体S/CO值为7.83,灵敏度为93.09%,特异度为95.83%,曲线下面积(area under the curve,AUC)为0.98(P<0.0001)。结论为临床提供本实验室阳性预测值≥95%时HCV感染抗体的S/CO值以协助临床诊疗。

靶向HER2胞外结构域Ⅳ的单克隆抗体在乳腺癌中的应用进展

人表皮生长因子受体2(HER2)阳性乳腺癌侵袭性强且易转移,抗HER2靶向药物的应用能显著改善HER2阳性乳腺癌患者的预后。在已上市的HER2靶向药物中,靶向HER2胞外结构域Ⅳ的大分子单克隆抗体是治疗HER2阳性乳腺癌的基础靶向药物,主要包括曲妥珠单抗、伊尼妥单抗和马吉妥昔单抗。曲妥珠单抗用于乳腺癌全线治疗,循证医学证据充分,实践经验充足且安全性可控;伊尼妥单抗与曲妥珠单抗在HER2阳性转移性乳腺癌和新辅助/辅助治疗中疗效相似,且安全性可控;马吉妥昔单抗聚焦于携带CD16A-158F等位基因的患者,是晚期乳腺癌后线治疗的选择。临床上需根据患者具体病情选择最适合的药物。

2021—2023年贵港市HIV-1感染者的流行特征和检测结果分析

目的分析2021—2023年贵港市人类免疫缺陷病毒1型(HIV-1)抗体阳性者的免疫蛋白印迹试验(WB)带型特征,探讨免疫状况及相关指标在获得性免疫缺陷综合征(AIDS)发展中的作用。方法对2021—2023年1719份经贵港市AIDS确证实验室确证为HIV-1抗体阳性且在治疗前开展了CD4^(+)T淋巴细胞检测的样本,用SPSS 25.0分析人口学特征和实验室相关检测结果。结果1719例HIV-1抗体阳性以男性、40岁以上、已婚、农民、文化程度较低、医疗机构临床筛查为主;CD4^(+)T淋巴细胞计数与年龄呈负相关,与WB条带数呈正相关(P<0.05)。带型p55、p39、p17检出阳性率在不同免疫程度和病程间差异有统计学意义(P<0.05)。结论农民仍然是贵港市AIDS宣教、检测工作的重点人群,p55、p39和p17可作为疾病发展和免疫情况的一个潜在判别依据。

以球麻痹为主要表现的多项神经节苷脂抗体阳性的Miller-Fisher综合征1例并文献复习

目的 探讨Miller-Fisher综合征(MFS)的诊断学特征。方法 回顾性分析我院诊治的1例以球麻痹为主要表现的多项神经节苷脂抗体阳性的MFS患者的临床资料,对照吉兰-巴雷综合征(GBS)常见类型及临床表现进行分析探讨。结果 GQ1b抗体是MFS患者发病的关键因素,可引起视神经损害和延髓麻痹的症状。结论 MFS患者的临床表现常不典型,GQ1b抗体的沉淀部位与临床表现有相关性,不典型的MFS患者可表现为以球麻痹症状起病。

临床输血检验中不规则抗体检验的应用

目的探讨临床输血检验中不规则抗体检验的应用价值。方法选择2022年6月—2023年6月平邑县人民医院收治的2260例输血治疗患者作为研究对象,所有患者输血前均接受不规则抗体检验,统计输血不良反应发生率,分析不规则抗体检出情况及阳性分型。结果2260例输血患者中检出不规则抗体阳性40例,阳性检出率为1.77%,其中抗-M分型29例,占比最高,可达72.50%,其次是抗-E分型5例,占比为12.50%;输血不良反应发生率为1.02%(23/2260)。女性、有妊娠史女性、有输血史人群的不规则抗体阳性检出率[分别为2.55%(28/1098)、3.53%(21/1595)、3.24%(29/895)]均明显高于男性、无妊娠史女性和无输血史人群[分别为1.03%(12/1162)、1.39%(7/503)、0.81%(11/1365)],差异均有统计学意义(均P<0.05)。结论在临床输血前实施不规则抗体检验意义重大,可准确检出不规则抗体,保证输血治疗的安全性,避免严重输血反应发生。

帕妥珠单抗联合含蒽环类化疗方案新辅助治疗HER2阳性乳腺癌的获益与安全性

目的 探究帕妥珠单抗联合含蒽环类化疗方案新辅助治疗人表皮生长因子受体2(HER2)阳性乳腺癌的获益与安全性。方法 前瞻性选取2021年5月至2022年5月在运城市中心医院进行治疗的HER2阳性乳腺癌患者486例纳入本研究,按照随机数字表法将患者分为对照组(n=243)和研究组(n=243)。对照组接受传统含蒽环类化疗方案,研究组接受帕妥珠单抗联合含蒽环类化疗方案新辅助化疗,两组化疗后均接受手术治疗。比较两组疗效,检测并记录两组治疗前后肿瘤标志物[癌胚抗原、癌抗原(CA)125、CA153]水平,并记录两组不良反应发生情况和预后情况。结果 研究组的治疗总有效率为90.12%,高于对照组(76.15%),差异有统计学意义(P<0.05)。治疗后,两组患者的癌胚抗原、CA125、CA153水平均较治疗前有所下降,差异均有统计学意义(P<0.05);研究组的癌胚抗原水平为(1.89±0.78) pg/mL,低于对照组[(1.89±0.78) pg/mL],差异有统计学意义(P<0.05),但两组间的CA125、CA153水平比较,差异均无统计学意义(P>0.05)。两组不良反应发生情况比较,差异无统计学意义(P>0.05)。研究组的复发率、转移率、病死率及总预后不良率分别为4.94%、6.58%、10.70%、22.22%,均低于对照组(10.29%、13.58%、22.63%、46.50%),差异均有统计学意义(P<0.05)。结论 帕妥珠单抗联合含蒽环类化疗方案新辅助治疗HER2阳性乳腺癌患者是一种有效、安全的治疗方案。其可提高治疗有效率,且不会给患者带来额外的不良反应,改善患者的预后情况。

TCbHP在老年HER-2阳性乳腺癌患者新辅助化疗中的应用效果

目的:研究TCbHP在老年HER-2阳性乳腺癌患者新辅助化疗中的应用效果。方法:选取2020年3月—2022年4月苏州大学附属第三医院收治的100例老年HER-2阳性乳腺癌患者,随机将其分为对照组(n=50)和观察组(n=50)。对照组给予THP新辅助化疗,观察组给予TCbHP新辅助化疗。比较两组临床疗效、治疗前后肿瘤标志物及不良反应。结果:观察组客观缓解率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组癌胚抗原与糖类抗原125水平均低于治疗前,观察组癌胚抗原与糖类抗原125水平均低于对照组,差异有统计学意义(P<0.05)。两组血小板减少、肝损伤、脱发、恶心呕吐、手足综合征发生率比较,差异无统计学意义(P>0.05)。结论:相比THP,TCbHP可进一步抑制老年HER-2阳性乳腺癌患者肿瘤标志物表达,有效控制疾病发展,不会加重化疗引起的不良反应。

HER2阳性乳腺癌靶向治疗的研究进展

乳腺癌是全球女性发病率较高的恶性肿瘤,其中人类表皮生长因子受体2(HER2)阳性乳腺癌病例占总乳腺癌病例的20%~30%。与其他分子分型的乳腺癌比,HER2阳性乳腺癌预后更差,更易复发和转移。近年来,HER2阳性乳腺癌治疗备受关注,针对抗HER2的靶向药物能显著改善HER2阳性乳腺癌患者的疗效。该文对HER2阳性乳腺癌靶向治疗的研究进展作一综述。

社区早筛抗线粒体抗体阳性的中医药早期干预效果分析

目的探讨社区早筛抗线粒体抗体阳性的中医药早期干预效果。方法选取前期从龙华、凌云、康健3个社区20000个案例中筛查出的106例单纯抗线粒体抗体阳性患者作为研究对象,随机分为研究组和对照组,每组53例,分析两组肝功能指标及中医体质辨识评分变化情况。结果治疗前,两组肝功能检测结果差异无统计学意义(P>0.05);治疗后,与对照组相比,研究组总胆红素(TBil)水平显著降低,差异有统计学意义(P<0.01)。运用“中医体质分类与判定”量表对两组患者进行中医体质辨识分型,治疗前两组体质分类和总体评分差异无统计学意义(P>0.05);治疗后,两组体质变化差异无统计学意义,但研究组总体评分降低,其中最常发生的5种症状——干燥、便秘、喜饮水、口苦、小便黄,研究组相关评分较对照组明显降低,差异有统计学意义(P<0.05)。结论对社区早筛抗线粒体抗体阳性患者进行中医药早期干预有利于改善不适症状,提高生活质量,值得进一步研究。